Gastroesophageal Reflux Disease (GERD)

The lower oesophageal sphincter, which connects the oesophagus and the cardia of the stomach, is responsible for preventing food in the stomach and gastric acid from backing up into the oesophagus. Abnormal relaxation of the sphincter allows gastric acid to travel back into the oesophagus, which can lead to inflammation, ulcer, bleeding and pre-cancerous changes in the oesophagus if its fragile mucous lining comes under sustained stimulation by gastric acid.

Causes of GERD

GERD has much to do with the unhealthy dietary habits of city dwellers: heavy consumption of coffee and fatty foods, central obesity, habit of late night snacks and irregular eating schedule, etc. These factors cause relaxation of the oesophageal sphincter, leading to GERD. Besides, smokers and drinkers are vulnerable to the condition as well.

Symptoms of GERD

Burning sensation in the chest

The most common symptom is “heartburn”, a burning sensation in the chest which is often mistaken as heart disease.

Acid reflux

Some patients with recurrent inflammation of the throat that flares up again right after calming down can be suffering from GERD, as gastric juice/acid may back up to the throat resulting in burns and symptoms similar to pharyngitis. Prolonged gastric juice/acid reflux can, in the worst case, lead to changes in oesophageal cells and even cancer of the oesophagus.

Generally speaking, acid reflux into the oesophagus is more serious at night than during the day, because it is easier for gastric acid to reach the oesophagus when you lie down on your back. Consult your doctor as soon as possible if you have such signs as weight loss, difficulties or pain with swallowing, vomiting of blood or feelings of suffocation.

Other atypical symptoms

Atypical symptoms include cough, asthma, etc.

GERD, if not treated in time, may cause oesophagitis, pharyngitis and even oesophageal cancer, etc.

Diagnosis of GERD

Gastroscopy

Gastronomy aids the diagnosis of GERD. An endoscope with a light source is inserted through a long, thin catheter via the oesophagus into the stomach and duodenum by the doctor so that the oesophagus, stomach and duodenum can be viewed clearly. After the procedure, the patient may experience sore throat, mild bloating and dizziness, but these should not be of any concern.

Ambulatory 24-hour gastric pH monitoring & oesophageal manometry

An oesophageal manometer is usually deployed by the doctor first to check for normal peristalsis of the oesophagus and determine the exact position of the lower oesophageal sphincter. Then a gastric pH monitor (around the thickness of an electric wire) is passed through the nose and placed above the lower oesophageal sphincter for 24-hour monitoring and diagnosis of GERD.

Bravo pH monitoring system

The patient first has to swallow a small pH capsule, which wirelessly transmits data about pH levels in the oesophagus to a small receiver worn on a belt or waistband. Two days later, the doctor will assess the symptoms of GERD by studying the data on the frequency and duration of acid reflux.

Proton pump inhibitor (PPI)

Proton pump inhibitor (PPI) is used clinically for effective diagnosis of GERD. This drug can suppress the secretion of gastric acid with a sensitivity of as high as 80%. The doctor will prescribe it to the patient for 2-4 weeks. If the symptoms improve or subside, the presence of GERD can then be established. On the other hand, if the symptoms persist, they should be related to other diseases and further examination will be required.

Treatment of GERD

Medications

Currently, there are three main types of therapeutic medications, including anti-bloating drugs, antacids and proton pump inhibitor (PPI). Among them, PPI has the best efficacy with effective suppression of gastric acid secretion. Patients report significant improvements with inflammation and ulcer issues after taking it for four weeks on average with a success rate of up to 90%.

Surgery

Patients who do not wish to be on long-term medication can consider undergoing a surgery to strengthen the lower oesophageal sphincter.

Prevention of GERD

Maintain a healthy lifestyle
Quit smoking, since nicotine weakens the functioning of the oesophageal sphincter
Avoid excessive consumption of foods which impair sphincter function, such as greasy foods, tomato, grapefruit, orange, coffee, chocolate, carbonated beverages (soft drinks, soda water, etc.) and alcohol
Avoid eating too much food that causes bloating, such as onion, garlic, cabbage and cauliflower
Stay away from late night snacks, and do not go to bed until at least 3 hours after dinner
Raise the head of your bed to keep your head and shoulders slightly higher than the rest of your body, in order to reduce acid reflux when you sleep
If you are overweight, weight loss can help lower abdominal pressure

Last Updated : Aug 2017

Please note that all medical health articles featured on our website have been reviewed by Quality Healthcare doctors. The articles are for general information only and are not medical opinions nor should the contents be used to replace the need for personal consultation with a qualified health professional on the reader’s medical condition.

Source: Bupa website www.bupa.com.hk