Introduction:
GERD (gastroesophageal reflux disorder) is a long-lasting problem with a high recurrence rate. People with poor health are at higher risk of developing GERD. The conditions that increase the chances of having GERD are improved weight, pregnancy, bad eating habits like eating late or lying down immediately after eating, having too many caffeinated beverages, and smoking. The health-related quality of life of patients suffering from GERD is poorer than the healthy population. However, this improves getting treatment and lifestyle changes.
A question that usually comes to people’s minds is when to see a doctor. The answer is that when the patient has chest pain and heartburn along with arm pain, he or she should immediately visit the doctor as these symptoms can suggest a heart attack.
What Is GERD?
GERD, known as gastroesophageal reflux disorder, is a condition of the stomach in which the stomach contents flow back to the esophagus, the food pipe connecting the mouth and the stomach. This acidic stomach content irritates the esophageal lining leading to chest pain and heartburn. The associated symptoms of GERD are chest pain or burning sensation in the chest, usually after a meal, difficulty swallowing, inflammation of vocal cords, hoarseness of voice, cough, and wheezing. Chronic GERD can also lead to serious complications like esophageal stricture (inflammation of the esophagus leads to scarring of tissue and hence narrowing of the esophagus), esophageal ulcer (acid reflux can cause ulcers on the esophagus lining, which can be painful and can bleed) and Barrett's esophagus (tissue changes of the esophagus due to acid can be precancerous changes).
How to Diagnose GERD?
After visiting the doctor, he would ask the patient questions regarding signs and symptoms and medical history. Based on these, he would make a provisional diagnosis and recommend a few tests that would help him to arrive at a final diagnosis.
The test includes,
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Endoscopy - This involves inserting a tube with a camera and light attached to it inside the throat to check for inflammation in the esophageal lining and stomach.
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Ambulatory Acid (pH) Probe Test - This involves placing a tube as a monitor in the esophagus to check when and for what duration acid regurgitates.
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Esophageal Manometry - This measures esophageal muscle contractions.
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X-ray of the Upper Digestive System - This would help in finding out the narrowing of the esophagus.
How to Treat GERD Naturally?
Just making a few changes in the way of eating can subside the chances of having GERD. Eating every meal in the correct quantity, avoiding overeating, eating at least three to four hours before bed, quitting smoking, doing regular physical exercise to reduce weight, not having caffeinated beverages like coffee, avoiding wearing tight clothes to reduce pressure on the abdomen can help in getting rid of GERD. The patient can raise his head by about 6 inches to get some relief from GERD. Chewing gum is another effective method as it stimulates the production of saliva, which helps in neutralize the acid.
How to Treat GERD Permanently?
Treating GERD permanently involves different types of approaches. They are:
1. Lifestyle Changes - This is the first thing advised by the doctor. Eating healthy food, avoiding junk food, eating food at the right time, doing regular exercise and reducing weight, avoiding food that produces acid in the stomach, having food that helps in the neutralization of excess acid in the stomach, not lying down immediately after the meal, while laying down keeping the head at a higher level are some of the changes that help in the treatment of GERD.
2. Medication - The main aim of prescribing the medicines is to either prevent the reflux of stomach acid or to reduce the inflammation of the esophageal lining. Medicines that are usually given are:-
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Antacids - Such as Mylate and Rolaids, are over-the-counter medicines that help neutralize stomach acid.
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Histamines or H2 blockers - Such as Cimetidine, Famotidine, and Ranitidine, help lower acid secretions. They are more effective than antacids.
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Proton Pump Inhibitors - Like Omeprazole, Lansoprazole, and Pantoprazole are more efficient than H2 blockers. They also help in reducing acid production.
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Prokinetic Agents - These are usually prescribed with an acid-reducing drug. They improve the activity of the smooth muscle of the gastroesophageal tract.
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Baclofen - It is the drug that is given to improve the strength of the lower esophageal sphincter.
3. Surgery - When the above treatment options are ineffective, doctors advise surgery. The main aim of surgery is to strengthen the acid reflux barrier. The surgical procedure involves open surgery, endoscopic therapy, and laparoscopic surgery. Endoscopic therapy is comparatively less painful, takes less time, and has a faster recovery rate than laparoscopic surgery.
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Endoscopic therapy involves inserting an endoscope (a flexible tube with an attached camera and light) with preloaded instruments into the throat and tightening the sphincter. This procedure is also known as transoral incisionless fundoplication (TIF). This is a non-invasive procedure.
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Fundoplication is another surgical procedure that is usually done through the minimally invasive method, namely, the laparoscopic method. In this procedure, the surgeon wraps the upper portion of the stomach around the lower esophageal sphincter. This surgery has some complications like gastric perforation and hernia, and medical therapy is required.
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Another method to strengthen the reflux barrier is the LINX device, which is a magnetic beaded device that is wrapped around the stomach and esophagus junction surgically. Magnetic force helps in retaining the strength of the barrier and, at the same time, leaves enough space for the food to pass through.
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The majority of patients opt for surgery to avoid medication for life. But there is a section of patients for whom surgery is not advisable, and they have to be on lifelong medication.
Conclusion:
GERD is a problem that can be managed effectively if taken seriously at an early stage. It is very important for patients to maintain a healthy lifestyle and seek a doctor's advice at the earliest once they notice symptoms. As advised by the doctor, patients have to take certain precautions like avoiding smoking, avoiding caffeinated beverages, and doing regular exercise. As acid reflux can affect other organs apart from the esophagus, like the larynx and pharynx, and may also cause lung problems, seeking a doctor’s advice is recommended.
