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Gastroesophageal Reflux Disease (Heartburn)
What is Gastroesophageal Reflux Disease (GERD)?
  • Gastroesophageal reflux disease is a condition in which acid from the stomach reflux or "back up" from the stomach into the esophagus. The most classical symptoms of GERD is heartburn that is a harsh, burning sensation in the area in between your ribs or just below your neck. Heartburn is an extremely common condition with one in four individuals experiencing it once in a while. About one in ten individuals have heartburn atleast once a week. Some people however have heartburn on a daily basis and need treatment.
What are the typical symptoms of GERD?
  • The most typical symptom of GERD is heartburn. Apart from a burning sensation in the chest, it ca also manifest as a burning type of pain at the top of the stomach. Mild heartburn is usually relieved with milk or antacids.
What are the other symptoms of GERD?
  • Some patients with GERD may have intermittent chest discomfort and this may mimic a heart problem. GERD can also cause soreness or irritation of the throat, chronic dry cough, change in voice and difficulty in swallowing. Frequent regurgitation of ingested food may also be a symptom of GERD. Some patients have cough and wheezing (like asthma) especially at night.
What causes GERD?
  • When you eat, food travels from your mouth to your stomach through a tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.
What contributes to GERD?
  • Some people are born with a naturally weak sphincter (LES). For others however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux.
What is a Hiatus Hernia?
  • The food-pipe passes from the chest into the abdominal cavity through an opening in the diaphragm that is the muscular wall separating the chest cavity from the abdomen. Sometimes a part of the stomach bulges into the chest through the opening. This is known as a hiatus Hernia. Patients who have persistent heartburn may have small hiatus Hernia. Surgical repair of such Hernia is performed during anti-reflux surgery.
How is GERD treated?
    GERD is generally treated in three progressive steps:
  • Life style changes: In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
  • Drug Therapy: If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms. This therapy needs to be discussed with your surgeon.
  • Surgery: Patients who do not respond well to lifestyle changes or medications or those who continually require medications to control their symptoms, will have to live with their condition or may undergo a surgical procedure. Surgery is very effective in treating GERD.
  • Novel Procedures: There are procedures being tried, known as Intraluminal Endoscopic Procedures, which are alternatives to laparoscopic and open surgery. You will need to discuss with your surgeon and physician whether you are a candidate for any of these procedures.