What is gastroesophageal reflux disease?
Gastro-esophageal reflux disease (GERD) is a common condition, where acid from the stomach leaks up into the esophagus (gullet). It usually occurs as a result of the ring of muscle at the bottom of the esophagus becoming weakened.
Is GERD the same thing as heartburn or acid reflux?
Not exactly. Many people get acid reflux from time to time. Reflux refers to the process of stomach acid washing up into the esophagus.
What are the symptoms of GERD?
GERD signs and symptoms include:
- Acid Reflux.
- Heart Burn.
- A sore, inflamed esophagus (oesophagitis).
- Bad breath.
- Bloating and belching.
- Feeling or Being sick.
- Difficulty Swallowing, which may feel like a piece of food is stuck low down in your throat.
- Pain when swallowing.
- A sore throat and Hoarseness.
- A persistent cough or wheezing, which may be worse at night.
- tooth decay and gum disease.
Why does GERD happen?
Digestion is a complex process that begins when you put something in your mouth. After you swallow, food passes down into the esophagus and the sphincter at the bottom opens briefly. This valve is supposed to shut tight and stay that way as soon as food moves into your stomach and acid is released—but that doesn't always happen. In a patient with reflux, the valve does not work properly, so stomach contents (including acid) regurgitate into the esophagus.
Is it dangerous?
GERD is mostly uncomfortable. Occasionally the symptoms are severe enough that people head to the ER because they think they're having a heart attack. Over time, GERD can become serious: Acid can irritate and wear away the lining of the esophagus, causing inflammation, bleeding, and a precancerous condition called Barrett's esophagus.
Can you have GERD if you don't get heartburn?
Yes. Heartburn is the most common symptom, but it's not the only one. Less typical ones include hoarseness, recurrent pneumonias, upper abdominal pain, and a chronic cough, with hoarseness.
Risk factor for GERD
Conditions that can increase your risk of GERD include:
- Obesity.
- Bulging of top of stomach up into the diaphragm (hiatal hernia).
- Pregnancy.
- Smoking.
- Dry mouth.
- Asthma.
- Diabetes.
- Delayed stomach emptying.
- Connective tissue disorders, such as scleroderma.
How is GERD diagnosed?
Your GP will often be able to diagnose gastro-esophageal reflux disease (GERD) based on your symptoms. Tests for GERD may include:
- An endoscopy: is a procedure where the inside of your body is examined using an endoscope, that show if the surface of your esophagus (gullet) has been damaged by stomach acid.
- A barium swallow or barium meal test: is a test to assess your swallowing ability and look for any blockages or abnormalities in your esophagus.
- Manometer: Manometer is used to assess how well the ring of muscle at the end of your esophagus is working, by measuring the pressure in your esophagus.
- 24-hour pH monitoring: It may be necessary to measure the acidity level (pH) in your esophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy.
- Blood tests: it may be carried out to check for anemia, which can be a sign of internal bleeding.
How is GERD treated?
Heartburn and gastro-esophageal reflux disease (GERD) can often be treated with self-help measures and over-the-counter medicines.
If these don't help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.A. Self-help
You may find the following measures can help reduce heartburn and other symptoms of GORD:
- Eat smaller and more frequent meals, rather than three large meals a day.
- Avoid anything you think triggers your symptoms: common triggers include coffee, chocolate, tomatoes, alcohol, and fatty or spicy food.
- Don't wear tight clothing: clothes that are tight around your tummy may make your symptoms worse.
- Raise the head of your bed by up to 20cm (8 inches): placing a piece of wood or blocks underneath one end of your bed may reduce symptoms at night; don't just use extra pillows, as this can put a strain on your tummy.
- Try to relax: stress can make heartburn and GERD worse, so learning relaxation techniques may help if you're often feeling stressed.
- Maintain a healthy weight: if you're overweight, losing weight may help reduce your symptoms.
- Stop smoking: smoke can irritate your digestive system and may make your symptoms worse.
B. Medication
1. Initial treatments to control heartburn
Over-the-counter treatments that may help control heartburn include:
- Antacids that neutralize stomach acid: Antacids, such as Maalox, Gaviscon..., may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
- Medications to reduce acid production: Called H-2-receptor blockers, these medications include cimetidine, nizatidine or ranitidine. H-2-receptor blockers don't act as quickly as antacids do, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form.
- Medications that block acid production and heal the esophagus: Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole and omeprazole.
Contact your doctor if you need to take these medications for longer than two to three weeks or your symptoms are not relieved.
2. Prescription-strength medications
If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:
- Prescription-strength proton pump inhibitors: Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), and dexlansoprazole (Dexilant). These medications are generally well-tolerated, but long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency.
- Medications to strengthen the lower esophageal sphincter: Baclofen may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than do proton pump inhibitors, but it might be used in severe reflux disease. Baclofen can be associated with significant side effects, most commonly fatigue or confusion.
GERD medications are sometimes combined to increase effectiveness.
C. Surgery
If you're thinking about going the surgical route, ask your doctor about laparoscopic options, including one that uses a magnetic ring (Linx device) to strengthen the sphincter. You might also want to inquire about a minimally invasive technique called Stretta, which involves targeting the weakened sphincter with low levels of radiofrequency energy.
Does my Insurance Policy cover GERD treatment?
Yes. According to CCHI unified Policy terms and conditions, health insurance policies in Saudi Arabia cover the treatment of GERD.
Please Click Here to access the Unified CCHI Policy Wordings.References:
"Gastroesophageal Reflux Disease." 8 Things You Don't Know About GERD. N.p., 19 Apr. 2016. Web. 23 Oct. 2016."Gastroesophageal Reflux Disease." Diseases and Conditions GERD. N.p., 31 July 2014. Web. 23 Oct. 2016.
"Gastroesophageal Reflux Disease." Heartburn and Gastro-oesophageal Reflux Disease (GORD). N.p., 2 Mar. 2016. Web. 23 Oct. 2016.
"gastroesophageal reflux disease." Rules and Regulations. N.p., n.d. Web.