Acidity, heartburn, acid reflux, GERD awareness- By Dr Vishal Khurana (Senior Gastroenterologist, Faridabad)

WHATS IS ACID REFLUX AND GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

Gastroesophageal reflux, also called "acid reflux" occurs when the stomach contents back up into the esophagus and/or mouth. Occasional reflux is normal and can happen in healthy infants, children, and adults, most often after eating a meal. Most episodes are brief and do not cause bothersome symptoms or complications.

In contrast, people with gastroesophageal reflux disease (GERD) experience bothersome symptoms or damage to the esophagus as a result of acid reflux.

HOW DOES IT OCCURS?

When you eat, food is carried from your mouth to your stomach through the esophagus, a tube-like structure.

At the lower end of the esophagus, where it connects to the stomach, there is a circular ring of muscle called the lower esophageal sphincter (LES). After you swallow, the LES relaxes or open to allow food to enter your stomach, where it mixes with acids that help with digestion. The LES then contracts to prevent the food and acid from backing up into your esophagus.

However, sometimes the LES relaxes inappropriately or is weak or too relaxed; this allows liquids in the stomach to wash back into the esophagus. 

This happens occasionally to everyone. Most of these episodes occur shortly after meals, are brief, and do not cause symptoms.

In some people, acid reflux causes bothersome symptoms or injury to the esophagus over time; when this happens, it is considered GERD. 

In general, damage to the esophagus is more likely to occur when acid refluxes frequently, the stomach contents are very acidic, or the esophagus is unable to clear away the acid quickly.

WHAT ARE RISK FACTORS FOR GERD?

Certain things increase a person's risk of developing GERD, including:

●Hiatus hernia – This is a condition in which part of the upper stomach pushes up through the diaphragm (the large, flat muscle at the base of the lungs). The diaphragm has an opening for the esophagus to pass through before it joins with the stomach (called the "diaphragmatic hiatus"); in people with a hiatal hernia, part of the stomach also squeezes up through this hole.

●Obesity – People who are obese or overweight seem to have an increased risk of GERD. While the reasons for this are not well understood, it is thought to be related to increased pressure in the abdomen.

●Pregnancy – Many women experience acid reflux during pregnancy. This usually resolves after delivery, and complications are rare.

●Lifestyle factors and medications – Some foods (including fatty foods, chocolate, and peppermint), caffeine, alcohol, tobacco and smoking can all cause acid reflux and GERD. Certain medications also increase the risk.

WHAT ARE GERD SYMPTOMS?

The most common symptoms of GERD are:

●Heartburn – This typically feels like a burning sensation in the center of the chest, which sometimes spreads to the throat. It most often happens after a meal.

●Regurgitation – This is when stomach contents (acid mixed with bits of undigested food) flow back into your mouth or throat.

Other symptoms of GERD may include:

●Stomach pain (pain in the upper abdomen)

●Chest pain

●Difficulty swallowing (called dysphagia) or pain on swallowing (called odynophagia)

●Persistent laryngitis/hoarseness (due to the acid irritating the vocal cords)

●Persistent sore throat or cough

●Sense of a lump in the throat

●Nausea and/or vomiting

WHAT ARE GERD COMPLICATIONS?

Over time, GERD can lead to complications. These include problems related to esophageal damage as well as other issues.

Most people with GERD will not develop serious complications, especially if they get treatment. However, potentially serious complications can sometimes happen in people with severe GERD.

• Erosive esophagitis — This is when the esophagus is damaged (eroded) as a result of burning from stomach acid. This can lead to ulcers, which may bleed. Bleeding from ulcers is not always visible, but it can be detected with stool tests.

• Esophageal stricture — Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus. The narrowing is caused by scar tissue that develops as a result of ulcers that repeatedly damage and then heal in the esophagus.

• Barrett's esophagus — Barrett's esophagus occurs when the normal cells that line the lower esophagus (called squamous cells) are replaced by a different cell type (called intestinal cells). This process usually results from repeated damage to the esophageal lining; longstanding GERD is the most common cause.

• The intestinal cells have a small risk of transforming into cancer cells over time. As a result, people with Barrett's esophagus are advised to have a periodic upper endoscopy to monitor for early warning signs of cancer. 

• Lung and throat problems — If stomach acid backs up into the throat, this can cause inflammation of the vocal cords, a sore throat, or a hoarse voice. The acid can also be inhaled into the lungs and cause pneumonia or asthma symptoms. Over time, acid in the lungs can lead to permanent lung damage.

• Dental problems — Repeated episodes of acid reflux can erode the enamel of the teeth over time.

HOW IT IS DIAGNOSED?

Most people are diagnosed with GERD based on a well-taken history and physical exam. Your health care provider may consider further testing based on the history if the diagnosis is in question.

Diagnosis based on symptoms — If you have the "classic" symptoms of GERD (heartburn and/or regurgitation) your health care provider may be able to diagnose you with GERD based on this alone. In this situation, they will likely suggest a trial of medication; if your symptoms improve, it is likely that GERD was the cause.

Additional testing — Your provider might recommend additional evaluation and testing if you:

●Do not have an improvement in symptoms after taking a proton pump inhibitor

●Do not have the classic symptoms of GERD (heartburn or regurgitation)

●Have symptoms that may indicate a more serious problem

●Have risk factors for certain complications such as Barrett's esophagus

It is important to rule out potentially life-threatening problems that can cause symptoms similar to those of GERD. For example, chest pain can also be a symptom of heart disease, and should be evaluated immediately.

If life-threatening problems have been ruled out and the diagnosis of GERD is not clear, your provider will likely recommend one or more of the following tests.

• Upper endoscopy 

• 24-hour esophageal pH study 

• Esophageal manometry

HOW LONG GERD LASTS?

GERD is usually relieved with the right treatment after a few days. However, it is a chronic condition for many people and it is not uncommon to have recurrences.

WHEN SHOULD I CALL DOCTOR?

Remember, if you have heartburn two or more times a week, or still have symptoms on your over-the-counter or prescription medicines, see your doctor.

Notify your health care provider if you have any of the following alarm symptoms:

• Unexplained weight loss

• Difficulty or pain with swallowing

• Chest pain

• Choking

• Blood in your vomit or dark-colored vomit that looks like coffee grounds

• Black stool

• Persistent vomiting

• Reduce appetite or unintentional weight loss

• Early fullness after a meal

• Have new stomach pain and are age 60 or older

• If symptoms do not improve with over the counter antacids

WHAT CAN I DO TO PREVENT ACID REFLUX AND GERD?

• Limit Caffeine. Limit coffee to 2-3 cups per day. Limiting consumption of other caffeine-containing beverages (tea, soft drinks) may also be helpful.

• Avoid Tight Clothing: Tight belts, tight pants or girdles can increase the pressure on the stomach.

• Avoid Foods That Cause Your Symptoms: Foods to avoid are: oily, spicy and fatty foods

• tomato and citrus juices (such as Lemon and orange), chocolate, mints, coffee, tea, cola, and alcoholic drinks.

• Do Not Lie Down for 2 Hours After Eating: Allow gravity to work. Also, avoid bending over at the waist to pick up things; instead bend at the knees

• Stop Smoking: If you cannot stop, decreasing the number of cigarettes you smoke may help.

• Bed Blocks: Elevate the head of your bed 6 inches with wood blocks or bricks. Using extra pillows is not a good substitute; this can cause an unnatural bend in the body that increases pressure on the stomach, which can worsen acid reflux. Use of a foam wedge beneath the upper half of the body is an alternative. People with nighttime heartburn can elevate the head of their bed, which raises the head and shoulders higher than the stomach, allowing gravity to prevent acid from refluxing.

• Maintain Your Ideal Weight: Excess weight increases the amount of pressure constantly placed on your stomach. Even small amounts of weight loss may help.

• Eat Smaller Meals: Don’t overfill your stomach.

• Avoiding late meals – Lying down with a full stomach may increase the risk of acid reflux. By planning meals for at least two to three hours before bedtime, symptoms may be reduced.

MEDICATIONS

• Antacids: Can be taken at bedtime and 30-60 minutes after each meal or as directed by your physician.

• Acid Suppression Medications: Take these medications 30-60 minutes

before meals.  Proton pump inhibitors (PPIs) are the most effective medications for reducing stomach acid. They include dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole.

SURGERY

Because lifestyle changes and medications are very effective in controlling symptoms in most cases, there is a limited role for surgical treatment of GERD. However, it may be an option for certain people whose symptoms are not adequately controlled with other treatments, or who cannot or do not wish to comply with a medication regimen.

In general, "anti-reflux" surgery involves repairing the hiatal hernia (if present) and strengthening the lower esophageal sphincter.

DO YOU HAVE GERD?

Take this "Richter Scale/Acid Test" to see if you're a GERD sufferer and are taking the right steps  to treat it.

1. Do you frequently have one or more of the following:

• an uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach?

• a burning sensation in the back of your throat?

• a bitter acid taste in your mouth?

2. Do you often experience these problems after meals?

3. Do you experience heartburn or acid indigestion two or more times per week?

4. Do you find that antacids only provide temporary relief from your symptoms?

5. Are you taking prescription medication to treat heartburn, but still having symptoms?

If you said yes to two or more of the above, you may have GERD. To know for sure, see your doctor or a gastrointestinal specialist. They can help you live pain free.

Dr Vishal Khurana

MBBS, MD, DM (Gastro), MNAMS, Mem.WEO, Mem.ACG

Senior Gastroenterologist

Metro hospital Sector 16A, Faridabad

Getwel medicentre, sector 86, Faridabad

Mobile: 7289840710