Gastroesophageal reflux disease (GERD) is the retrograde movement of gastric contents from the stomach back into oesophagus. This acid reflux irritates the lining of the oesophagus. It is the commonest cause of indigestion and is more commonly known as heartburn. It can affect up to 10-20% of the population. Occasional acid reflux is reasonably common and can often occur after overeating, lying down soon after eating or eating certain foods. If there is recurrent acid reflux, then this is diagnosed as GERD.
The cause is a poor closure of the lower esophageal sphincter. Risk factors for this include a hiatal hernia, pregnancy, smoking, obesity, some medications (eg calcium channel blockers, antidepressants)
Four factors may be involved in pathogenesis: – transient lower oesophageal sphincter relaxation; a lower resting pressure of the sphincter; a decreased ability of the oesophagus to clear itself of reflux material; and a delay in gastric emptying.
Clinical features:
‘Heartburn’ (burning sensation in chest) is the most common symptom, especially after going to bed.
There may be a sour or bitter taste in the mouth.
Other symptoms can include nausea, pain in the chest, pain when swallowing, difficulty swallowing, chronic cough, bad breath.
The acid reflux into the mouth can cause breakdown of the teeth enamel leading to decay.
Diagnosis is typically based on the clinical features and the response to treatment, but investigations include an oesophageal pH monitoring test and an upper gastrointestinal endoscope.
Complications:
Oesophagitis, oesophageal stricture, Barrett’s oesophagus, respiratory problems (eg asthma)
Management:
Lifestyle changes: cessation of smoking; reduced consumption of alcohol; reduction in dietary fat; smaller meals; weight reduction if overweight; avoid lying down for 3 hrs after eating; elevation of head of bed; avoidance of foods that precipitate.
Pharmacological: Antacids; H2 antagonists (eg Cimetidine); proton pump inhibitor (eg: omeprazole, pantoprazole, lansoprazole)
Surgical: eg fundoplication
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