Gastroesophageal Reflux Disease (GERD) Treatment- Gastroenterology, Pediatrics

Gastroesophageal Reflux Disease also known as Acid reflux is a very common condition that happens when acid flows back from your stomach into the esophagus causing its irritation, which translates to heartburn that usually happens after eating.

When this happens too often, more than twice per week to be precise, a person is said to have gastroesophageal reflux disease (GERD). The condition affects around 20% of the population, and it’s usually simple to treat. If left untreated, GERD can lead to serious consequences.

Symptoms

Some frequent symptoms of acid reflux include:

• Heartburn, which is described as a burning sensation in your chest that commonly happens after you eat
• Chest pain
• Persistent cough
• Sore throat
• Sour or bitter taste in your mouth when you wake up
• Swallowing difficulties

It is important to get a physician’s opinion if you’re having one of these symptoms to establish the correct diagnosis. Chest pain can be a symptom of cardiac disease, and should not be taken lightly.

Causes

The muscular tube that connects our mouth to our stomach is called the esophagus. At the end of the esophagus, there’s a muscular ring called “the lower esophageal sphincter” or LES, which normally tightens to close the esophagus and prevent stomach acid from flowing upwards. When the LES is weak for any reason, acid backwashes into the esophagus causing its irritation. This is acid reflux. When this happens frequently, doctors call it GERD, and it can cause chronic changes in the lower part of your esophagus.

Risk factors

Doctors have identified several factors that put you at risk of developing GERD:

• Obesity
• Hiatal hernia (sliding of your stomach above the diaphragm)
• Pregnancy
• Certain disorders (such as scleroderma)
• Gastroparesis (slow emptying of stomach contents)

Lifestyle and behavior can play a central role in acid reflux. Several habits may worsen your condition, such as:

• Smoking
• Eating large portions of food, especially close to bedtime
• Consuming certain trigger foods and beverages, such as spicy foods, alcohol, or coffee.

Taking certain drugs, such as ibuprofen or aspirin

Complications

If left untreated, GERD can lead to chronic changes in your esophagus. This can be one of the following:

• Esophageal strictures: The chronic acid reflux will lead to a long-standing inflammation of the lower part of the esophagus, which can cause scarring and narrowing of the tract. People who have esophageal strictures might have difficulty swallowing solid foods.
• Esophageal ulcers: Gastric acid is very strong, and it can destroy the outer layer of the esophageal wall, leading to an open sore. This can also lead to swallowing difficulties, and may even bleed.
• Barrett’s esophagus: When acid reflux is chronic, the cells of the esophagus will try to adapt and become more resilient. Unfortunately, this process is an early step toward developing esophageal cancer. If Barrett’s esophagus is treated early on, cancer is preventable.

Diagnosis

GERD can usually be easily diagnosed by your doctor based on your symptoms and physical examination. To make sure the diagnosis is right, and assess your esophagus for possible complications, your doctor might order further testing:

• Gastroscopy: Also known as an upper endoscopy. This is a test done at the hospital with minor sedation. After numbing your throat, your gastroenterologist inserts a thin flexible scope through your mouth and advances it to your stomach. The scope has a camera at its tip and is attached to a screen to allow your doctor to see all of the esophagus and stomach. Your doctor will be able to see how badly your esophagus is damaged, or if there are any strictures or ulcers, and they will be able to take small biopsies if needed.
• Ambulatory pH monitor: The doctor advances a small probe through your nostril and advances it until it’s at the end of the esophagus. This probe measures how much acid is back flowing from your stomach. The cord coming out of your nostril connects to a monitor that you will use to record when you sleep and when the symptoms occur. This device will remain in place and record the variables over 24 hours.
• Esophageal manometry: This test checks if your esophagus is contracting in an abnormal pattern which might explain why your LES is incompetent

Barium swallow: After ingesting barium, an X-ray of your esophagus and stomach are taken. This helps doctors see if there is any narrowing in the tract. This technique is less frequently used today with the availability of gastroscopy.

Treatment

Medical treatment

It is important to establish the correct diagnosis before starting treatment. Gastric cancer, for example, can have similar symptoms to GERD, and taking pills to reduce symptoms would lead to a delayed diagnosis.

After establishing the correct diagnosis, your doctor will initially recommend a few lifestyle changes that will reduce acid reflux. They might also prescribe one of the following medications:

Antacids: These drugs are usually available over the counter and require no prescription. They work by neutralizing the acid in your stomach, however, they’re only effective in mild cases, and might cause some side effects like diarrhea and kidney problems.

H2-receptor blockers: cimetidine, famotidine, and nizatidine are known as H2-receptor blockers. These drugs decrease the amount of acid produced in the stomach.

Proton pump inhibitors (PPIs): esomeprazole, lansoprazole, pantoprazole, and others are famous drugs that are considered the most effective in reducing acid produced by your stomach for extended periods of time.

Baclofen: This drug works by strengthening your LES and hence preventing acid from back flowing into your stomach. Side effects include nausea and fatigue. 

Surgery

Medications and lifestyle changes are usually enough to treat GERD, however, some patients might not respond well to treatment. In these patients, surgery might be an option.

The goal of surgery is to tighten the LES and mechanically stop acid from washing back into the stomach. Several procedures have been developed to treat acid reflux, and these include fundoplication, TIF (Transoral Incisionless Fundoplication), Stretta procedure, and LINX surgery.

Lifestyle changes

Changing some of your daily habits might be very effective in reducing the symptoms of acid reflux:

• Lose weight if you’re overweight or obese
• Quit smoking
• Don’t sleep flat. Consider using multiple pillows to raise your head when you sleep and make it harder for acid to flow upwards.
• Avoid eating close to bedtime
• Avoid eating very large meals
• Avoid trigger foods and beverages like coffee, alcohol, spicy foods, onions, garlic, mint, chocolate, and tomato sauce.

If you think you have acid reflux or GERD, we recommend visiting your physician to get a full assessment. Treatment is usually simple, and a few lifestyle changes can make all the difference.

To learn more about Gastroesophageal Reflux Disease (GERD) Treatment, please check our blog on WHAT IT'S LIKE TO LIVE WITH GERD AND WHAT YOU CAN DO and TREATMENT FOR BARRETT’S ESOPHAGUS.

Sources:

• https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-gastroesophageal-reflux-in-adults
• https://www.uptodate.com/contents/surgical-management-of-gastroesophageal-reflux-in-adults
• https://www.uptodate.com/contents/complications-of-gastroesophageal-reflux-in-adults
• https://www.uptodate.com/contents/medical-management-of-gastroesophageal-reflux-disease-in-adults
• https://www.uptodate.com/contents/antiulcer-medications-mechanism-of-action-pharmacology-and-side-effects
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124788/

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