Gastroesophageal reflux disease (Gerd) is a condition in which the liquid contents of the stomach regurgitate back into the oesophagus, typically as a result of an abnormal lower oesophageal spinchter relaxation or delayed gastric emptying.
Since the contents of the stomach are highly acidic and may at times contain bile coming from the duodenum, a typical burning sensation behind the breastbone or the upper abdomen is felt.
This discomfort tends to aggravate when lying flat or on one’s right side. Gerd is generally classified as a chronic condition, which means that once an individual is diagnosed with it, the symptoms will tend to recur every now and then.
Gravity, swallowing and saliva are important protective mechanisms for the oesophagus, but they are effective only when individuals are in the upright position. During sleep, gravity has no effect, swallowing stops and the secretion of saliva is reduced. Therefore, reflux that occurs during the night is more likely to cause a greater irritation to the oesophageal lining.
The causes of Gerd are quite complex and tend to vary in different individuals. However, several contributing factors that may increase the susceptibility of a person to develop this condition include stress, abdominal obesity, multiple pregnancies, hiatus hernia, connective tissue diseases, as well as certain enzyme deficiencies.
The diagnosis of Gerd is usually suspected by a physician when typical symptoms associated with this condition are present over a prolonged period of time. These may include heartburn, acid or bile regurgitation, increased salivation, nausea and vomiting. Nevertheless, Gerd has also been related to extra-oesophageal manifestations, such as asthma, chronic cough and laryngitis. However, most of these symptoms are non-specific. Thus, the current gold standard for the definite diagnosis of Gerd is 24-hour oesophageal pH monitoring.
Endoscopy, gastric emptying and oesophageal motility studies are recommended in those individuals who do not respond well to treatment or present with more alarming symptoms, such as difficulty in swallowing, anaemia, blood in the stool, wheezing, weight loss or voice changes.
The primary treatment of Gerd typically revolves around simple lifestyle modifications, as well as prescribed medications to neutralise the acid reflux and preventing the formation of excess acid in the stomach.
As a general guideline, coffee, chocolate, caffeinated drinks, citrus fruits, tomato-based products and spicy and fatty foods should be avoided.
Moreover, smoking and alcohol intake should be minimised. Several changes in eating habits, such as eating smaller portions of food, earlier evening meals and waiting for a minimum of three hours to lie down after eating are recommended.
A weight management programme should be considered to target obesity. Ingestion of chewing gum and milk, as well as elevation of the head and upper body while sleeping, may also improve the symptoms.
The primary medications used for the treatment of Gerd include proton-pump inhibitors, H2 receptor blockers and antacids. These drugs are usually effective in treating the symptoms and complications of Gerd. Nevertheless, sometimes they are not. In these cases, the standard surgical treatment for severe Gerd is fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower oesophageal sphincter to strengthen it, prevent loosening and thereby impair the backflow of hydrochloric acid from the stomach.
In western populations, Gerd affects approximately 10 to 20 per cent of individuals. The prevalence rate of Gerd in developed nations is also tightly linked with age, with adults aged 55 to 65 being the most commonly affected. However, infants and teenagers can also be affected. While this condition is generally non-progressive, some cases are in fact associated with the development of complications of increasing severity.
These may include oesophagitis, ulcers, oesophageal strictures, Barrett’s oesophagus, as well as iron deficiency. Thus, it is vital to seek medical advice if the symptoms persist longer than four weeks.
Georgiana Farrugia is a diagnostic radiographer and third year medical student at the University of Malta.