Gastro-oesophageal reflux disease or GERD is a common condition where acid leaks back into esophagus from the stomach. When we eat food passes from the esophagus, which is the tube that carries food from mouth to stomach. At the end of esophagus, there is a muscle valve called lower oesophageal sphincter (LES) that occurs from acid reflux.
This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction. But in GERD, sphincter relaxes between swallowing and the stomach contents and acid leak back to the esophagus.
Stomach has a tough lining that precedes the damage from acid, but esophagus does not. Thus the leak or the reflux irritates and causes damage to the esophagus, causing symptoms.
In some patients, however, the pain may be sharp or pressure-like. Such pain can mimic heart pain (angina). It can also cause belly pain similar to ulcers, and in others it may extend to the back.
• Acid indigestion / Regurgitation – Regurgitation is the taste of refluxed liquid in the mouth, more when sleeping or bending over.
• Nausea – It may be frequent or severe and may result in vomiting.
• Bitter taste
• Persistant dry cough
• Feeling tightness in the chest – There is a sensation of food particles stuck in the throat or benefit the chest.
• Difficulty in sallowing
• Water Brash – Excessive salivation is common during heartburn, as saliva is generally slightly alkaline and is the body's natural response to heart burn, acting simply to an antacid.
The following are several causative factors that weaken or relax the lower oesophageal sphincter. These factors act on LES in different ways, some irritate it, some relax it between sliding period and some put pressure on it.
• Diet – Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavors.
• Medications – Calcium channel blockers (used to lower blood pressure), Theophylline (commonly used for Ashtma), Nitrates, Antihistamines (allergy medication), Bisphophnates.
• Lifestyle – Eating large meals, eating soon before bedtime, use of alcohol or cigarettes, obesity, poor posture (slouching), tight clothing around the waist.
• Other medical conditions – Pregnancy, diabetes, rapid weight gain, hiatus hernia (a condition in which stomach protrudes out of diaphragm and then diaphragm can no longer act as additional barrier foe preventing reflux of acid in the oesophagus).
Most of the cases of GERD are diagnosed by its characteristic symptom, which is heart burn. Physicians often give medications based on that, and if the symptoms are suppressed to a large extent, the diagnosis is confirmed.
But there are some conditions that mimic GERD and also respond to its medications, like duodenal ulcer. So the following diagnostic tests are applied if the symptoms are severe:
Esophageal pH Monitoring – It's the current gold standard for the diagnosis of GERD. It measures the level of acid in the esophagus over a 24-hour period.
Upper gastrointestinal endoscopy – also known as esophago-gastro-duodenoscopy or EGD is a common way of diagnosing GERD. It involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum. It may prove very useful to visualize the inflammation on the walls, erosions, ulcers, strictures that may have occurred due to GERD.
Esophageal motility testing – Esophageal motility testing determines how well the muscles of the esophagus are working. Apart from diagnostic purpose, motility testing is often done in complicated cases of GERD to determine the type of surgery to be performed.
Barium swallow – patient is asked to swallow barium, a paste-like solution, and x-ray is taken to look for ulcers, strictures, abnormal contractions of the esophagus, or reflux of barium into the food pipe.