What is Gastroesophageal Reflux Disease (GERD)?

GERD stands for gastroesophageal reflux disease.

It refers to the flow of the acidic juices of the stomach into the oesophagus (the food passage that links the oral cavity to the stomach).

GERD happens when the junction between the gullet and the stomach does not function normally, resulting in reflux.

Symptoms

Symptoms include heartburn (burning sensation of the chest that usually rises from the stomach to the throat) and acid regurgitation (bitter or sour taste in the mouth).

Other symptoms possibly associated with GERD include:

Burping or belching
Chest pain or discomfort
Bloated belly
Difficulty swallowing
Hoarseness of voice
Persistent sore throat
Persistent cough

What problems can it cause?

Most people with GERD do not get severe problems other than the symptoms of GERD. Long standing reflux may potentially cause:

Oesophagitis - inflammation of the lower gullet

Stricture - severe long standing inflammation can cause narrowing of the gullet lumen

Barrett's esophagus - changes to the cells of the lower oesophagus, due to the damage done by the long standing acid reflux. Patients with Barrett's oesophagus have higher risk of oesophageal cancer compared to the general population.

Diagnosis

GERD can be diagnosed by symptoms and the response to medication.

In some cases of GERD, inflammation of the gullet may be seen on endoscopy (a procedure when a flexible tube is placed via the mouth into the gullet and stomach).

Oesophagitis

GERD can also be diagnosed with the help of 24-hour pH monitoring. A tube is placed through the nose to the gullet and the acidity is measured.

When combined with Impedance testing (where a tube with multiple electrodes is inserted into the gullet), one can differentiate the contents of the reflux fluid, thus guiding the doctor in treatment.

Can lifestyle changes improve the symptoms?

Lifestyle changes can improve the symptoms, as described below:

You should try to avoid:

Alcohol
Chocolate
Coffee
Spicy food
Tea
Citrus fruits

You should also:

Avoid overeating for each meal
Avoid eating within 2-3 hours before bedtime
Avoid lying down after meals
Eat regular meals
Raise the head of the bed if there is night-time symptoms
Lose weight if you are obese

When to seek medical advice

Please see a doctor if you have persistent symptoms despite appropriate lifestyle measures.

Treatment (provided by NUH)

Antacids acts by neutralising the acidic gastric juice
Prokinetics, refering to drugs that improves the stomach emptying
Histamine-2-receptor antagonists reduces acid production
Proton pump inhibitors (PPI) also decrease acid production, and is more effective than histamine-2-receptor antagonists

Is there any role for surgery?

Most patients with GERD do not need surgery. However, if surgery is needed, a surgeon should be consulted to discuss the pros and cons of surgical treatment for GERD.

The indications for surgery in the patient with GERD include:

Endoscopic and/or symptomatic failure of medical treatment of GERD
Recurrence despite PPI therapy
Volume regurgitation, dysphagia (difficulty swallowing)
Atypical oesophageal and extra-esophageal symptoms
Large hiatal hernias (>4 cm) (upper part of the stomach moves above the diaphragm)
Barrett's oesophagus
Stricture formation (narrowing of the gullet lumen)
Poor oesophageal peristalsis
Prolonged reflux episodes (>5 min) on pH study
Pathological bile testing

Doctors