Gastro Esophageal Reflux

Gastro esophageal reflux (GERD) is the disease wherein the mucosa is damaged by the changes that happens in between stomach and esophagus due to relaxation or improper function of the lower esophageal sphincter.

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This results in expulsion of gastric juices in to esophagus. Hiatal hernia also causes this condition. In chronic cases this reflux defect affects respiratory and laryngeal portions also. They are called extra esophageal reflux disease. (EERD)

Heartburn, regurgitation and difficulty in swallowing are the common symptoms. Rarely does it accompany with pain in swallowing, high salivary secretion, nausea and chest pain.

GERD in some cases causes injury to esophagus and it includes ulcers in the junction of the stomach and esophagus. (Necrosis), narrowing of the esophagus (stricture), metaplasia and rare form of cancer in the esophagus. It causes damage to other organs than esophagus (EERD) which includes cough, laryngitis, asthma, sinusitis and dental damage. Even somebody have symptoms of pharyngitis, sinusitis and even recurrent ear infections.

In children, GERD causes various symptoms like vomiting, cough and other respiratory symptoms. All children have different symptoms and their behavior changes in food intake, unnecessary crying, fails to gain weight and some children have belching as in adults.

Babies when affected they used to scream while sleeping, poor sleeping patterns, vomiting after feeding, unusual hiccups, running nose condition, problems in swallowing of feed, gagging, frequent ear infection and sinus congestion. Refusing food or taking food often is common in babies. Nocturnal cough, bad breath is also common in infants.

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Most infants are having possetting after a feed, there is weight gain, they eat well and there are no other symptoms also. But when they grow, some babies show improvement and their lower esophageal sphincter becomes more proper. Some babies with GERD do not have any vomiting symptoms and most of the babies are mostly affected by more reflux and more damage to esophagus. Commonly called spitting up in infants is the main symptom of infant’s GERD. “Barrett’s esophagus” is a condition where cell changes occur which are precursor for carcinoma.

Endoscopic study shows clearly about the narrowing of the junction of stomach and esophagus and which causes the difficulty in swallowing or dysphagia. Barium meals X-ray, manometry are all valuable investigations including EGD. In GERD, now, monitoring pH of esophagus is having vital importance in calculating the severity of the disease and improvement status after medication or surgery. In chronic cases it is advised to take three yearly endoscopy to study possibilities of any adverse conditions in the esophagus such as dysplasia. EGD is also a form of endoscopy which facilitates to see the surface of the esophagus and stomach.

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Biopsies show any form of edema, inflammatory changes, even pre-cancer identifications such as dysplasia and carcinoma. Some of the patient will not show any surface changes and they are called non-erosive type of reflux.

In healthy adults that the junction between stomach and esophagus has a valve arrangement which prevent anything comes back from stomach to esophagus but in the adults of having reflux, they do not have proper valve arrangement and they have their stomach content in to the esophagus such as enzyme, stomach acid and bile substances which cause inflammation to esophagus. Hiatal hernia, obesity and hypercalcemia play an important roll in developing this condition.

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Life style modification and certain foods definitely promote this condition. Providing elevation to head while sleep is the best result giving practice and almost several patients feel comfort without reflux when they avoid food two hours before going to bed.

Proton pump inhibitor such as pantoprozole, H2 receptor blocker like ranitidine is very much useful and widely used to heal the disease by reducing acid secretion.  Antacids play an important roll in treating this condition. Prokinetics like cisapride and mosapride of having the value of improving action of the lower esophageal sphincter and helps in rapid gastric emptying and thereby stopping reflux actions in to esophagus.

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