Gerd

What is Gerd?

Gastro-esophageal reflux disease or acid-reflux disease is a condition in which the contents of the stomach reflux backwards into the esophagus (food pipe). Since the stomach contents are acidic in nature, this damages the inner lining of the food pipe and causes symptoms of heartburn, pain, etc.

Some amount of reflux of stomach contents is normal in all individuals but not everyone develops GERD. The main reason behind this is that only in some individuals this refluxed fluid is more acidic and remains in the esophagus for longer duration thus causing GERD. Dietary causes and certain faulty habits are frequently responsible for initiating this condition in individuals who are prone to develop it.
At the junction of the food pipe (esophagus) and the stomach is a muscular gateway (called lower esophageal sphincter or LES). Under normal circumstances, this sphincter remains contracted so that no contents of the stomach can go back into the esophagus but when this sphincter becomes relaxed due to any reason or is weak, it may allow the contents of the stomach to flow back into the esophagus causing inflammation of the lining of the oesophagus. There can also be many other causes of GERD which will be discussed in details later.

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GERD Causes

There are multiple causes responsible for initiating GERD, and different causes may be functioning in different individuals or even in the same individual at different times

 Functional abnormalities of the lower esophageal sphincter

  • Abnormally weak contractions of the sphincter
  • Abnormal relaxations of the sphincter
    Both of the above contribute to increases chances of backflow of the stomach contents into the esophagus.

Hiatus Hernia

A condition in which there is protrusion of the stomach up into the opening normally occupied by the esophagus in the diaphragm [the muscle that separates the chest (thoracic) cavity from the abdomen.

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Abnormal Esophageal Contractions

Co-ordinated esophageal contractions cause the forward movement of food from the esophagus into the stomach. When the wave of contraction is defective, the refluxed acid is not pushed back into the stomach and it can cause damage to the lining of the esophagus.

Delayed Emptying of the Stomach

When food remains in the stomach for a longer duration, the stomach is distended for longer time and this increases the chances of reflux of the stomach contents.

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There are several other contributing factors for GERD which are as follows:

  • Dietary habits: Fatty and fried foods, chocolates, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings, pungent foods, etc.
  • Habits: Use of alcohol, cigarettes; poor posture (slouching) especially after meals
  • Drugs: Calcium channel blockers, antihistamines, theophylline, nitrates,
  • Eating habits: Large meals, eating soon before sleeping
  • Other contributory conditions: Obesity, pregnancy, diabetes, rapid weight gain, etc.
  • Stress: Though this has not been directly linked to GERD, most patients report an increase in their symptoms during stressful times.
  • Other medical conditions: Diabetes, pregnancy, Obesity

GERD Symptoms

Uncomplicated GERD presents with the following symptoms commonly:

  • Heartburn: This is the commonest presentation of GERD. Patients often complain of burning pain in the middle of chest region (retrosternal). The pain may also be present in the upper part of the abdomen and sometimes travels up to the throat. Occasionally the pain may be sharp or pressing instead of burning. The pain is worse after meals and can last upto a couple of hours. Symptoms may be worse on lying down.
  • Regurgitation: The refluxed stomach contents may come into the throat or mouth and this may occur especially on bending or sleeping. There may be a feeling of ‘something stuck in the throat’.
  • Dry cough, hoarseness of voice, bad taste in the mouth are other symptoms caused due to the regurgitation of the food.
  • Occasionally patients may develop nausea (though this is not very frequent) and GERD should always be considered in patients who have unexplained nausea.
  • In children, the common symptoms are vomiting, coughing and other respiratory problems.

Diagnosis of GERD

Diagnosis of GERD is frequently done based on the symptoms and often physicians put the patients on a therapeutic trial of antacids. But it must be remembered that patients responding positively to therapeutic trial of antacids do not always have GERD; they may well be suffering from some other condition (Gastric ulcer, duodenal ulcer, etc). Hence it’s very important to evaluate every case of heartburn to diagnose if it’s due to GERD or due to any other cause.

Following are the commonest investigations done to diagnose GERD:

  • Upper Gastrointestinal Endoscopy: Also commonly known as OGD scopey or Oesophago-gastro-duodenoscopy (endoscopy of the upper digestive tract). This involves viewing the inside of the food pipe, stomach and upper part of intestine using a fibre-optic tube to look out for any inflammation, erosions, ulcers and to rule out any complications of GERD.
  • Biopsy of the esophagus is more important for ruling out cancer of the esophagus or other cellular changes as a cause of heartburn. A biopsy can also pick up other cellular changes that may be complications of GERD.
  • Specialised x-ray of the esophagus (called esophagram) using barium as contrast: This is done to rule out complications of GERD such as ulcers, strictures, etc. This test is not used frequently nowadays and Endoscopy remains the primary diagnostic test.
  • Esophageal motility testing: To evaluate the function of the muscles of the esophagus.
  • Gastric emptying studies: To detect if the patient has slow emptying of the stomach.
  • Esophageal acid testing: To determine the amount of time during 24 hours that the esophagus contains acid.

GERD in Children

GERD is not an uncommon disorder amongst infants but this diagnosis is frequently missed out due to the fact that spitting up after a meal is a common occurrence in children. However, this is a difference between spitting up after a meal and the symptoms of GERD. If the parents are able to observe that their infant possibly has symptoms that are not normal, they will seek treatment well in time.

GERD causes upward movement of the contents of the stomach (food+acid) into the food-pipe (esophagus) of the child, sometimes into or out of the mouth.

  1. Causes of GERD in children
  2. Symptoms of GERD in children
  3. Consult your health care provider when following occurs
  4. Diagnosis of GERD in children
  5. Treatment of GERD in children

Causes of GERD in children

A poorly coordinated gastro-intestinal tract is the commonest cause of GERD in children. An immature digestive system is the prime reason for this complaints and this is precisely why most of the infants outgrow this condition by the time they complete 1 year of age. The causes of GERD in older children are predominantly the same as the causes of GERD in adults.

Certain other factors that may contribute to GERD include obesity, overfeeding, certain medications, etc. There also appears to be an inherited component to GERD, as it is more common in some families than in others.

Symptoms of GERD in children

The common symptoms of GERD in children are as follows:

  1. Recurrent vomitingFrequent or persistent cough
  2. Refusing feeds or notable difficulty in eating
  3. Choking or gagging during feeds
  4. Older children may complain of heartburn, abdominal pain, gas
  5. Infants may demonstrate colicky behavior (frequent crying and fussiness).
  6. Regurgitation and re-swallowing

Severe cases may lead to any of the following in the long run:

  1. Poor growth
  2. Breathing problems
  3. Recurrent pneumonia

Consult your health care provider when following occurs

  1. Large or persistent vomiting, particularly in infants under 2 months of age
  2. Vomiting of fluid that is greenish, yellowish, appears like grounded coffee or blood
  3. Difficult breathing associated with vomiting or spitting up
  4. Excessive irritability related to feeding
  5. Weight loss or poor weight gain associated with refusal to feed.
  6. Difficult or painful swallowing

Diagnosis of GERD in children

In most of the cases, the history given by the parents is sufficient enough to diagnose this condition. Repeated recurrence of the above-mentioned complaints and visible distress of the child are adequate for diagnosis.

However, following tests can be conducted to confirm the diagnosis

  1. Upper GI endoscopy
  2. Barium swallow
  3. Gastric emptying study
  4. Esophageal pH probe

Treatment of GERD in children

Most babies outgrow GERD by the time they complete one year of age. However, even during this period, proper treatment must be administered to ensure that the complaints do not worsen. For children in whom this condition persists beyond one year of age, the treatment gives significant relief from distress and also controls the progress of the complaints. Click here to read about the Homeopathic treatment of GERD in children. Please note that the principles of treatment largely remain the same as in adults. However, certain additional life-style changes are suggested for infants for better control of the symptoms:

  1. Elevate the head end of the baby’s crib
  2. Hold the baby upright for at least 30 minutes after a feed.
  3. Burp feeding on each side.
  4. Try several short feeds frequently rather than one large feed
  5. With the approval of your doctor, introduce semi-solid foods into the diet of your infant
  6. Avoid over-feeding the child at any time
  7. Older children should not be allowed to lie down for at least 2 hours after meals
  8. Limit foods that you think worsen your child’s complaints

GERD Complications

Chronic long-standing GERD may cause certain complications that have been described below:

  • Esophageal erosions: Inflammation of the esophagus, ulcers or breaks in the lining of the esophagus can occur due to repeated contact with refluxed acid from the stomach.
  • Esophageal strictures: Repeated damage to the esophageal lining caused by acid reflux forms a scar tissue (stricture). These strictures can trap food and cause difficulty in swallowing.
  • Barrett’s esophagus: In some patients, the normal esophageal lining, or epithelium, may be replaced with abnormal epithelium. This condition is called Barrett’s esophagus and it has been linked to cancer of the esophagus.
  • Inflammation of the vocal cords due to refluxed acid; this may lead to hoarseness of voice.
  • Lung (pulmonary) aspiration, asthma and chronic pulmonary disease may also be caused by GERD.

GERD – Lifestyle Changes

Patients of GERD can benefit immensely if they follow the following set of instructions and incorporate these into their daily lives. These changes in lifestyle can bring under good control most of the symptoms of GERD and can significantly alleviate the symptoms of GERD.

  1. Don’t eat at least 2-3 hours before bedtime. This will help emptying of the stomach before the person goes into the reclined position and will prevent the reflux.
  2. Don’t lie down right after eating at any time of day.
  3. Keep the head end of your bed elevated by at least 6 inches with blocks because gravity helps in preventing the reflux of the acid from the stomach.
  4. Don’t eat large meals; instead opt for smaller, more frequent meals throughout the day.
  5. Give up smoking because smoking weakens the lower esophageal sphincter and increases reflux.
  6. Avoid alcohol because it increases the likelihood that acid from your stomach will back up.
  7. Reduce your weight if you are overweight because obesity increases the chances of reflux of the acid.
  8. Avoid fatty, greasy foods, chocolate, caffeine, spicy foods, citrus foods and other things which worsen your heartburn.
  9. Avoid remaining in stooped posture; keep an upright posture when standing or sitting.
  10. Be cautious with over-the-counter painkillers as these might worsen your complaints, always ask your physician before taking any such medication.

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