GERD is known as Gastro-Esophageal Reflux Disease. This is an abnormality in the GER (Gastroesophageal reflux- the regurgitation that occurs after a meal). Around 7-30% of the Indian population suffers from this disease.

American college of gastroenterology has defined GERD as mucosal damage caused due to abnormal reflux of gastric contents into the esophagus. There are some chances where the patient won’t have any symptoms but he might have mucosal damage.

In order to understand the disease, it is essential to know about a structure present in the esophagus known as LES. The Lower oesophageal sphincter is one that opens when food passes through and closes the rest of the time.

This mechanism is to make sure that the highly concentrated stomach acid doesn’t flow up. There are some instances where the acid moves up to the esophagus. In that case, saliva known to be basic in nature is sent down and hence the effect is neutralized. Apart from that, there is this peristalsis movement (set of alternate contractions) which will push down the stomach acid.

In the case of GERD, there is a weakened and abnormal response of LES pressure. The pressure needs to be high for it to be closed. Some of the possible causes include delayed gastric emptying, decreased salivation, impaired resistance, etc.

Apart from these, there are certain substances that can reduce esophageal pressure. Some of the prominent and common substances are coffee, ethanol, peppermint, chocolate, fat, spicy food, glucagon, secretin, cholecystokinin, progesterone, serotonin etc.     

 The following are the events occurring in GERD:-

  • Increased secretion of stomach acid
  • Delayed emptying of gastric contents into intestine
  • Abnormal saliva production
  • Impaired/lowered LESP
  • Frequent relaxation of lower oesophageal sphincter

Some of the common symptoms of GERD include heartburn, regurgitation, belching (formation of bubbles in the stomach), cough, wheezing, NCCP (Non-Cardiac Chest Pain), etc.

The following shows the percentage-wise prevalence for individual symptoms.

SymptomPrevalence
Heartburn80
Regurgitation54
Pain29
Cough27
Belching15
Wheezing7

Testing the Ph of the esophagus can be a good method for diagnosis. A lesser value indicates the presence of acid in the esophagus that can lead to GERD. The best method is endoscopy. This is a medical imaging technique that is used to image the esophagus. This can be used to check for the condition of the esophagus.

This method can be used to evaluate Barrett’s esophagus which is a cancerous condition. There is another method can esophagus-gastro-do endoscopy which collects a biopsy sample from the stomach sent for pathological analysis.

Another possible method for diagnosis includes the assessment of LESP. This is done using esophageal manometry.

The simplest solution to GERD is to use antacids. They provide quick but short-lived solutions. The commercially available antacids (Digene, eno, etc) contain chemicals magnesium and aluminum hydroxide.

Another important thing to be followed is lifestyle modification. This is also a lifestyle disease, hence changes in lifestyle are essential. Avoid fried, spicy foods, alcohol, and chocolate as much as possible, reduce weight and elevate the level of the bed. (30% response). Bitter foods can help to prevent acid reflux. Bitter gourd juice can help to subsidize the effects of GERD.

Some of the advanced medicines that can be used are Histamine H2 receptor antagonists which can block the H2 receptor channel hence reducing the secretion of stomach acid (50% response). The other one which can be used is PPI (Proton Pump Inhibitors) but produce some side effects. (80% response)

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Results

#1. Which of the following parts are being affected in GERD?

Select all that apply:


#2. What are the complications of GERD?


#3. Choose the one factor not related to the etiology of GERD?


#4. Which mechanisms help in overcoming the stomach acid in esophagus in normal conditions?


#5. Which of the substances can reduce the lower esophageal sphincter pressure?

Select all that apply:


#6. Find the odd one out of the symptoms for GERD


#7. Select the tests that imply for screening GERD

Select all that apply:


#8. What are the different antacids available for GERD treatment?


#9. Which lifestyle modification wont be fruitful for GERD?


#10. Mention some of the advanced drugs for GERD?


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