Gastroesophageal reflux disease (GERD) is a form of chronic illness that affects the lower esophageal sphincter (LES). It is a relapsing condition which has a risk of morbidity and chances of mortality due to the complications like Barrett’s esophagus, a pre-malignant condition that may progress to esophageal cancer.
The etiology of GERD includes the acid reflux when the sphincter muscles get weak or abnormal resulting in the backflow of acidic content into the esophagus. The associated risk factors with GERD include obesity, pregnancy, connective tissue disorders, and hiatal hernia where the upper part of the stomach bulges out within the diaphragm or delayed type of stomach emptying. Other factors include large meals, fatty or fried food items, smoking, alcohol, caffeine intake or medicines such as aspirin, obesity, urban environment and lower education status.
EPIDEMIOLOGY AND PREVALENCE:
Gastroesophageal reflux disease is a widespread condition which is seen among adults. The prevalence of GERD is increasing worldwide although there are marked differences in the reported prevalence, ranging from 2.5% to 6.6% in Eastern Asia up to 13.8% to 25.8% in North America. It has a prevalence of around 10-20% in the western world affecting around 30 million individuals in the USA alone. 60% of adults with GERD suffer from symptoms over a period of 12 months while 25-30% adults suffer from weekly symptoms and 7% adults suffer from GERD symptoms on daily basis throughout lifetime.
The pathophysiology of GERD involves complex changes i.e. epithelial resistance, reflux exposure along with visceral sensitivity. The noxious gastric reflux results in esophagus injury, eliciting symptoms. This esophageal exposure occurs due to the compromised state of the anti-reflux barrier along with the reduced functioning of the esophagus to buffer and clear the reflux. The symptoms of GERD start to appear when the stomach contents run back towards the esophagus due to the weak sphincter muscles.
MANAGEMENT & TREATMENT OPTIONS:
Most of the individuals suffering from GERD perform self-diagnosis and self-treatment without seeking any medical attention which makes the condition worse.
Lifestyle modifications should be practiced throughout the GERD treatment. Avoid foods which are acidic, avoid consuming large meals, reduce the intake of fats, avoid sleeping after eating a meal and wait for 3-4 hours before sleeping and keep your head elevated around 10-20 cms during sleep, avoid medicines which aggravate the symptoms of GERD such as beta-agonists, calcium channel blockers, theophylline, alpha-adrenergic agonists, nitrates or sedatives. Avoid tight clothes around the waist. Try to lose some weight and stop smoking.
Use of antacids, H2 receptors antagonists and proton pump inhibitors helps in treating the GERD symptoms.
Anti-reflux surgery is indicated in patients who prefer surgery, where medicines failed to recover the condition, complications associated with GERD, atypical symptoms or medical complications such as a hiatal hernia.
Endoscopic treatment such as radiofrequency heating over the gastroesophageal junction help in reduction of medicines, improve the quality of life, and reduce the GERD symptoms without the risks of surgery.
GERD is a common condition which is affecting lots of individuals. Most people ignore the symptoms of GERD and treat it with self- medicines. It is important to seek medical advice if you are suffering from GERD symptoms.