GERD (Gastroesophageal Reflux Disease)

What is GERD?

GERD is a clinical condition when gastric juices, containing acid, travel back from the stomach into the gullet (the swallowing pipe called the esophagus) cause troublesome symptoms or complications.

• The food in the stomach is partially digested by stomach acid and enzymes (special chemicals that act on food to break it down to simpler material that the body can use). 
  
  
• Normally, the partially digested acidic content in the stomach is delivered by the stomach muscle into the small intestine for further digestion. 
  
  
• In patients with GERD, stomach acid content regularly refluxes backwards into the esophagus, causing heartburn and inflammation.

How do you get GERD?

Doctors know that in Western countries, 20% of adults suffer from heartburn at least once a week, the main symptom of GERD. Up to 50 % of patients with GERD also have reflux esophagitis.

• In most people, GERD is caused by the digestive juices in the stomach, repeatedly moving upwards into the lower esophagus (called reflux). 
  
  
• The condition may be due to an abnormal mechanical working of the esophagus (where it enters the stomach), since it can normally squeeze itself together to act as a shut-off valve, or tap, to keep stomach contents out. 
  
  
• It can occur in some people when the stomach does not empty quickly enough and becomes overfilled with digestion contents.

How serious is GERD?

In some patients, damage to the inner lining of the esophagus can be seen during an endoscopic examination. This involves a doctor feeding a tube with a special camera down the patient's throat into the esophagus. However, even when damage cannot be seen, patients can experience severe symptoms. 

• Heartburn is the most common symptom of GERD, and is a burning feeling rising from the stomach or lower chest up towards the neck. 
  
  
• Other symptoms include regurgitation (food may come up into the mouth), chest pain, a difficulty in swallowing (a condition called dysphagia), hoarseness and asthma. 
  
  
• If untreated, severe heartburn can reduce quality of life for sufferers. In severe cases of reflux esophagitis, the lining of the esophagus may become ulcerated, leading to pain and possible narrowing due to scarring (making the swallowing of food and sometimes even liquids difficult). 
  
  
• In people with reflux esophagitis, there may be a small increased risk of cancer of the esophagus.

How long does GERD last?

The symptoms of GERD are frequent and may last several weeks, months or longer if left untreated. They can also re-occur after treatment.

How is GERD treated?

Medications commonly used in the treatment of GERD include: 

• Acid suppressants, such as histamine2-receptor antagonists (blockers). Histamine is a chemical released in the body under many different conditions. In the stomach it can release more acid, so blocking histamine’s action reduces acid production. 
  
  
• Proton pump inhibitors also work on the cells in the stomach wall, which make acid, to reduce the amount of acid produced and released into the stomach chamber. 
  
  
• Other medicines (called prokinetic agents) increase the movement of the stomach. They work by increasing the pressure of the lower esophageal sphincter (the point where the esophagus joins the stomach) and promote emptying of the stomach. 
  
  
• Antacids are medicines that are commonly used to treat acid-related symptoms, like heartburn or indigestion, and work by neutralising acid in the stomach. However, they are not usually recommended to treat the frequent heartburn suffered by people with GERD.
  

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