GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)
Author : Dr.Lakshman,
(Acid Reflux / Heartburn)
What is gastro-oesophageal reflux disease?
When there is reflux (back flow) of acid and other contents from the stomach into oesophagus (food pipe) it is called gastro-oesophageal reflux disease. The acid causes damage to the lining of the food pipe and hence symptoms like heartburn and belching.
Why am I having acid reflux?
Normally, there are mechanisms in the body which prevent reflux of acid from the stomach into the food pipe. They are the purse string or pinch cock mechanism of diaphragm (muscle between chest and abdomen), inner lining between stomach and food pipe that is thrown into folds and also a valve like mechanism at their junction (Sphincter)
The lining of the food pipe is thinner than that of the stomach and is hence prone for damage during reflux.
What are the symptoms of reflux?
The important symptoms are
Heartburn where a person feels burning in the middle of the chest. Also, occasionally the pain could be on the left side sometimes mistaken for a heart problem. However, this pain is related to food or sometimes to posture, increasing on bending or after a full meal. Reflux. Acid or food coming from the stomach into the chest can be felt, sometimes it can reach as high as the mouth and a person feels like spitting the contents of the mouth out which is sour to taste. Belching or burping, which happens because of weakness of the valve when air escapes from the stomach. Other symptoms include change in the voice due to acid affecting the vocal cords or voice box, cough or wheezing at night mimicking asthma or sometimes food getting stuck in the middle of the chest. What are the underlying causes and triggers for reflux disease? The usual underlying problem is a weak valve or a hiatus hernia where stomach is pulled into the chest. There are also some factors which weaken the valve called the lower Oesophageal sphincter. These include smoking, significant alcohol intake, more of fatty foods including chocolates and ice
What tests are needed to confirm gastroesophageal reflux?
Symptoms for a short duration do not need any tests. It could improve with proper life style modifications and by taking tablets called proton pump inhibitors or H2 receptor antagonist. If symptoms of reflux and heartburn persist for more than a month, perhaps it may be best to get an endoscopy, which means that a small camera fitted on a flexible tube is inserted through mouth into stomach. The doctor will do this test and uses a monitor to see the internal views. It could make out a hiatus hernia or damage caused by reflux. At the time of endoscopy, a sample (biopsy) may also be needed if the doctor feels there is something abnormal. Rarely, other tests are needed to rule out any problems with the heart or lungs.
What lifestyle changes are needed to improve this condition?
Stopping smoking and cutting down alcohol significantly. Small and frequent meals. Weight reduction, if obese. Avoiding anything which will bloat the stomach like a fizzy drink or a heavy meal. Not to lie down for at least three hours after last meal of the day. If resting after meals, it should be in a reclining position with a 6-9 inch raise at the head end. Do not drink lot of water immediately after food if you have this problem. You can take half a cup or one cup of water and an hour later you can take additional cups of water for digestion.
What are the medications/treatments?
Medications which prevent/reduce the amount of hydrochloric acid secreted in the stomach and hence the acidity and damaging capacity of contents that reflux into the food pipe. They include H2 receptor antagonists (Ranitidine, Famotidine, etc) and Proton pump inhibitors (PPIs) (omeprazole lansoprazole, pantoprazole etc.)
The duration of treatment with both varies and usually for 6 to 8 weeks initially and further can be continued depending upon the response to the symptoms, recurrence of the symptoms, and the endoscopic findings.
Antacids - Liquid or solid antacids help in neutralizing the acid as well as preventing its effect on the inner lining of the food pipe by coating it.
Surgery - When the reflux is large and uncontrollable, an operation may be needed. Wrapping the stomach around lower food pipe increases the tone between the food pipe and stomach. This is called Nissen’s fundoplication. This also can be done laparoscopically (keyhole surgery).
Are there any complications of reflux disease?
Yes, there are a few complications which can happen rarely. Stricture- narrowing of the food pipe due to inflammation and scarring. When this happens there maybe difficulty to swallow food and the food will go down the food pipe slowly. This obstruction will be more to the solids but swallowing liquids also become affected at a later state. If it happens, treatment is possible endoscopically where a balloon is inserted to stretch the stricture. Barrett’s esophagus - This inner lining especially at the lower part of the food pipe becomes thicker due to constant assault and may change to cancer over years. According to many studies, the lifetime risk of this changing into cancer is about 5% and this can be diagnosed by endoscopy and biopsies and this Barrett’s mucosa can be minimized with the help of long-term proton pump inhibitors.
Heart burn is a common symptom which can be easily diagnosed and treated. However , at times a heart attack can also mimic a heart burn and so it is prudent to see the doctor and let them make the diagnosis rather than self medicate all heart burn as ‘acidity’ or ‘gas’