Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a chronic digestive condition where stomach contents (especially acid) reflux backward into the esophagus, causing irritation, inflammation, and symptoms like heartburn and regurgitation.

🧬 What Happens in GERD?

Normally, the lower esophageal sphincter (LES) acts like a valve between the esophagus and stomach. In GERD:

• The LES becomes weakened or relaxed.
• Acid, bile, and food flow back into the esophagus.
• This causes mucosal damage, inflammation, and discomfort.

⚠️ Common Symptoms

🎯 Risk Factors

• Hiatal hernia
• Obesity
• Smoking
• Pregnancy
• Overeating or lying down after meals
• Trigger foods: spicy, fatty, chocolate, coffee, alcohol, peppermint

🧪 Diagnosis

✅ Clinical Diagnosis (in mild/moderate cases):

• Based on classic symptoms and response to treatment (e.g., PPIs)

🧪 Further Testing (if symptoms are atypical or severe):

• Upper endoscopy (EGD): checks for inflammation, ulcers, Barrett’s esophagus
• 24-hour pH monitoring: measures acid exposure in the esophagus
• Esophageal manometry: measures LES pressure and motility
• Barium swallow: visualizes reflux or anatomical abnormalities

💊 Treatment

1. Lifestyle Modifications (First-line)

• Elevate head of bed 6–8 inches
• Eat smaller meals
• Avoid lying down for 2–3 hours after eating
• Lose weight if overweight
• Avoid trigger foods/drinks
• Stop smoking and alcohol

2. Medications

3. Surgical Options

• Nissen fundoplication – wrapping top of the stomach around LES to strengthen it
• LINX device – magnetic ring that augments LES closure
• Surgery is considered when:
  • Symptoms are severe or refractory to meds
  • Patient wants to stop long-term PPIs
  • Complications arise (e.g., strictures, Barrett’s)

📉 Complications (if untreated)

• Esophagitis (inflammation)
• Esophageal stricture (narrowing)
• Barrett’s esophagus (precancerous change)
• Esophageal adenocarcinoma (rare but serious)
• Chronic cough or respiratory issues

🛡️ GERD vs Occasional Heartburn