What is GERD?
Gastroesophageal reflux disease occurs when stomach acid flows back into the esophagus also known as food pipe. Esophagus is a conduit like organ meant for transfer of food from oral cavity into the stomach. Lower esophageal sphincter a valve between esophagus and stomach, protect against reflux of acid or stomach back into stomach. Weakness of lower esophageal sphincter lead to weakening of this barrier eventually leading to reflux. Although occasional acid reflux is common and experienced by many individuals, the diagnosis of GERD is established when this reflux becomes a regular occurrence over time, resulting in troublesome symptoms and potential complications disturbing quality of life.
Esophagus is virtually a straight tube connecting the oral cavity to the stomach. It lacks the protective lining against the acid, which is inherently present in the stomach. Stomach produces acid for digestion, but is protected against the same, by virtue of protective lining with columnar epithelium which produces mucus and other protective molecules against injury by acid present in lumen of stomach. When stomach acid flows back into the esophagus, an environment that is ill-equipped to handle such acidic environment, causing painful symptoms and inflammation and ulceration.
Differentiating GERD from acid reflux?
Many people have occasional acid reflux, which can be triggered by factors like specific foods, lying down after eating, physiological conditions like pregnancy, or lifestyle choices. It's usually a temporary and occasional discomfort.
However, when acid reflux becomes frequent, affecting quality of life and well being, it's diagnosed as GERD. Unlike occasional acid reflux, GERD is persistent and indicates a malfunction in the mechanisms that typically prevent stomach acid from flowing back into the esophagus.
Hiatus hernia and GERD
Hiatus hernia is a condition often diagnosed on endoscopy or barium swallow, result from migration of part of stomach into chest. Stomach is an abdominal organ, weakening of supportive structures, may lead to migration of stomach into chest, a condition known as hiatus hernia. Predominant symptoms of hiatus hernia occur due to reflux of gastric contents into esophagus.
Prevalence of GERD in India/ How common is GERD ?
The prevalence of these conditions can vary over time and across different regions. According to Indian consensus on gastroesophageal reflux disease in adults, the prevalence of GERD in India ranges from 7.6% to 30%, being less than 10% in most population studies.
Common signs and symptoms of GERD
GERD can cause various signs and symptoms, and their intensity can differ from person to person and at different times.
• Heartburn: This is a burning sensation or discomfort that might move from the chest to throat. It often occurs after eating spicy/oily food or when lying down.
• Regurgitation: This involves the backflow of stomach contents, including acid or food, into the throat or mouth, leading to a sour or bitter taste.
• Dysphagia: It refers to difficulty swallowing or the feeling of food getting stuck in the throat. It occurs due to weakening of esophageal muscles due to prolonged acid exposure.
• Chest Pain: Similar to the pain of a heart attack, GERD-related chest pain needs to be distinguished from cardiac-related chest pain. A thorough clinical history can help identify GERD as the main cause of pain in patients with non-cardiac chest pain.
• Chronic Cough: GERD can cause a persistent cough, often accompanied by the sensation of a lump in the throat. This may result from aspiration of acid into lungs.
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