Gastroesophageal reflux disease – GERD, or
gastric reflux disease, is a chronic condition where stomach acid flows back up and damages
the mucosa of the food pipe – the esophagus. At the junction between the esophagus and
the stomach is the lower esophageal sphincter – the LES. The LES is a ring of muscle that
is generally closed tight to prevent stomach acid from coming up. In normal digestion,
the LES only opens briefly with each swallow to allow food bolus to pass down into the
stomach. GERD occurs when the LES is ABNORMALLY relaxed and cannot close properly. Heartburn
is a burning sensation in the chest associated with each regurgitation of gastric acid and
is the most prominent symptom of GERD. Hiatus hernia is believed to be another cause
of GERD. Hiatus hernia is a condition where the top portion of the stomach is pulled up
forming a herniation above the diaphragm. This situation somehow compromises the barrier
between the esophagus and the stomach, facilitating acid reflux.
If left untreated, GERD can lead to a number of complications, including:
– Esophageal stricture – narrowing of the esophagus as scar tissue builds up from reflux
damage. The resulting narrowed food pathway may cause difficulty swallowing.
– Esophageal ulcer – open sore as a result of acid erosion. An ulcer may bleed, cause
pain and again make swallowing difficult. – Barrett’s esophagus – precancerous changes
to the esophagus. These changes are associated with an increased risk of esophageal cancer.
GERD can be treated with dieting, life style changes and medication. Patients are advised
to maintain a healthy weight; avoid alcohol, tobacco and foods or drinks that trigger heartburn;
wait at least 3-4h after eating before going to bed; and sleep with an elevated head position.
Drugs of choice include proton-pump inhibitors, which act to reduce gastric acid production.
If these fail, a surgery may be recommended. In a procedure called fundoplication, the
top portion of the stomach is wrapped around the lower esophagus and sewn into place. With
this configuration, the muscles in the wall of the stomach reinforce the closure of the
esophagus. This surgical procedure is particularly recommended when hiatus hernia is present
as this can be fixed at the same time.