The full form of GORD or GERD is Gastro-Esophageal Reflux Disease also known as reflux esophagitis. It is the recurrent reflux of gastric contents that is gastric juice or acid into the distal part of the esophagus.
Pathophysiology of GERD:
The pathophysiology depends on many factors but the main factor is improper functioning of the lower esophageal sphincter also known as LES.
Some mobility-related disorders of the distal part of the esophagus can also cause it, like decreased velocity and increased duration of peristaltic movement, and reduced peristaltic amplitude. All these effects increased exposure of the esophagus to gastric juice which is refluxed into it.
Risk factors of GERD:
The pathophysiology of GERD is affected by many diseases or disorders such as
- Relaxed or hypotonic LES (Lower Esophageal Sphincter): It may be caused by Diabetes mellitus, hiatus hernia, or excessive fatty meals.
- Reduced LOS pressure: It can be caused by prolonged intubation of gastric tube, scleroderma, and medicines like anticholinergics, β-adrenergic agents, calcium channel blockers, nitrates.
- Raised intra-abdominal pressure: It is seen in obesity, pregnancy, ascites, etc.
- Impaired functions of the mucous membrane of the esophagus can be seen in alcoholism, smoking, etc.
- Pyloric obstruction, gastroparesis, and excessive intake of fatty food can cause delayed gastric emptying.
- Increased gastric content is seen in the intake of large meals and Z-E syndrome that is Zollinger-Ellison syndrome.
Symptoms of GERD:
Regurgitation and heartburn is the most common symptom and it is aggravated by a change of position. It mostly felt after meals.
When there is esophagitis, one can have difficulty in swallowing.
It can happen due to recurrent esophageal bleeding.
- Associated symptoms:
like epigastric pain, nausea, bloating with heartburn may be seen.
- Atypical symptoms:
like recurrent coughing, hoarseness of voice due to recurrent laryngitis, loss of weight, asthma, dysphagia, vomiting, or gastrointestinal blood loss may also be seen.
- Barium swallow with fluoroscopy:
It is helpful for finding upper esophageal sphincter disorders like the improper opening of a pharyngo-esophageal segment, airway aspiration, and incoordination of weak contraction of muscles after swallowing.
It is also helpful in finding hiatus hernia, stricter, ulcers in the mucous membrane, esophageal dilation, etc.
It is the most helpful investigation to find out stricture, ulcers in the mucosa, and any other disorders. Along with this, we have also an advantage of taking a biopsy if needed in endoscopy.
It is used for the measurement of strength and coordination of muscles of the esophagus.
It is helpful in the detection of the tone of the upper esophageal sphincter and relaxation during swallowing. Also for coordination between the relaxation of the upper esophageal sphincter and contraction of the pharynx.
For muscle of the body of the esophagus, it can find out the amplitude, duration, and velocity of waves.
It measures tonic pressure and relaxation of the lower esophageal sphincter.
- Monitoring of pH:
It helps monitor Acid Reflux time duration and the number of episodes of reflux. Also for the percentage of symptom episodes that are associated with reflux episodes.
It is specially indicated for atypical symptoms, medical therapy not effective on the patient, preoperative assessment, and follow-up of patients undergoing reflux surgery.
- Bernstein test:
It is also known as the acid-perfusion test to produce the pain associated with reflux.
It is performed by esophageal perfusion of 0.1N HCL alternating with normal saline solution at a rate of 6 ml per minute.
It is helpful for the measurement of episode number, length of time, and pH of the distal esophagus.
This investigation can demonstrate the reflux and also gives a quantitative measurement of its presence.
In this test technetium99 (99Tc) is introduced into the stomach followed by compression of the abdomen and radiographic counting of the esophagus is done.
Antacid or Alginate medicine:
This type of medicine neutralizes the acid in the stomach and esophagus. This prevents damage to the inner wall of the esophagus and stomach from gastric acid.
Proton Pump Inhibitors (PPIs):
It is also called an acid pump and is helpful by blocking the protein which is required for the production of stomach acid.
This medicine includes lansoprazole, omeprazole, pantoprazole, dexlansoprazole, esomeprazole, and rabeprazole.
These types of medicine blocks the secretion of acid in the stomach and medicines include famotidine, cimetidine, nizatidine, and ranitidine.
A combination of prokinetic drugs like domperidone and metoclopramide with acid suppression is helpful if severe reflux disease is there. These medicines may have serious side effects. So must be taken by the advice of your treating doctor.
Medicines that increase the LOS pressure:
like domperidone and mosapride is also helpful.
Total Nissen or partial (Toupet) fundoplication when required.
Diet and lifestyle changes:
It is very much helpful for long-term benefits.
- Avoid taking meals 3 hours before bedtime and also avoid taking fatty and large volume meals.
- Chew every bolus properly. Ayurveda suggests you should chew a bolus 32 times and then swallow it. Also, try to develop a habit of eating slowly.
- Stop bad habits like smoking, recurrent taking meals, alcoholism, etc.
- Raise your head: Sleeping in such a position that your head remains elevated will help to stop the regurgitation of gastric acid into the stomach. So design or make your bed in such a way that it can keep your head and upper portion of the body elevated.
This article is for education purposes only. Take the advice of your doctor or professional Health Care worker before taking any action. Thank you.