Understanding GERD

Do you get burning sensation behind your chest bone, or have sour food come into your mouth? Do you wake up at night with “heartburn” or “acidity”, and need to drink water or take antacids for relief ? If this happens more than once a week, you are suffering from GERD (Gastro-esophageal Reflux Disease) one of our modern day maladies.

GERD is caused by refluxing of acid that is normally produced by the stomach, into the food pipe or esophagus, due to malfunctioning of the oneway valve located at the stomach-food pipe junction (GE valve). A nation-wide survey from 25 centres, conducted by the Indian Society of Gastroenterology, found that 8.4% of Indians suffer from this disorder. If you are a sufferer, you have 80 million in India for company!

GERD is primarily a lifestyle disorder, and hence a phenomenon of our times. Those who are overweight or obese, tend to have loose GE valves and are prone to reflux. Alcohol, nicotine (in tobacco), caffeine (in coffee and tea), fatty food ( pastries, fried food, cheese, cream), chocolates, and pungent spices cause relaxation of the GE valve and are notorious for causing GERD, accounting for the early morning “heartburn” often experienced after that perfect late night party. An aspirin or pain killer swallowed to clear the headache can worsen the reflux.

Diagnosis of GERD is fortunately not difficult as the symptoms are quite specific for this disorder. The commonest test advised is an endoscopic examination, during which the doctor assesses whether ulcers have formed in the food pipe (esophagitis) by the refluxing acid chyme. In many with severe symptoms, the changes on endoscopy are surprisingly mild, prompting specialists to coin a term ENRD (endoscopy negative reflux disease). In few however, ulcers form in the foodpipe, often leading to scarring and narrowing, and sometimes to cancer. Lower esophageal cancer is on the rise in most parts of the world due to increasing frequency of GERD.

Changes in life style certainly help; the problem today is the practical feasibility to adhere to them. Regular exercises, maintenance of ideal body weight, avoiding all the predisposing foods and beverages, a small early dinner of “sukhi roti” and boiled veggies, and elevating the head end of the bed, do work. Those who can’t change their ways prefer to take pills that reduce acid production in the stomach (Proton Pump Inhibitors or PPIs) or tighten the GE valve. They work well, but only as long as you keep taking them. Recent reports suggest that gulping these pills for years may be harmful. An interesting recent observation has shown that GERD can be partly in our genes.

Many refluxers would tell you that their parent(s) often gulped antacids for heartburn. Another form of treatment that is getting popular is a laparsoscopic surgery (fundoplication) that tightens the GE valve and prevents reflux.

Refluxers are often confronted with a difficult choice; a life of “Pleasure and Pill”or that of a “Frugal Pauper”, or now, surgery.