GERD and Its Prevention

Gastro-Esophageal Reflux Disease (GERD) is the most common gastro intestinal disorder which we encounter in hospitals in outpatient basis. Out of 10, 7 people complain of heartburn or pain in chest at least once a week or daily. Symptoms are caused by back-flow of gastric acid and other gastric contents into the esophagus due to incompetent barriers at the gastro-esophageal junction. Exposure of the esophagus to refluxed acid correlates with potential for mucosal damage.

Clinical Features

Regurgitation of sour material in the mouth and heartburn are the characteristic symptoms of GERD. Some patient present with chronic cough more during night which is mostly due to reflux into the pharynx, larynx, and tracheobronchial tree, bronchoconstriction, pharyngitis, laryngitis, bronchitis, or pneumonia. Morning hoarseness is noted in some. Heartburn is produced by the contact of refluxed material with ulcerated esophageal mucosa. Angina-like or atypical chest pain occurs in some patients, while others experience no heartburn or chest pain. Many patients with GERD remain asymptomatic and do not seek attention until complications occur.

Diagnosis 

The diagnosis is easily made by history alone. Diagnostic studies are indicated in patients with persistent symptoms or complications or those who do not respond to therapy. Endoscopy is done to see the changes in mucosa of stomach/esophagus. a therapeutic trial with a proton pump inhibitor (PPI) (such as omeprazole, 40 mg bid) for 1 week provides strong support for the diagnosis of GERD.

Management :

    1) Life Style Modification: It’s the most important step in prevention of GERD. Such as- weight reduction, sleeping with the head of the bed elevated. Patients should not smoke and should avoid consuming fatty foods, coffee, chocolate, alcohol, mint, orange juice.
  
    2) Drugs: omeprazole (20 mg/d), lansoprazole (30 mg/d), pantoprazole (40 mg/d) frequently used.