GERD: delay in diagnosis leads to complications

Lifestyle changes are must for medical management of GERD

May 13, 2015 12:00 am | Updated 06:00 am IST

Even the doctors are not comfortable with the bombastic name ‘gastroesophageal reflux disease’ and have abbreviated it to GERD. GERD is more common than a lot of ailments.

Everyone suffers from heartburn (burning sensation in the chest) at one time or the other. Heartburn is caused due to the regurgitation (backward flow) of gastric acid. Heartburn is a major symptom of GERD. Gastroenterologist brothers Nandigam Venu (surgical) and N. Bhavanarayana (medical) who work in the Kamineni Hospitals say that most GERD patients suffer because of a delay in diagnosis. GERD is caused because of changes in the barrier between the stomach and the esophagus, the technical name for the food-pipe.

The Lower Esophageal Sphincter (LES) is an elastic constriction between the esophagus and the stomach. This sphincter acts a barrier between the food-pipe and the stomach and prevents food from going back into the esophagus. It is very important that this barrier works effectively because the wall of the esophagus is not as resistant to acid as the wall of the stomach.

If the strong acids of the stomach leak into the esophagus its wall gets damaged resulting in GERD. “In some people the LES becomes lax and there is acid reflux.

The first line of treatment for GERD is antacids or H2 Receptor Blockers which decrease the production of acid in the stomach. The antacids are followed by proton-pump inhibitors (PPIs) which are the most potent inhibitors of acid secretion available.

The use of PPIs must be monitored by a medical gastroenterologist,” Dr Venu says.

Endoscopy is mostly diagnostic when it comes to GERD. Delay in diagnosis leads to the development of Esophageal strictures (persistent narrowing of the esophagus caused by reflux-induced inflammation) and Barrett’s esophagus a condition in which the nature of the tissue of the food-pipe changes.

Cancer usually follows this stage. These complications can be prevented with early treatment.

Lifestyle changes are a must for the medical management of GERD. Patients should stop eating huge meals. Persons with lax LESs will have acid reflux if they lie down immediately after eating. GERD patients should be as far away as possible from spicy and oily food, smoking and drinking. Surgery is performed only when medical management fails and when there are complications, Dr Venu says.

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