Article published in Global Health and Travel Magazine 2018
What is GERD?
GERD stands for gastroesophageal reflux disease, often known as acid reflux. Imagine your upper GI (gastrointestinal) system as one long pipe from the mouth to the stomach and into the beginning of your small bowel. At the end of the oesophagus (the first part), there is a ring of muscle that keeps your food down after you’ve swallowed it. Reflux happens when anything in your stomach comes past this valve-like structure and comes up the oesophagus. We are allowed some reflux normally, but when there are symptoms of GERD, that’s when it becomes a problem. Reflux doesn’t always mean a liquid, however. You can have air reflux – a burp is a kind of reflux. You can also get bile reflux, which isn’t acidic but alkaline. So not quite everything is actually acid reflux.
How serious is GERD?
Women produce less acid than men but have more symptoms, with men having the opposite problem. When acid causes problems, that’s when GERD becomes serious. If you think about it, something that is corrosive will damage the lining of the oesophagus, and anything that harms tissue in the long term has the potential of becoming more serious—I’m talking about cancers and the like. In Western society, you get a lot of reflux that can lead to Barrett’s oesophagus, which leads to the risk of cancers. But most of the time, people suffer more from symptomatic problems than pathological ones.
When you have symptoms, you should see a doctor, and we can do an endoscopy to check what’s wrong. With some people, we find absolutely nothing, but that doesn’t mean they don’t have GERD. It simply means that we need a different means of investigation. Our end goal is to stop the reflux from happening continuously.
Given that the oesophagus sits in proximity to the heart, in some patients we have to wonder if it’s reflux or if it’s a heart attack or other chest or lung problem. I always tell patients the first thing to find out is if it’s your heart. Often you will see a patient go through the whole rigmarole of getting their heart checked, and then we may treat them for reflux. A heart attack can seem like heartburn, and heartburn can feel like a heart attack. I’d say get your heart checked first and then move on.
How is GERD treated?
There are various ways to treat it, including with lifestyle changes, medicine, non-surgical procedures, and finally with surgery, although that’s very far down the line. Most published guidelines, advocate people who aren’t too old and have no warning signs or symptoms should first try over-the-counter medicines. If the symptoms persist, you should come in and have a thorough investigation which may involve endoscopy. But you can never downplay the symptoms if you’re over 50 because of the potential for other pathologies to exist. I tell people, if you have any symptoms, don’t go to Dr Google, it’s better to talk to someone and get a proper diagnosis. It may just be that you need to take some pills for the short-term and that’s it.
If you have bad reflux and your scope is fine but the symptoms still persist, the next thing you would need is a manometry, pH and impedance study to tell us what is actually happening. Is it actually reflux you’re getting, is the pressure in the oesophagus appropriate, or is it acid or bile that’s coming up? After that’s done, and if we find you have a weak lower oesophageal sphincter for example and lifestyle and medication has failed to control things, we can do the STRETTA procedure, which effectively delivers radiofrequency (RF) energy to the oesophagus to strengthen the muscle and tighten it up. This said, there are strict criteria to be met for this procedure. Others may still need surgery.
Doctor Prabhjot has been a Consultant in Gastroenterology & Hepatology in the UK for 19 years and is now back in Malaysia. With this blog, he aims to raise awareness of healthy living so we can all enjoy life to the fullest.
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