21 Mar Reflux Disorder – All you need to know
Reflux Disorder :
Definition- Reflux Disorder is a chronic disease when the stomach contents- digestive juices or food particles flow back into the foodpipe causing heartburn or other symptoms or damage to the foodpipe lining.
Such signs/symptoms when occur atleast once a week or interfere with daily activities or cause specific damage or inflammation of foodpipe, merit to be called GERD or Gastro-esophageal reflux disorder
Incidence– World over, various studies quote the incidence in range of 8.8 % to 27.8 %. Though there is paucity of studies in Indian population, a recent study puts this figure in range of 22.2%.
What causes GERD????
- The laxity of Lower esophageal sphincter that acts as a one way valve is the primary pathology.
- Presence of sliding hiatus hernia that is when a portion of upper stomach slips into the chest is another cause.
What are the factors promoting reflux?
- Eating large portions of food
- Spicy and fatty diet
- Lying down just after meals
- Alcohol/ Smoking/ Fizzy drinks
- Food rich in onion, garlic
- Chocolate/ peppermint/ tea/coffee in excess
What are the symptoms??
- Heartburn , that is feeling of burning sensation in lower chest and upper abdomen is the commonest and most prominent symptom
- Reflux of sour fluid back into the mouth, and sometimes that of food particles especially upon bending and in lying down position
- Chest pain, especially radiating to back and gripping in character
- Change of voice- hoarseness, laryngitis
- Dry irritating cough for which no pulmonary cause is found
- Asthma and recurrent pneumonia
- Bad breath
What symptoms should alarm you?
- Weight loss
- Dysphagia, that is difficulty in swallowing food
- Black coloured stools
- Extra- GI symptoms, i.e. change of voice or irritating cough
When should you consult the doctor?
- when symptoms occur regularly that is more than once a week
- when the symptoms start interfering your daily routine or sleep
- any of the alarming symptoms as above
What all tests will be needed?
Usually, the typical symptoms are enough to make the diagnosis of Reflux Disorder, however, your doctor may prescribe the following tests to confirm or assess the severity of the disease:
- Upper GI endoscopy – it involves putting a camera down the throat into the food pipe and stomach. It can reveal the status of the mucosal lining of esophagus and stomach, any ulcers or inflammation, barrett’s esophagus, strictures or cancer. Also , it can ascertain the presence of hiatus hernia which is an independent factor while deciding the management as also can be used to take biopsies from any suspicious lesions.
- 24 hr pH study – this involves putting a small electrode in the lower esophagus to record the pH changes in the food pipe associated with reflux of acid from the stomach over a period of 24 hours. This gives an objective assessment of the symptoms .
- Lower esophageal manometry– it provides a detail of the functioning and pressure changes in the lower esophageal sphincter (LES) and helps to differentiate the GERD from other related disorders
- Barium study– though not used routinely, it can be helpful in documenting the reflux objectively under fluoroscopy and also to document the presence of hiatus hernia
- CT scan– used rarely to evaluate the atypical symptoms, mass lesions or strictures or assess the hiatus hernia
What are the complications of reflux?
Food pipe is not meant to handle the acid. So any reflux is bound to injure the mucosal lining of esophagus which can lead to- esophagitis, ulcers, barrett’s esophagus, strictures and cancer of lower esophagus. Infact, GERD is now recognised the most important factor in development of cancer of lower esophagus.
What are the treatment options??
- Lifestyle changes- keep a gap of atleast 3 hours between meals and going to bed
- sleep in a head-up position
- avoid smoking/ alcohol
- avoid wearing tight belts
- lose weight
- avoid heavy activity/bending/lifting weight just after meals
- sleep on your left (never on your belly)
- Dietary changes- divide your food intake. Eat more frequently but in lesser amount
- avoid chocolates/peppermint/ onion/ garlic
- avoid tea/ coffee/ soda/ fizzy drinks
- avoid spicy/ fatty diet
- Medications- acid suppression drugs like PPIs and H2 blockers are the first line treatment for reflux but offer relief to the tune of 60 to 70% only. The therapy has to be long term and has significant failure rates.
- Surgery- laparoscopic Nissen’s fundoplication. It is the gold- standard treatment for reflux disorder. It entails making small holes in your abdomen , reducing the hernia, if any and creating a wrap around the lower esophagus which tightens the LES. It involves 1 to 2 days stay in the hospital and gives 97% resolution. Consult your surgeon for more details.
In conclusion, GERD is one of the commomest gastro-intestinal disease and a lot misunderstood one, the complications of which are serious. The symptoms are mostly passed off as due to “gas” or “acidity”. Patients rely on home remedies or ‘over the counter’ drugs . A timely consult with your doctor is desirable.