GERD

Gastroesophageal reflux disease (GERD) is when the stomach acid rushes back into the tube that connects your mouth and stomach regularly (esophagus). Acid reflux can irritate the lining of your esophagus. It can create hurdles in your day-to-day life and eating choices.

Many people suffer from acid reflux. GERD is defined as a mild acid reflux occurring a minimum of twice a week or moderate to severe acid reflux occurring at least once a week. Most people can control their GERD symptoms with simple lifestyle modifications and over-the-counter medications. However, some patients with GERD may require stronger medicines or surgery to alleviate symptoms.

PREVALENCE IN MIDDLE EAST

It is estimated chat between 8. 7 percent and 33.1 percent of the population in the Middle Ease suffer from the disease, which is on the rise in the region and across the Western world.

As per studies, the prevalence of GERD is noted among approximately 8.7-33.1% of the population in the Middle East. Over the previous decade, the UAE has observed an increase in chronic GERD patients. The accompanying rise in obesity rates has been the most significant contributor to the dramatic rise in GERD.

More about GERD

GERD is also often known as chronic acid reflux, and is defined by symptoms and/or tissue damage caused by recurrent or extended exposure of the esophageal lining to acidic contents from the stomach. It happens when the lower esophageal sphincter (LES) fails to seal off the esophagus from the stomach. Simply put – it is the burning sensation in your chest moving up to your throat, that usually mimics the symptoms of a normal acidity.

Almost everyone suffers from acid reflux at some point in their lives. It is very common to have acid reflux and heartburn on occasion. However, if you suffer acid reflux/heartburn more than twice a week for several weeks, consume heartburn meds and antacids regularly, and if your symptoms persist, you may have GERD. In such cases, you should visit and get treated by a doctor. This is important, because GERD symptoms can elevate and can also progress into more severe problems, even cancer.

Causes & Symptoms of GERD

There is no single cause of GERD. It normally occurs when the entire system in your digestive system is not working efficiently. To further explain it: the LES is a circular ring of muscle located at the bottom of the esophagus. When it is functioning properly, it relaxes and opens when you swallow. After that it tightens and shuts again. Acid reflux occurs when this LES fails to tighten or shut appropriately. This causes the digestive juices and other stomach contents to move up your esophagus.

MAJOR RISK FACTORS IN THE UAE

Other possible reasons include lying down soon after having a large meal, regularly having large meals, or hiatal hernia.

SYMPTOMS OF GERD

• HEART BURN
• ACID REFLUX
• DIFFICULTY SWALLOWING
• NAUSEA AND VOMITING
• ABDOMINAL PAIN
• RASPIRATORY PROBLEMS

Acid reflux is the most common symptom of GERD. Acid reflux can create a burning sensation in your chest that can move to your neck and throat. This sensation is commonly referred to as heartburn. If you suffer from acid reflux, you may experience a sour or bitter taste at the back of your tongue. It may also cause food or drink to be regurgitated from your stomach into your mouth. Other GERD symptoms typically include chest pain, nausea, difficulty swallowing, bad breath, etc.

Diagnosis

GERD is often diagnosed by a combination of clinical symptoms, reaction to acid suppression, and objective testing through upper endoscopy and esophageal pH monitoring. Your doctor may order the following tests to confirm a diagnosis of GERD or to check for complications:

• Ambulatory acid probe test – This test monitors the amount of acid in your stomach over 24 hours. Your doctor will insert a catheter, which is a long, thin, flexible tube, via your nose and down your throat. You will wear a tiny gadget that measures the amount of acid that enters your esophagus or throat from your stomach. Your doctor may also implant a tiny capsule-shaped device into the wall of your esophagus. It detects acid and delivers signals to a small gadget worn by the patient. It will fall out of your esophagus and travel through your stool in around 2 days.
  
• X-rays – They are taken after you sip a chalky liquid that covers and fills the interior lining of your digestive tract. Your doctor can see a silhouette of your esophagus, stomach, and upper intestine owing to the coating. You may also be asked to take a barium tablet to assist identify an esophageal narrowing that is interfering with swallowing.
  
• Esophageal Manometry – This test monitors the rhythmic muscular contractions in your esophagus while you swallow. Esophageal manometry also evaluates the coordination and force exerted by your esophageal muscles. Your doctor will insert a long, thin tube into your esophagus, to assess how it moves and how much acid it pushes upward.
  
• Upper gastrointestinal (GI) endoscopy – It is a process in which a doctor uses an endoscope – a flexible tube equipped with a camera – to examine the lining of your upper GI tract, which includes your stomach, esophagus, and duodenum. A doctor may get biopsies during upper GI endoscopy by putting a device through the endoscope to collect small bits of tissue from the lining of your esophagus. The tissue will be examined under a microscope by a pathologist. Doctors may conduct an upper GI endoscopy to search for GERD complications or other conditions that may be causing your symptoms.

LIFESTYLE CHANGES & PREVENTIVE MEASURES

• Instead of eating large portions a few times a day, eat smaller, regular meals
• Obtain and sustain a healthy weight
• Avoid wearing clothes that are too tight around the waist. They can squeeze your stomach and force acid up into your esophagus
• Before going to bed, try not to consume anything. Go to bed at least three hours after you've eaten
• Quit smoking

Lifestyle Changes & Preventive Measures

Doctors recommend that you undertake a few lifestyle changes to help reduce your GERD symptoms. Some changes that may help, are:

• Instead of eating large portions, eat smaller, regular meals throughout the day
• Reduce the amount of fat in your diet by cutting back on butter, oils, salad dressings, gravy, fatty meats, and full-fat dairy products like sour cream, cheese, and whole milk
• Obtain and sustain a healthy weight
• When sleeping, use wooden blocks beneath the bedposts to elevate the head of the bed 6 to 8 inches. Extra pillows are generally ineffective
• Avoid wearing clothes that are very tight around the waist. They can squeeze your stomach and force acid up into your esophagus
• Sit upright when eating and remain upright (sitting or standing) for 45 to 60 minutes thereafter
• Before going to bed, try not to consume anything. Go to bed at least three hours after you have eaten
• Quit smoking
• Eliminate any potential trigger foods from your diet. You can identify triggers by being aware of what you eat and if acid reflux follows it

Treatment

If diagnosed with GERD, your doctor would most likely advise you to start with lifestyle changes and over-the-counter medications. If you do not feel better after a few weeks, your doctor may suggest prescription medicine or surgery.

Over-the-counter or prescription medications include:

Antacids

Antacids may be prescribed by doctors to treat minor heartburn and GERD symptoms. They are available without a prescription. Mild symptoms can be alleviated with antacids. However, unless you have discussed your antacid usage with your doctor, you should not use these medications every day or for severe symptoms. These medications may cause diarrhea or constipation as adverse effects.

H2 receptor blockers

The doctor may prescribe acid-reducing drugs for persistent reflux and heartburn. These medications include H2 blockers, which assist to inhibit acid secretion in the stomach.

Proton pump inhibitors (PPIs)

PPIs also decrease the amounts of acid produced by your stomach. As they perform better than H2 blockers, they are more beneficial when it comes to healing the esophageal lining, which can get damaged when someone has GERD for a long period. PPIs, like H2 blockers, are available over-the-counter, and your doctor can also prescribe a stronger dose.

Surgery for severe GERD

Medication and lifestyle changes are often used to treat GERD. If none of these methods work or you are unable to take medications for a long period, surgery may be the best option. Some common surgeries include:

Fundoplication

The most prevalent GERD surgery is fundoplication. In many cases, it results in long-term relief of GERD symptoms. A surgeon sews the top of the stomach around the end of the esophagus during the surgery to increase pressure to the lower esophageal sphincter and assist prevent reflux.

Transoral incisionless fundoplication (TIF)

A newer version of this procedure wraps the stomach around the LES with plastic fasteners using an endoscope (a tiny tube with a camera). It is less invasive than a traditional fundoplication.

Stretta Procedure

The doctor will insert a small tube into the esophagus that will employ low-radiofrequency heat to reshape the LES.

LINX Surgery

LINX surgery involves wrapping a ring of magnetic titanium beads across the intersection of your stomach and esophagus. The magnetic attraction of the beads maintains it slack enough to allow food to pass through, but tight enough to prevent reflux.

Bariatric Surgery

If you have GERD and are obese, your doctor may advise you to have weight-loss surgery, often known as bariatric surgery. The most commonly recommended one is gastric bypass surgery. Bariatric surgery can help you lose weight while also alleviating GERD symptoms.

Prognosis

Acid reflux (GERD) has a fair prognosis in mild to moderate cases. Chronic instances usually respond to prescription medications, but severe cases may need surgery to avoid significant consequences. The symptoms of GERD can be managed. You should be able to control your GERD symptoms, if you change your eating and sleeping habits and use medicines as needed.

If you encounter acid reflux/heartburn more than twice a week for several weeks and your symptoms persist, visit your healthcare professional.