ACID REFLUX

Acid Reflux or Gastroesophageal reflux disease (GERD) occurs when acidic liquid contents from stomach frequently back up into the food pipe from the stomach. This flow back can irritate the lining of the food pipe (esophagus) causing either injury of the esophagus lining(erosive esophagitis) or just inflammation (non erosive esophagitis) Mild GERD (acid reflux occurring only once a week) is quite common and may be managed with some lifestyle changes and mild over the counter medicines but severe GERD (Acid reflux once a day) may need stronger medications or in refractory situations even surgery to ease symptoms. WHEN TO CONSIDER GERD You should suspect GERD if you feel • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night • Chest pain • Difficulty swallowing • Regurgitation of food or sour liquid • Sensation of a lump in your throat Patients with severe reflux or night time reflux may also complain of • Chronic cough • Laryngitis • New or worsening asthma • Disrupted sleep WHAT CAUSES ACID REFLUX GERD is caused by either a condition that causes increased acid output (excess refluxate volume) or when the junction of the food pipe and stomach has loose /weak muscle valve. Acid reflux occurs when the LES doesn’t close properly or tightly enough. A faulty or weakened LES allows digestive juices and stomach contents to rise back up into the esophagus. When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again. If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backflow of acid irritates the lining of your esophagus, often causing it to become inflamed which can subsequently develop erosions. PREDISPOSING FACTORS Conditions that can increase your risk of GERD include: • Obesity • Hiatus hernia (Stomach bulges towards Esophagus because of weak lower esophageal sphincter) • Pregnancy • Scleroderma • Delayed DR SHANTI SWAROOP DHAR Consultant,Gastroenterology Max Hospital, Gurgaon & Max Multi Speciality Centre, Panchsheel Park, Delhi

stomach emptying Aggravating factors • Smoking • Eating large meals or eating late at night • Eating trigger foods rich in fat or fried • Drinking certain beverages, such as alcohol, carbonated drinks, coffee, tea and caffeine rich energy drinks. • Medications like aspirin, painkillers LONG TERM PROBLEMS Over time, chronic injury to the esophagus can cause: • Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. • An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult. • Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer. However this type cancer is very rare, even in people with Barrett’s esophagus. WHEN TO SEEK HELP Please see a Doctor if you: • Experience severe or frequent GERD symptoms • Take medicines for heartburn more than twice a week • Severe chest pain with breathlessness and left arm or jaw pain may be a symptom of heart disease. Immediate medical help should be sought in such a situation. DIAGNOSIS Doctors usually diagnose GERD based on symptoms and physical examination. Some times a short duration of treatment with mild antacids may be advised to see for response especially in the absence of any worrying symptoms. Further evaluation for diagnosis confirmation or for refractory symptoms includes • Upper gastrointestinal endoscopy. The doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down the throat, to examine the inside of esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett's esophagus. This endoscopy can be done either with or without sedation depending on patient comfort/demand or hospital protocol. • 24 hour Ambulatory acid (pH) and Impedance probe test. A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor might be a thin, flexible tube (catheter) that's threaded through your nose into your esophagus, or a clip that's placed in your esophagus during an endoscopy and that gets passed into your stool after about two days. Nowadays even low acid but high volume reflux can be diagnosed using the impedance probe. • Esophageal manometry. Esophageal manometry measures the coordination and force exerted by the muscles of the esophagus. This is primarily used to diagnose disorders of normal rhythmic esophageal movement but has a role in GERD specially before considering a surgical option. • X-ray of your upper digestive system. X-rays are taken after the patient drinks a chalky liquid (Barium) that coats and fills the inside lining of the digestive tract. The coating allows the doctor to see a silhouette of your esophagus, stomach and upper intestine. These tests are not the first line investigations any more and are more of a historical footnote yet they are sometimes useful in patients who cannot or will not undergo an endoscopy. They can also help to diagnose a narrowing of the esophagus