GERD / Acid Reflux

Understanding GERD / Acid Reflux

A ring of muscle called the lower oesophageal sphincter sits where the food pipe (oesophagus) meets the stomach. Normally it acts like a one-way valve, letting food down while keeping acidic stomach contents from coming back up. In GERD this valve is weak or relaxes at the wrong time, allowing acid to splash upwards and irritate the sensitive lining of the oesophagus.

Reflux that happens now and then is normal. It becomes a disease — GERD — when it occurs often, causes troublesome symptoms, or begins to damage the oesophagus. A hiatus hernia, where part of the stomach slides up into the chest, frequently makes reflux worse.

Symptoms

• A burning feeling in the chest (heartburn), often after meals or when lying down
• Sour or bitter fluid or food coming back up into the throat or mouth (regurgitation)
• Chest discomfort that can mimic heart pain
• Difficulty or pain when swallowing
• A persistent dry cough, hoarseness or sore throat
• A sensation of a lump in the throat, or worsening asthma-like symptoms

Causes & risk factors

• A weak or relaxed lower oesophageal sphincter
• A hiatus hernia (stomach pushing up into the chest)
• Being overweight or obese
• Pregnancy
• Smoking and alcohol
• Large, fatty or spicy meals, caffeine and eating late at night

Possible complications

• Oesophagitis — inflammation and ulcers of the food-pipe lining
• Narrowing (stricture) of the oesophagus causing swallowing difficulty
• Barrett's oesophagus — a change in the lining that carries a small cancer risk
• Bleeding from irritated or ulcerated tissue
• Chronic cough, hoarseness and dental erosion

How it is diagnosed

GERD is often diagnosed from the typical symptoms and a trial of acid-reducing treatment. When the diagnosis is unclear, symptoms are severe, or warning signs are present, an upper GI endoscopy lets the doctor look directly at the oesophagus and stomach and take biopsies if needed. Specialised tests such as 24-hour pH monitoring and oesophageal manometry may be used to measure acid exposure and muscle function before considering surgery.

Treatment options

Treatment usually starts with simple measures: losing excess weight, eating smaller meals, avoiding trigger foods, not lying down soon after eating, and raising the head of the bed. Acid-reducing medicines — particularly proton-pump inhibitors — heal the lining and relieve symptoms for most patients. These steps control the majority of cases.

Surgical treatment

Surgery is considered when symptoms persist despite proper medication, when a large hiatus hernia is present, or when a patient prefers a durable alternative to lifelong tablets. The standard operation is a laparoscopic fundoplication, in which the top of the stomach is wrapped around the lower oesophagus to reinforce the valve, usually alongside repair of any hiatus hernia. Dr. Sujan Shrestha performs this as a minimally invasive keyhole procedure through a few small incisions, which means less pain and a quicker recovery than open surgery.

Recovery & aftercare

After keyhole anti-reflux surgery most patients stay in hospital for one to two nights. A soft or liquid diet is advised for the first couple of weeks while swelling settles, then normal eating gradually resumes. Most people return to light activity within one to two weeks. Many are able to stop or greatly reduce their acid-reducing medicines once healed.

When to see a doctor

See a doctor if heartburn occurs more than twice a week, does not respond to over-the-counter remedies, or interferes with sleep and daily life. Seek prompt attention for difficulty swallowing, unintended weight loss, vomiting blood, black stools, or chest pain — these warning signs need urgent evaluation to rule out serious problems.