Do you also get heartburn after eating? I don't know if it's GERD (Gastroesophageal Reflux Disease)!

Hello! How are you? Today we are going to talk about a condition that many people have, but some do not pay much attention to it, but it is something that needs a little attention. Have you ever had a burning sensation in your chest after eating, a sour taste in your throat, or even when you eat? Some people think this is normal, but if it happens frequently and interferes with your daily activities, it may be a symptom of a condition called `GERD (Gastroesophageal Reflux Disease).` Let's talk about this in more detail, so that you can also have a better understanding of this.

What is GERD (Gastroesophageal Reflux Disease) simply?

Simply put, GERD is when the acid in our stomach, which is the liquid that helps digest food, flows back up, that is, into the esophagus (food pipe), towards the throat. Now you may be thinking, "Oh, that happens to me too, it feels like it's coming back up into our throat when we eat." Yes, that's what we call GER (Gastroesophageal Reflux) or simply "reflux". We may have had this experience from childhood. However, if this GER condition happens frequently, if you have symptoms like heartburn and regurgitation more than twice a week, or if it causes you other problems, for example, difficulty swallowing, a persistent cough, weight loss, or damage to the esophagus, then we call this condition GERD (Gastroesophageal Reflux Disease). That means `GERD` is a condition that requires more care and treatment than just a sore throat. Imagine, there is a muscle that is like a door between our stomach and esophagus. We call this `LES (Lower Esophageal Sphincter)` or the lower esophageal sphincter . This door opens when we swallow food, and it closes again when the food goes into the stomach. This prevents the food and acid in the stomach from coming back up into the esophagus. But if this `LES` does not close properly, or if it opens too often, then the contents of the stomach come up.

Why does GERD occur? What are the main causes?

There is not just one cause of GERD, there are many factors that can contribute to it. Let's take a look at the main factors that contribute to it.

• Weakness of the lower esophageal sphincter ( LES ): As I mentioned earlier, the problem starts when this muscle doesn't work properly. Certain foods, drinks (like coffee , tea, chocolate , alcohol), smoking , and some medications can cause this muscle to relax.
• Hiatal Hernia : This is when the upper part of the stomach pushes up into the chest. This increases the risk of acid reflux.
• Obesity(Overweight/Obesity): As body weight increases, pressure inside the abdominal cavity increases. This pressure can push the contents of the stomach upward.
• Pregnancy : Hormonal changes during pregnancy can cause symptoms of GERD , which can cause pressure in the stomach as the baby grows. This usually subsides after the baby is born.
• Eating habits: Eating a large meal at once, lying down after eating, and eating close to bedtime can also aggravate GERD.
• Certain foods and drinks: High-fat, spicy foods , tomatoes, citrus fruits (like oranges and limes), mint, chocolate, coffee, and carbonated drinks can increase GERD symptoms in some people. However, this varies from person to person .
• Smoking: Smoking weakens the LES muscle and reduces the production of saliva, which helps neutralize acids in the esophagus.
• Certain medications: Some asthma medications, high blood pressure medications, pain relievers, sleeping pills, and some antidepressants can also increase GERD symptoms. If you are taking any medications and think they are causing these symptoms, it is best to talk to your doctor.

What are the symptoms of GERD?

The symptoms of GERD can vary slightly from person to person. Let's take a look at some of the most common symptoms.

Symptoms most common in adults

• Heartburn: This is the main symptom that most people experience. It is a burning sensation that radiates from the center of the chest to the throat after eating, or when lying down or bending over. It is important to remember that this is not a heart problem , but if you experience sudden chest pain, it is important to seek medical advice.
• Regurgitation: The return of food or sour-tasting liquid from the stomach into the throat or mouth.
• Difficulty swallowing (Dysphagia): It can feel like choking or pain when swallowing food.
• Globus sensation: A feeling of a lump in the throat, but without food or water.

Some people may also have these symptoms (Atypical symptoms)

Although these are less common, they can be caused by GERD:

• Persistent dry cough: A cough that worsens especially at night and has no other cause.
• Laryngitis: The throat becomes sore and the voice changes.
• Asthma: GERD can cause new asthma or worsen existing asthma.
• Frequent nausea.
• Bad breath.
• Dental erosion: Stomach acids entering the mouth can damage teeth.
• Sleep disturbance: Chest pain and coughing that occur at night may make it difficult to sleep soundly.

Important: If you experience symptoms such as chest pain, difficulty breathing, or pain radiating to your jaw or arm, it could be due to GERD, but it is important to check for a more serious condition, such as a heart attack. So see a doctor right away.

What if young children and babies have GERD?

It's normal for babies to have some milk in their throat (GER). But if it turns into GERD, you may notice symptoms like these:

• Frequent vomiting or regurgitation of large amounts of milk.
• They cry when they are given food, don't want to eat, and get angry.
• The body weight is not increasing properly, and sometimes the weight is decreasing.
• Respiratory problems such as coughing and wheezing.
• When feeding or after feeding, they bend their bodies like a bow.
• I'm always crying inexplicably.

If your baby has these symptoms, it's best to see a pediatrician.

How do doctors diagnose GERD? (Diagnosis)

In most cases, a doctor can guess whether you have GERD by listening to your symptoms and examining you.

• Asking about symptoms: The doctor will ask you about what symptoms you have, how long they have been present, and when they are most severe.
• Lifestyle changes and medication: Sometimes your doctor may suggest some dietary changes and give you a simple GERD medication for a short period of time to see if your symptoms improve.
• Further tests: If symptoms are severe, if medication is not working, or if other complications are suspected, the doctor may order tests such as:
• Upper Endoscopy: This involves inserting a small, thin, camera-equipped tube through your mouth to examine your esophagus, stomach, and the first part of your small intestine. This can help check for damage to your esophagus or other problems. If necessary, a small sample of tissue (a biopsy) can be taken.
• Ambulatory acid (pH) probe test: In this test, a very thin tube is inserted through the nose into the esophagus and left in place for about 24 hours, measuring how often and for how long acid flows into the esophagus.
• Esophageal manometry: This measures the pressure and function of the LES and esophageal muscles. This is important for people who have difficulty swallowing.
• Barium swallow test `(Barium swallow / Esophagram)`:In this, you drink a liquid called barium and take X-ray pictures. This can show the shape of the esophagus and any obstructions. However, it is not used much anymore to diagnose GERD.

What are the treatments for GERD? What should we do?

There are three main methods for treating GERD: lifestyle changes, medication, and in some severe cases, surgery.

1. Lifestyle changes (these are the first and most important steps!)

Doing these things before or with medication can greatly help control GERD symptoms.

• Weight control: If you are overweight, trying to lose even a little weight can make a big difference.
• Avoiding trigger foods: Identify foods that you think may aggravate your GERD symptoms (such as spicy, fatty foods, chocolate, coffee, citrus fruits) and reduce them as much as possible. Not everyone is affected by the same foods, so you need to identify the ones that affect you.
• Changing eating habits:
• Instead of eating a lot at one meal, eat several small meals.
• After eating, don't lie down for at least 2-3 hours, stay seated.
• Finish dinner at least 3 hours before going to bed.
• Sleeping with the head of the bed elevated: Raise the head of the bed by about 6-8 inches. This is more effective by placing something like a piece of wood under the legs of the bed to elevate the head of the bed, rather than using a lot of pillows.
• Avoid smoking: If you smoke, quitting is not only good for GERD, but also for your entire body.
• Avoid tight clothing: Avoid wearing tight clothing that squeezes your stomach.

2. Medicines taken on medical advice

If lifestyle changes alone are not enough, your doctor may prescribe these medications. Never continue using these medications without medical advice.

• Antacids: These provide quick relief. They neutralize the acid in the stomach. However, using these frequently is not good, as they can cause side effects. (Example: `Digene`, `Gelusil`).
• H2 Receptor Blockers: These reduce the production of acid in the stomach. Medicines like Famotidine and Cimetidine belong to this category.
• Proton Pump Inhibitors (PPIs): These are the most powerful acid-reducing drugs available. Examples include Omeprazole, Esomeprazole, Lansoprazole, and Pantoprazole. These drugs work by blocking acid production to a large extent. However, they can cause some side effects when used long-term, so they should only be used under medical supervision.

3. Surgery in some cases

GERD can often be managed with lifestyle changes and medication. However, if neither of these works, if the medications cause severe side effects, or if GERD has caused serious complications (such as Barrett's esophagus), doctors may recommend surgery.

• Fundoplication: This is the most common surgery. In this, the upper part of the stomach is taken and wrapped around the lower part of the esophagus to strengthen the LES. This can now be done laparoscopically (through small incisions).
• There are several other modern methods as well.

What problems can occur if GERD is not treated properly? (Complications)

It's not a good idea to just assume that GERD is just a heartburn. If not treated properly, over time, complications such as:

• Esophagitis: The lining of the esophagus can become inflamed and irritated due to repeated acid reflux. This can cause pain, bleeding, and difficulty swallowing.
• Esophageal stricture: Long-term inflammation can cause scarring of the esophagus, making it difficult for food to pass through.
• Barrett's esophagus: In this condition, the cells in the lower part of the esophagus change to resemble the cells in the stomach. This is considered a precancerous condition that increases the risk of cancer . People with this condition are at increased risk of developing esophageal cancer.
• Esophageal cancer: People with Barrett's esophagus can develop this cancer over time. Not everyone with GERD develops it, and it is relatively rare , but there is a risk.
• Respiratory system disorders: If the acids that come up enter the respiratory tract, conditions such as frequent coughing, wheezing, and pneumonia can occur.

This is why it is important to seek medical advice without ignoring the symptoms of GERD.

Finally, things you need to remember (Take-Home Message)

GERD is a somewhat annoying condition that can be serious if left untreated. But the good news is that it can be largely controlled .

Remember:

* If you have frequent symptoms like chest pain or sore throat, don't ignore them. See a doctor for advice.

* Simple lifestyle changes (diet control, weight loss, changing sleeping position) can provide great relief.

* Use the medicine prescribed by your doctor exactly and for the prescribed period. Do not stop or start the medicine on your own.

* If you smoke, try to stop.

* If young children have symptoms of GERD, see a pediatrician immediately.

Living with GERD can be challenging, but with proper management, you can live a normal, comfortable life. Be open about your concerns and problems with your doctor. Wishing you good health! GERD, Gastroesophageal Reflux Disease, Heartburn, Acid Reflux, Sinhala Medical Article