Dealing with the belching, burning, nausea and chest pain caused by acid reflux is no fun. Gastrooesophageal reflux disease is a condition in which contents of the stomach (gastric acid) flow back into the oesophagus, causing injury to the oesophagus and problematic symptoms such as heartburn or regurgitation. The condition usually arises as a result of dysfunction of the lower oesophageal sphincter, especially during the night.
Up to 40% of the Western population is affected, however the specific prevalence of GORD in South Africa is uncertain. Heartburn (dyspepsia) and/or acid regurgitation are common symptoms. GORD may be aggravated by various comorbidities and risk factors and GORD can be classified into three different categories namely physiological gastrooesophageal reflux, pathological gastroesophageal reflux and secondary gastro-oesophageal reflux.
From a treatment perspective, however, the distinction between the management of GORD and peptic ulceration is purely arbitrary. Both are acid peptic diseases that are characterised by inflammatory and erosive changes in the normal gut mucosa. Both require an essentially similar pharmacotherapeutic treatment approach.
Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the oesophagus. The liquid can inflame and damage the lining (esophagitis) although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. The first part of the small intestine attached to the stomach. Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the oesophagus, but their role in the production of oesophageal inflammation and damage is not as clear as the role of acid (Marks & Davis, 2020).
GERD is a chronic condition. Once it begins, it usually is lifelong. If there is an injury to the lining of the oesophagus (esophagitis), this also is a chronic condition. Over time, chronic inflammation in your oesophagus can cause:
- Narrowing of the oesophagus (oesophageal stricture).Damage to the lower oesophagus 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 oesophagus (oesophageal ulcer).Stomach acid can wear away tissue in the oesophagus, causing an open sore to form. An oesophageal ulcer can bleed, cause pain and make swallowing difficult.
- Precancerous changes to the oesophagus (Barrett’s oesophagus).Damage from acid can cause changes in the tissue lining the lower oesophagus. These changes are associated with an increased risk of oesophageal cancer (https://www.medicinenet.com/gstroesophageal_refux_disease_gerd/article.htm).
Treatment of gastroesophageal reflux disease (GERD) involves a stepwise approach with the goals to control symptoms, to heal esophagitis, and to prevent recurrent esophagitis or other complications.
The treatment is based on (1) lifestyle modification and (2) control of gastric acid secretion through medical therapy with antacids or PPIs or surgical treatment with corrective antireflux surgery. Approximately 80% of patients have a recurrent but non-progressive form of GERD that is controlled with medications.
GERD occurs more commonly in people who are:
- overweight or obese because of increased pressure on the abdomen
- pregnant, due to the same increased pressure
- taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants
- smoking, and being exposed to second-hand smoke
Hiatal hernia is a condition where an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the oesophageal sphincter and raises the risk of GERD.
GERD will often be treated with medications before attempting other lines of treatment. Proton pump inhibitors are one of the main pharmaceutical treatment options for people with GERD. They decrease the amount of acid produced by the stomach.
Other options include:
- H2 blockers:These are another option to help decrease acid production.
- Antacids:These counteract the acid in the stomach with alkaline chemicals. Side effects can include diarrhoea and constipation. Antacids are available to purchase online.
- Prokinetics:These help the stomach empty faster. Side effects include diarrhoea, nausea, and anxiety.
- Erythromycin:This is a type of antibiotic that also helps empty the stomach.
If lifestyle changes do not significantly improve the symptoms of GERD, or medications do not have the desired effect, a gastroenterologist may recommend surgery.
Surgical treatments include:
Fundoplication: The surgeon sews the top of the stomach around the oesophagus. This adds pressure to the lower end of the oesophagus and is generally successful at reducing reflux.
Endoscopic procedures: This is a range of procedures that include endoscopic sewing, which uses stitches to tighten the sphincter muscle, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle (Patti & Anand, 2020).