Things to know about  GERD

gastro-Oesophageal Reflux Disease (GORD):

Causes, Symptoms & Treatment Guide:

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the oesophagus due to reduced strength or competence of the Lower Oesophageal Sphincter (LOS). This causes irritation and inflammation, leading to symptoms like heartburn and regurgitation.

Why Does GORD Happen?

GORD mainly occurs when the LOS becomes weak or damaged. Several factors can reduce its function:

Obesity 

Smoking and alcohol

Eating large meals or eating late

Hiatus (sliding) hernia

Reduced saliva (post-radiotherapy)

Conditions causing increased stomach pressure (e.g., diabetic gastroparesis)

When acid moves into the oesophagus repeatedly, it causes oesophagitis (inflammation), ulcers, and long-term complications if untreated.

Types of Oesophagitis Seen in GORD

Acute:

Alcohol excess, severe stress, corrosive ingestion

Chronic:

With hiatus hernia or after surgeries like oesophagojejunostomy

How GORD Progresses (A Simple Cycle)

Acid reflux → inflammation

Inflammation → oesophageal muscle spasm

Muscle spasm → stomach/oesophagus position changes

Position change → more reflux

This forms a vicious cycle unless treated.

Common Symptoms

The most common complaint is heartburn, a burning sensation behind the breastbone. Symptoms usually worsen when lying down and improve when sitting up.

Symptom:

.Heartburn (Pyrosis)

.Burning pain, can mimic angina

.Regurgitation

.Sour fluid/food coming back into the throat

.Chest Pain

.Non-cardiac, burning in nature

.Dysphagia

.Difficulty swallowing (late sign → stricture)

.Belching & Bloating

.Common, especially after meals

.Globus Sensation

If chest pain is severe or radiating, always rule out heart disease.

Possible Complications

Without treatment, GORD can lead to:

.Oesophageal ulcers and bleeding

.Peptic strictures (narrowing → food difficulty)

.Barrett’s Oesophagus (cell changes that may progress to cancer)

.Adenocarcinoma of oesophagus (rare but serious)

How GORD is Diagnosed

.Barium Swallow

.Endoscopy

Inflammation, ulcers, mucosa appearance are seen

.Manometry

Motility/pressure of oesophagus

24-Hour pH Test

Gold Standard – measures acid exposure

Treatment Options

Treatment depends on severity, but most cases improve with a combination of lifestyle changes + medications.

A. Lifestyle Modifications (First Step)

Reduce weight if overweight

Stop smoking & minimise alcohol

Avoid chocolate, coffee, aerated drinks (Coke), spicy/oily foods

Eat small, frequent meals instead of large portions

Do not lie down for 2–3 hours after meals

Sleep with the head end raised

B. Medications

Antacids + Alginate

Neutralises acid & forms a protective layer

Proton Pump Inhibitors (PPIs)

Pantoprazole 40 mg, Esomeprazole 20 mg

.Reduces acid production

C. Endoscopic Treatments

For patients not responding to medicines:

Radiofrequency therapy to strengthen LES

Injection therapy near the gastro-oesophageal junction

Endoscopic suturing/plication to tighten the LES

When Surgery Is Considered

If lifestyle changes, medicines, and endoscopic therapy fail, surgery like Fundoplication may be recommended.

Indications include:

Severe inflammation/stricture

Recurrent strictures

Large hiatus hernia

Barrett’s oesophagus with complications

Disclaimer:

The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified physician or other licensed healthcare provider with any questions you may have regarding a medical condition. Do not ignore or delay seeking medical advice because of information you read on this website. The use of any information provided here is solely at your own risk.