Gastroesophageal Reflux Disease (GERD)
GERD occurs when reflux exposes the patient to physical complications, or symptoms significant enough to impair well-being and quality of life – typically when symptoms occur on two or more days a week. 15-20% of adults experience heartburn at least once a week.
Risks of Untreated Reflux
- Peptic (reflux) oesophagitis – ulceration of the lower esophagus
- Esophageal stricture
- Barrett’s esophagus
- Adenocarcinoma – cancer of the distal esophagus
Predisposing Factors
- Hiatal hernia
- Fat, chocolate, caffeine and alcohol
- Smoking
- Connective tissue diseases such as scleroderma
- Obesity (BMI over 30)
- A first-degree relative with heartburn
- Chronic respiratory disease, asthma and cystic fibrosis
- Prolonged supine positioning
Symptoms
Directly related to reflux: heartburn, epigastric pain, regurgitation and waterbrash. Atypical symptoms can include angina-like chest pain, excessive belching, dyspepsia, nausea, asthma, chronic cough, laryngitis, sinusitis, hoarseness, sore throat, dysphagia (difficulty swallowing) and odynophagia (painful swallowing).
Diagnosis
Diagnosis is usually symptom-based, sometimes supported by a therapeutic trial of double-dose proton pump inhibitors for two weeks. Investigations may include endoscopy (the most sensitive test for reflux oesophagitis), a barium swallow/meal in specific cases, or 24-hour ambulatory esophageal pH monitoring.
Treatment
Management aims to relieve symptoms, restore quality of life, heal oesophagitis and reduce the risk of complications – through lifestyle modification, antacids and H2-receptor antagonists in mild cases, or anti-reflux surgery when medical therapy fails, causes intolerable side effects, or the patient prefers to be free of long-term medication.
We routinely perform laparoscopic anti-reflux surgery (laparoscopic Fundoplication) at our center with excellent results. The need for surgery is assessed individually – the best outcomes are achieved in centers specialized in the treatment of gastroesophageal reflux disease.