In recent time, the number of people experiencing reflux is increasing. The usual presentation to doctors are heartburn, acid taste in the mouth, central chest pain, excessive burping and even food particles that are regurgitated back into the mouth.
Furthermore, reflux can also worsen or trigger asthma, bronchitis, sore throat (laryngitis) and recurrent dry cough.
There are few ways to confirm the diagnosis. If these symptoms are relieved by lifestyle changes and acid-reducing medication, the likelihood of GERD is high.
Other tests done to look for GERD would include monitoring the acidity in the oesophagus (pH monitoring over 24 hours) and the pressure within the oesophagus (manometry)
A gastroscopy will also be recommended as GERD can cause reflux oesophagitis or inflammation of the oesophagus.
Over a period of time, if the reflux oesophagitis is not treated, the cells in that area can slowly change to become Barret’s oesophagus. This is a type of pre-cancerous condition that is usually reversible, depending on the severity. A small number of people having this condition over a long period of time, may develop cancer of the oesophagus.
Therefore, the gastroscopy can visualise any inflammation (oesophagitis) of the lower oesophagus and through the scope, biopsies (tissue samples) can be taken to assess the severity of the reflux.
Dr Ganesh Ramalingam believes that the mainstay of treatment for GERD is lifestyle and diet change. Eating small meals many times a day, less acidic food, early meals before sleeping at night and if symptoms are severe, sleeping with the head elevated with extra pillows or a triangular pillow will improve the symptoms.
If symptoms or discomfort persist, the next step would be medication. These would include acid- reducing medication and anti-reflux medication. Only a very small group of patients may need surgery. If these are severe lifestyle disrupting symptoms, lasting for many months despite high dose medical treatment, may qualify the individual for surgery. Also, if there are complications of reflux like narrowing or adverse reports on the biopsy taken on the reflux oesophagitis, may prompt the doctor to recommend surgery.
The surgery done in these instances is a fundoplication and also possibly a repair of the diaphragm if there is a large hiatus.
Fundoplication is a procedure where the stomach is used to create a valve at the inner oesophagus. This will help with reflux symptoms. However, some people will develop bloating, burping or even slow passage of food into the stomach. Therefore, surgery is usually recommended as the final result.