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GERD stands for Gastro-esophageal reflux disease or “acid reflux” and is a common condition when the acid produced in the stomach leaks out and seeps back into the esophagus or food pipe.
The esophagus is a muscular tube than runs from the mouth to the stomach. The seepage of the stomach’s acid into the esophagus leads to heartburn or burning chest pain or discomfort, a sour or bitter taste in the back of the mouth and in severe cases pain and difficulty swallowing. (1-7)
GERD is a common condition and most people experience occasional episodes of the condition from time to time that resolves on its own or on self-medication with over-the counter drugs.
However, for those with a more persistent condition with severe symptoms, treatment on the long term is usually needed. It is estimated that 1 in 5 people will experience at least one episode of GERD per week and 1 in 10 people will have symptoms of GERD daily.
Up to four in ten people have symptoms of GERD each year in the United Kingdom.
Population-based studies have shown that between 21 and 40% of people report suffering from symptoms of heartburn and GERD in any 6 to 12 months' period. More than 60 million adult Americans suffer from symptoms of heartburn at least once a month and over 25 million experience heartburn daily.
GERD affects all age groups including children but those over 40 are more at risk. Although the condition affects both men and women equally, GERD is two to three times more common in men than women and men develop more complications than women.
GERD is caused due to multiple factors. The esophagus is guarded at its lower end by a valve-like gate called the lower esophageal sphincter (LES). The LES acts like a valve, opening to allow food to be pushed into the stomach by the propulsive movements of the esophagus and closing to prevent acid leaking out of the stomach and into the esophagus.
In patients with GERD the muscle of this sphincter may not be working properly. Those who are obese, overweight, pregnant, smokers, take pain relievers like Ibuprofen and consume a spicy or high fat diet are at an increased risk of GERD.
GERD is more common among pregnant women and a higher complication rate exists among the elderly. Patients with GERD usually have decreases in productivity, quality of life and overall well-being.
For treatment of GERD lifestyle and diet needs to be addressed first. Once this fails, therapy is stepped up to include antacids that help to neutralise effects of stomach acid.
Medications that reduce the secretion of the stomach acid called Proton Pump Inhibitors are one of the mainstays of therapy in GERD. Surgery may be recommended when medication fails to control the symptoms.
Treatment of GERD is usually successful but relapses are common. Nearly half of the treated individuals experience a return of symptoms after a year. This mandates a long term course of medications.
If left untreated the stomach acid can irritate the inner lining of the esophagus and cause esophagitis. In more severe cases this may lead to open sores or ulcers that cause pain and difficulty swallowing.
For patients presenting with GERD symptoms, 40-60% or more have reflux esophagitis. Up to 10% of these patients will have erosive esophagitis after investigation that shows ulcers at the lower end of the esophagus. Over time in rare cases this may turn into cancers (esophageal cancer).