Gastric Reflux

Introduction

  • Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the oesophagus, irritating its lining.
  • Symptoms include heartburn, regurgitation, and difficulty swallowing.
  • While occasional reflux is common, persistent symptoms may require medical management.
  • Effective treatment includes lifestyle modifications, medications, and, in severe cases, surgery.

Causes of GORD

  1. Weak Lower Oesophageal Sphincter (LOS)
    • Allows stomach contents to flow back into the oesophagus.
  2. Hiatal Hernia
    • Stomach bulging into the chest through the diaphragm, affecting LOS function.
  3. Obesity
    • Increased abdominal pressure contributes to reflux.
  4. Dietary Triggers
    • Spicy foods, caffeine, alcohol, and fatty foods.
  5. Medications
    • NSAIDs, calcium channel blockers, and certain sedatives.

Symptoms of GORD

  1. Classic Symptoms
    • Heartburn: Burning sensation in the chest, often after eating or lying down.
    • Regurgitation: Sour or bitter-tasting acid backing up into the throat or mouth.
  2. Atypical Symptoms
    • Chronic cough or hoarseness.
    • Difficulty swallowing (dysphagia) or sensation of a lump in the throat.
    • Chest pain mimicking cardiac pain.
  3. Complications (Advanced Cases)
    • Oesophagitis: Inflammation of the oesophagus.
    • Barrett’s Oesophagus: Precancerous changes in oesophageal lining.
    • Strictures or ulcers in the oesophagus.

Diagnosis of GORD

  1. Clinical Assessment
    • Based on symptoms and response to empirical treatment with acid suppressants.
  2. Diagnostic Tests
    • Endoscopy: Visualizes oesophageal inflammation, ulcers, or Barrett’s Oesophagus.
    • 24-hour pH Monitoring: Measures acid levels in the oesophagus.
    • Manometry: Assesses oesophageal motility and LOS function.
    • Barium Swallow X-Ray: Evaluates structural abnormalities like hiatal hernia.

Treatment Options for GORD

1. Lifestyle Modifications

  • Dietary Adjustments
    • Avoid trigger foods like spicy meals, chocolate, and caffeine.
    • Eat smaller, frequent meals rather than large meals.
  • Behavioural Changes
    • Avoid lying down within 2–3 hours of eating.
    • Elevate the head of the bed by 6–8 inches.
  • Weight Management
    • Reducing body weight can significantly improve symptoms in overweight individuals.
  • Smoking Cessation and Alcohol Reduction
    • Both contribute to LOS weakening and increased acid production.

2. Medications

Drug ClassExampleBrand NameManufacturerCost Range
AntacidsAluminium HydroxideGavisconReckitt Benckiser$5–$15 per bottle
H2 Receptor BlockersRanitidineZantacGlaxoSmithKline$10–$20 per pack
Proton Pump Inhibitors (PPIs)OmeprazolePrilosecAstraZeneca$10–$25 per pack
EsomeprazoleNexiumAstraZeneca$15–$30 per pack
ProkineticsDomperidoneMotiliumJohnson & Johnson$10–$20 per pack

3. Surgical Options

  • Fundoplication
    • Wrapping the upper part of the stomach around the LOS to strengthen it.
  • LINX Device
    • A ring of magnetic beads placed around the LOS to prevent reflux.
  • Bariatric Surgery
    • Weight-loss surgery may help obese patients with refractory GORD.

4. Alternative Therapies

  • Herbal Remedies
    • Ginger tea or chamomile to soothe the digestive tract.
  • Acupuncture
    • May provide symptomatic relief in some patients.

Monitoring Parameters

  • Symptom improvement with lifestyle changes or medications.
  • Monitoring for side effects of medications (e.g., PPIs can cause nutrient malabsorption).
  • Regular endoscopy for patients with Barrett’s Oesophagus or severe symptoms.

Patient Counseling Points

  • Explain the chronic nature of GORD and the importance of adherence to lifestyle changes and medications.
  • Discuss potential triggers and how to avoid them.
  • Emphasize the importance of long-term follow-up for those with complications like Barrett’s Oesophagus.
  • Educate on the appropriate use of antacids and other over-the-counter medications.

Use in Children

  • Commonly presents as regurgitation or vomiting; treatment includes thickened feeds, dietary changes, and medications like PPIs or H2 blockers.

Use in Pregnancy

  • Often resolves postpartum. Safe treatments include antacids and H2 blockers; avoid PPIs unless necessary.

Use in Elderly

  • Monitor for atypical symptoms like chest pain or silent reflux.

FAQs About GORD

Q1: What causes GORD?

  • Weakness in the lower oesophageal sphincter, hiatal hernia, obesity, and dietary triggers.

Q2: Can GORD be cured?

  • It can be managed effectively, but chronic cases may require long-term treatment.

Q3: What foods should I avoid with GORD?

  • Spicy foods, citrus fruits, caffeine, chocolate, and carbonated drinks.

Q4: How is GORD diagnosed?

  • Through symptom history, endoscopy, and pH monitoring.

Q5: Are antacids safe for long-term use?

  • Short-term use is safe, but prolonged use may not address underlying causes.

Q6: Can GORD lead to cancer?

  • Chronic GORD can lead to Barrett’s Oesophagus, which increases oesophageal cancer risk.

Q7: Is surgery necessary for GORD?

  • Only for severe or refractory cases that do not respond to medication.

Q8: Can stress worsen GORD symptoms?

  • Yes, stress can exacerbate symptoms.

Q9: How do PPIs work?

  • They reduce stomach acid production, relieving symptoms and healing oesophagitis.

Q10: Can children develop GORD?

  • Yes, especially infants, but most cases resolve as they grow.

Q11: Does lying down after eating worsen GORD?

  • Yes, it increases the likelihood of acid reflux.

Q12: Can weight loss improve GORD symptoms?

  • Absolutely, especially in overweight or obese individuals.

Q13: Is milk good for GORD?

  • Milk may provide temporary relief but can stimulate acid production.

Q14: Can GORD cause bad breath?

  • Yes, due to acid regurgitation and bacterial growth in the oesophagus.

Q15: Are herbal remedies effective for GORD?

  • Ginger and chamomile may provide mild relief but are not substitutes for medical treatment.