Gastroesophageal Reflux Disease (GERD) Treatment in Mumbai, India

Gastroesophageal reflux disease (GERD) is an issue in which stomach acid goes back into the oesophagus. This backward flow, known as acid reflux, can irritate the oesophagus lining.

While occasional acid reflux is common, persistent reflux over time can lead to GERD.

In most cases, GERD can be managed through lifestyle changes and medication. Although rare, some individuals may require surgery to alleviate symptoms.

Alternative Names

GERD is also known as acid reflux disease or chronic heartburn. Chronic heartburn is another term that emphasizes the recurring nature of the symptoms, particularly the sensation of heartburn or burning in the chest. While these terms are often used interchangeably with GERD, they all refer to the same underlying condition, which involves the frequent occurrence of acid reflux and its potential to lead to more serious complications if left untreated.

Types of GERD

There is no clinical stage classification of GERD. The gastroenterologists decide the treatment protocols depending on the levels of severity and nature of symptoms. If the patient ignores the symptoms and avoids treatment for a long duration, the condition may affect the oesophagus lining (Barrett’s oesophagus), increasing the risk of further complications.

Mild GERD

Acid reflux occurs occasionally, typically once or twice a month. At this stage, symptoms are usually manageable with dietary and lifestyle adjustments, along with over-the-counter medication if necessary.

Moderate GERD

Symptoms become frequent enough to need daily prescription medication. GERD may start interfering with daily activities.

Severe GERD

Symptoms are intense and may not improve even with prescription medication. Quality of life is significantly affected, and surgery may be recommended for treatment.

Symptoms of GERD

Symptoms that may suggest the presence of GERD include:

• Aspiration (small amount of acid or food accidentally entering into the breathing tube, resulting in coughing or breathing difficulty)
• Persistent hoarseness or coughing
• Dental issues
• Difficulty swallowing due to scarring
• Frequent heartburn
• Food regurgitation, particularly at night

Causes of GERD

GERD occurs when there is frequent acid reflux or the reflux of nonacidic stomach contents.

When you swallow, the lower oesophagal sphincter relaxes to let food and liquid enter the stomach. It then tightens to prevent backflow.

If the sphincter doesn't relax properly or becomes weak, stomach acid can flow back into the oesophagus. This constant acid reflux irritates the oesophagus lining, often leading to inflammation.

Diagnosis of GERD

A healthcare provider may diagnose GERD based on symptoms and a physical exam, but to confirm the diagnosis or check for complications, they may recommend:

• Upper Endoscopy: A flexible tube along with a camera inspects the oesophagus and stomach, looking for inflammation or complications like Barrett's oesophagus. It can also take biopsies or treat narrowed areas.
• Ambulatory pH Probe Test: A monitor tracks acid reflux in the oesophagus using either a catheter or a capsule.
• X-ray of the Upper Digestive System: An X-ray reveals the shape of the oesophagus and stomach, which is useful for swallowing issues. A barium pill may help detect narrowing.
• Esophageal Manometry: This test measures muscle contractions in the oesophagus to assess swallowing issues.
• Transnasal Esophagoscopy: A camera inserted through the nose examines the oesophagus for damage.

Treatment for GERD

A healthcare provider may first suggest lifestyle changes and over-the-counter medications to manage GERD. If these don’t provide relief within a few weeks, prescription medications and additional testing might be recommended.

Over-the-Counter Medications

• Antacids: These neutralise stomach acid (e.g., Mylanta, Tums) and offer fast relief, but they don't repair oesophagus damage and can cause side effects like diarrhoea.
• H-2 Blockers: These reduce acid production (e.g., cimetidine, famotidine), offering longer-lasting relief than antacids, though they take longer to work.
• Proton Pump Inhibitors (PPIs): Stronger acid reducers that help heal the oesophagus (e.g., lansoprazole, omeprazole) and are available without a prescription.

While these medicines are known to offer relief from the symptoms, consult with your gastroenterologist before starting any medication.

Prescription Medications

• Stronger PPIs: Prescription versions of PPIs (e.g., esomeprazole, pantoprazole) may be prescribed.
• Prescription H-2 Blockers: More potent versions of famotidine and nizatidine, with mild side effects.

Surgical Options

When medications are ineffective, surgery may be an option:

• Fundoplication: The surgeon modifies the junction where the oesophagus meets the stomach to reduce reflux.
• LINX Device: A magnetic ring is placed at the stomach-esophagus junction to stop acid reflux by using minimally invasive surgery.
• Transoral Incisionless Fundoplication (TIF): This endoscopic procedure tightens the sphincter without incisions.

For some individuals, weight-loss surgery may be recommended if obesity is contributing to GERD.

Prevention of GERD

Adopting healthy lifestyle changes can significantly reduce the risk of developing GERD or manage its symptoms.

Dietary Adjustments

• Don’t consume trigger foods such as spicy, fatty, or acidic items that can irritate the oesophagus.
• Limit caffeinated beverages and chocolate, which may worsen symptoms.

Healthy Habits

• Avoid late-night snacks and allow at least 2-3 hours between eating and lying down.
• Have a healthy weight to decrease pressure on the abdomen, which can trigger reflux.

Smoking and Alcohol

• Avoid smoking, which can weaken the lower oesophagal sphincter.
• Reduce alcohol consumption, as it can relax the sphincter and increase acid reflux risk.

Risk Factors of GERD

Conditions that may raise the risk of GERD include:

• Obesity
• A hiatal hernia, where the top of the stomach pushes up through the diaphragm
• Pregnancy
• Connective tissue disorders, like scleroderma
• Slow stomach emptying

Factors that can worsen acid reflux include:

• Smoking
• Consuming large meals or eating late at night
• Eating specific foods, like fatty or fried items
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, including aspirin

Complications of GERD

Chronic inflammation in the oesophagus over time can lead to:

• Esophagitis, or inflammation of the oesophagal tissue. Stomach acid can damage the oesophagus, causing inflammation, bleeding, and sometimes ulcers (open sores). This condition can result in pain and difficulty swallowing.
• Esophageal stricture is a narrowing of the oesophagus. Stomach acid damage to the lower oesophagus leads to the formation of scar tissue, which narrows the passage and makes swallowing difficult.
• Barrett’s oesophagus, which involves precancerous changes to the esophageal lining. Acid damage can alter the tissue in the lower oesophagus, and result in a greater risk of esophageal cancer.

Why Choose Nanavati Max Hospital for GERD Treatment?

Nanavati Max Hospital is a top choice for GERD treatment, offering expert care in gastroenterology with minimally invasive procedures. With a team of experienced specialists, Nanavati Max provides personalised care plans tailored to each patient’s needs. Patient education and lifestyle counselling are integral parts of the treatment process, helping individuals manage GERD through dietary changes, weight management, and other lifestyle adjustments. Combining cutting-edge technology with compassionate care, Nanavati Max Hospital delivers the highest standard of GERD treatment.

Outlook

The outlook for GERD is generally positive with proper treatment, including lifestyle changes, medications, and, in some cases, surgery. Most people can prevent complications like esophagitis or Barrett’s oesophagus. Early intervention is key to avoiding long-term issues, and regular follow-ups help ensure the condition remains under control. With ongoing care, many individuals with GERD can lead normal, healthy lives.

Frequently Asked Questions

1. Who Treats GERD?

GERD is typically treated by gastroenterologists, and in severe cases, surgeons may be involved.

2. Is Surgery Necessary for GERD?

Surgery is generally considered only for severe or persistent GERD cases that do not respond to medication and lifestyle changes.

3. How is GERD Different from Acid Reflux?

While acid reflux occurs occasionally, GERD is characterised by frequent or persistent acid reflux that causes symptoms and potential damage to the oesophagus.

4. Are Over-The-Counter Medications Effective for GERD?

Over-the-counter medications like antacids and H2 blockers can provide relief for mild GERD symptoms, but prescription medications may be needed for more severe or persistent cases. Consult your gastroenterologist before starting any medication.

5. Is GERD Related to Diet?

Certain foods and drinks, like spicy foods, citrus, chocolate, and alcohol, can trigger or worsen GERD symptoms. Avoiding these can help manage the condition.

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