Gastro-oesophageal Reflux Disease (GERD) - Causes & Treatment

Gastro-oesophageal reflux disease (GERD or GORD) is a chronic digestive condition in which stomach acid flows back into the oesophagus. This backwash (reflux) irritates the lining of your oesophagus and leads to symptoms like heartburn, regurgitation, and chest discomfort.

GERD vs GORD – Is There a Difference?

Both terms refer to the same condition. The only distinction lies in the spelling:

• GERD: Gastroesophageal Reflux Disease (used in the US)
• GORD: Gastro-oesophageal Reflux Disease (used in the UK and Commonwealth nations)

What Causes Gastro-oesophageal Reflux Disease?

GERD is multifactorial. Based on the diagram, causes can be grouped as:

Physiological

• Positive intra-abdominal pressure
• Failure of the lower oesophageal sphincter (LOS) to stay closed

Anatomical

• Crural sling weakness
• Mucosal rosettes
• Gastro-oesophageal angle of His abnormalities
• Hiatus hernia (sliding or rolling type)

Functional

• Poor gastric emptying
• Overeating/distension
• Use of sedatives, alcohol, or certain drugs
• Recumbent (lying down) position

Hormonal and Drug Triggers

• Calcium channel blockers
• Nitrates
• Progesterone
• Beta-blockers

Common Symptoms and Clinical Features

Recognizing GERD symptoms is key to early diagnosis:

• Retrosternal burning pain (heartburn)
• Regurgitation of sour or bitter fluid
• Waterbrash (excess salivation)
• Dysphagia (difficulty swallowing)
• Nocturnal cough or wheeze
• Chest pain mimicking heart issues
• Epigastric or back pain (especially with Barrett’s)

Grades of Oesophagitis (As Per Diagram)

• Grade A: >1 mucosal break, <5mm
• Grade B: >1 mucosal break, >5mm
• Grade C: Mucosal breaks covering <75% of circumference
• Grade D: Mucosal breaks >75% of circumference

GERD Complications You Must Know

Untreated GERD can lead to:

• Aspiration and chronic cough
• Barrett’s oesophagus
• Oesophageal strictures (narrowing due to scarring)
• Bleeding, Anaemia, Haemorrhage
• Perforation
• Shortening of the oesophagus

Barrett’s Oesophagus and Its Risks

Barrett’s oesophagus occurs when the normal squamous lining of the oesophagus transforms into columnar epithelium (intestinal metaplasia), increasing cancer risk.

Diagnosis Criteria:

• Endoscopy showing columnar epithelium above the junction
• Biopsy confirming intestinal metaplasia

Risk of Cancer (Adenocarcinoma):

• 2% if no dysplasia
• 20% with low-grade dysplasia
• 50% with high-grade dysplasia

GERD Diagnosis: How It’s Confirmed

Oesophagoscopy

• Direct visual assessment
• Biopsy and dilation of strictures

Barium Swallow & Meal

• Detects hiatus hernia, ulcer, or strictures

24-Hour pH Monitoring

• Assesses acid reflux severity

Manometry

• Measures oesophageal sphincter function

Best Treatment for GERD: Lifestyle + Medication

General Advice

• Lose weight
• Elevate head of the bed
• Avoid alcohol, caffeine, chocolate, citrus, smoking
• No tight clothes or late meals

Medications

• PPIs (e.g., omeprazole) – mainstay for acid suppression
• H2 blockers (e.g., ranitidine) – alternative to PPIs
• Antacids – symptomatic relief
• Alginates – coat the oesophagus
• Prokinetics (e.g., metoclopramide) – improve gastric emptying

When to Consider GERD Surgery

Surgical Indications

• Medical treatment failure
• Barrett’s oesophagus
• Severe oesophagitis
• Benign strictures
• High-volume reflux

Post-Surgery Outcomes: Fundoplication

Nissen fundoplication is the gold standard surgery. It involves wrapping the upper part of the stomach around the lower oesophagus to reinforce the sphincter.

Other procedures include:

• Gastroplasty + fundoplication (for shortened oesophagus)
• Laparoscopic fundoplication (minimally invasive)

Final Words: How to Prevent GERD Long Term

• Maintain a healthy weight
• Treat constipation and poor digestion
• Monitor and treat hiatal hernia
• Avoid stress and poor sleep posture
• Regular follow-ups for Barrett’s cases

Frequently Asked Questions (FAQs)

Q1. Is GERD curable?

No, but it’s highly manageable with lifestyle, medication, and surgery.

Q2. Can GERD cause cancer?

Yes, especially if it progresses to Barrett’s oesophagus, which increases the risk of oesophageal adenocarcinoma.

Q3. What’s the difference between GERD and acid reflux?

Acid reflux is a symptom. GERD is a chronic condition where reflux occurs frequently.

Q4. Does GERD always need surgery?

No, only in severe, resistant, or complicated cases.