What is GERD?

GERD, also known as Gastro-Esophageal Reflux Disease or Acid Reflux Disorder, refers to the condition characterized by the backflow (reflux) of the stomach content like stomach acid and bile into the oesophagus. The oesophagus is the hollow, muscular organ that carries food and liquids from the throat to the stomach.

Normally, during digestion process, the lower esophageal sphincter (LES) present at the junction of oesophagus and stomach opens to let the food pass into the stomach and closes to block the backflow of the food and stomach acidic juices into the oesophagus. However, in the case of GERD, the reflux occurs due to weak LES or if it works or relaxes in an inappropriate way.

GERD results in esophageal inflammation and thereby an increase of ulcers, narrowing of esophageal stricture or oesophageal cancer.

GERD is always associated with chronic heartburn which is the most common symptom of GERD. Acid regurgitation, which is reflux of gastric acid into the mouth, is the other common symptom. Other less common symptoms are:

• Pain and difficulty in swallowing
• Dysphagia is the abnormal sensation of food being stuck in the oesophagus.
• Chronic sore throat
• Excessive saliva production.
• Inflammation of larynx, gums etc.
• Bad breath
• Tooth enamel erosion.

Causes:

The factors that are responsible for causing GERD are;

• Abnormalities in LES.
• Abnormal contractions of esophagus
• Prolonged time in stomach emptying
• Hiatal hernias
• Dietary foods like coffee, fatty foods, chocolates, alcoholic beverages can trigger reflux.
• Obesity and pregnancy also contribute to procuring GERD symptoms.

Nissen Fundoplication

The ‘gold-standard’ therapy for treating gastroesophageal reflux disease (GERD) in those who don’t respond to drugs or can’t take them for other reasons is the Laparoscopic Nissen fundoplication. The top section of the stomach is wrapped around the lower esophageal sphincter (LES) during the Nissen fundoplication to tighten the sphincter, reduce acid reflux, and repair a hiatal hernia. After surgery, most people find a considerable reduction in acid reflux symptoms.

Gastroesophageal reflux disease (GERD) is a digestive system illness affecting the esophagus. If you have GERD, your stomach acid and contents flow back up into your esophagus on a regular basis.

In individuals with GERD, fundoplication basically fixes the valve at the end of the esophagus that isn’t working properly. Unlike GERD drugs, surgery prevents all reflux, including digestive enzymes and acid. As a result, unlike drugs, surgery can cure GERD.

The procedure is named after Dr Rudolf Nissen (1896-1981), who described the first fundoplication in the 1950s for treatment of severe reflux esophagitis.

Nissen fundoplication procedure is usually performed laparoscopically. Laparoscopic operations are carried out through small incisions while the physician observes the procedure on a video display. The fundus (the top of the stomach, thus the term fundoplication) is wrapped around the bottom of the esophagus during surgery. A ‘wrap’ is another word for a fundoplication.

A completed Nissen fundoplication
By Dana Hamers – Own work, CC BY-SA 3.0,
https://commons.wikimedia.org/w/index.php?curid=20453728

What are different Treatment Options for GERD?

Following enlisted are the treatment options for treating GERD and acid reflux;

1. Lifestyle modification:

   These include alteration in sleeping habits. Patients are recommended to sleep at night with slightly elevating your upper body as patients experiencing heartburn might have reflux at night. This position is of benefit to avoid the reflux at night.

2. Dietary modification:

   Encourage smaller and earlier meals in the evening as it results in lesser expansion of the stomach that may reduce the reflux. Some foods and beverages like chocolates, caffeinated drinks, alcoholic beverages, peppermint etc. are responsible for promoting the reflux, and thus should be avoided. Consumption of fatty foods should be reduced. Smoking should be stopped. Spicy and foods containing acids like carbonated beverages, tomato or citrus juice should be avoided.

3. Medications:

   Following drugs are recommended to lessen the symptoms:

   • Antacids
   • Foam barriers
   • Proton pump inhibitors
   • Histamine antagonists
   • Promotility drugs
4. Ayurveda Treatment:

   There are various Ayurveda treatment options to cure heartburn. You could simply opt for medications or can choose to stay in a wellness resort/ayurveda hospital to completely get rid of your heartburn and other Gastrointestinal problems.

5. Surgical interventions:

   Following are surgical treatments that aid to relieve and cure the GERD and its symptoms.

   • Fundoplication:

     This is the standard surgical intervention to tighten and strengthen the LES. In this, the higher part of the stomach is draped around the outer side of the lower part of the esophagus to give strength to LES. This surgery can be done as

     • Open fundoplication surgery: Open Fundoplication surgery is done when either it is not possible or not safe to perform the laparoscopic surgery. The reasons can be many, which include history of prior abdominal surgery, obesity or bleeding during the operation. The surgeon is the best person to decide which procedure is best suited for you.
     • Minimally invasive/ Laparoscopic Fundoplication (also known as Nissen Fundoplication): Laparoscopic Nissen fundoplication is a minimally invasive procedure which is done to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) by wrapping the stomach around the esophagus.

When is GERD surgery needed?

If non surgical methods have failed to relieve you of heartburn, or you have any of the following conditions, surgery may be an option for you:

• Inflammation of the esophagus, the tube that connects your mouth and stomach.
• An esophageal constriction that isn’t caused by malignancy.
• Barrett’s esophagus is a condition in which the cells of the esophagus alter as a result of acid reflux.