GERD – Exploring the treatment options

GERD or Gastroesophageal reflux disease is a chronic condition. It typically involves regurgitation of stomach acid and other contents into the esophagus, leading to symptoms such as heartburn, chest pain, difficulty swallowing, and coughing. It occurs when the lower esophageal sphincter (LES), a ring of muscle at the bottom of the esophagus, fails to close properly, leading to reverse flow of the stomach contents back up into the esophagus.

GERD can be caused by various factors including obesity, hiatal hernia, pregnancy, smoking, and certain medications. Additionally, certain foods and beverages, such as citrus fruits, tomatoes, spicy foods, caffeine, alcohol, and chocolate, can exacerbate symptoms.

Treatment for GERD aims to alleviate symptoms, heal esophageal damage, and prevent complications. Here are some common approaches:

1. Lifestyle Modifications:

Making changes to diet and lifestyle can often help manage GERD symptoms. This includes avoiding trigger foods, eating smaller meals, avoiding lying down or bending over after eating, losing weight if overweight, and quitting smoking.

2. Medications:

* Antacids: Over the counter antacids such as Gelusil, Mucaine gel or Ulgel can help neutralize stomach acid and provide temporary relief from heartburn.
* H2-receptor antagonists (H2RAs): These medications, including ranitidine and famotidine, provide longer-lasting relief than antacids by reducing the production of stomach acid.
* Proton pump inhibitors (PPIs): Drugs like omeprazole, esomeprazole, rabeprazole and lansoprazole are more potent acid suppressors than H2RAs and are often prescribed for more severe cases of GERD or to heal esophageal damage.
* Prokinetic Agents: These medications help strengthen the lower esophageal sphincter and improve esophageal motility, reducing the frequency of reflux episodes. Examples include metoclopramide and baclofen.

3. Surgery:

For patients who do not respond to lifestyle changes and medications, surgical intervention may be necessary. Fundoplication is a common surgical procedure for GERD, that involves wrapping up the upper part of the stomach around the LES to strengthen it and prevent reflux.

4. Endoscopic Treatments:
Less invasive procedures such as endoscopic suturing or radiofrequency energy delivery can be used to tighten the LES and improve its function, reducing reflux symptoms.

5. Biologic Therapies:
In recent years, biologic therapies targeting specific pathways involved in GERD pathophysiology have emerged as potential treatments. These therapies aim to modulate acid production, improve esophageal function, or reduce inflammation.

It’s important for individuals with GERD to work closely with their healthcare providers to develop a customized comprehensive treatment plan catering to specific needs and preferences. Untreated GERD can lead to complications such as esophageal ulcers, strictures, a pre-cancerous condition called Barrett’s esophagus, and esophageal cancer rarely.

In summary, GERD is a chronic condition characterized by the regurgitation of stomach contents into the esophagus. The condition presents with symptoms such as heartburn and chest pain. Treatment options include lifestyle modifications, medications, surgery, endoscopic procedures, and biologic therapies, with the goal of alleviating symptoms, healing esophageal damage, and preventing complications.

By Dr. Lohith U, Consultant – Surgical Gastroenterology Bariatric and GI Oncology, Manipal Hospital Sarjapur Road