Gastroesophageal Reflux Disease (GERD) is a chronic condition where stomach contents, including acid, flow back into the esophagus. This backward movement, known as reflux, leads to discomfort, irritation, and long-term complications if untreated. GERD is one of the most common digestive disorders and significantly affects daily life and sleep quality. Understanding its causes, symptoms, and treatment helps in better management and prevention.
1. What Is GERD?
GERD occurs due to weakening or improper relaxation of the lower esophageal sphincter (LES), a muscular valve that prevents stomach acid from entering the esophagus. When the LES fails, acid repeatedly flows upward, causing inflammation and symptoms such as heartburn.
2. Causes of GERD
- Weak or relaxed LES allowing acid to escape into the esophagus
- Hiatal hernia
- Delayed gastric emptying
- Obesity and increased abdominal pressure
- Pregnancy
- Frequent consumption of spicy or fatty foods
- Smoking and alcohol intake
- Certain medications (anticholinergics, nitrates, benzodiazepines)
3. Risk Factors
- Obesity
- Smoking
- Pregnancy
- High-fat diet
- Excess caffeine or carbonated beverages
- Large meals, especially at night
- Stress and irregular sleeping patterns
4. Symptoms of GERD
Common Symptoms
- Heartburn (burning sensation behind the chest)
- Acid regurgitation
- Chest discomfort
- Difficulty swallowing (dysphagia)
- Chronic cough
- Sore throat or hoarseness
Alarm Symptoms (Require urgent medical care)
- Unexplained weight loss
- Vomiting blood
- Difficulty swallowing solid food
- Black tarry stools
5. Diagnosis of GERD
Diagnosis is based on symptoms, medical history, and investigations when needed.
- Endoscopy (EGD): Detects inflammation or complications
- pH Monitoring: Measures acid exposure in the esophagus
- Esophageal manometry: Assesses esophageal muscle function
- Trial of acid-suppressing therapy: Used as a diagnostic tool
6. Treatment of GERD
1. Lifestyle Modifications
- Avoid spicy, fatty, and acidic foods
- Eat smaller, more frequent meals
- Avoid lying down for 2–3 hours after meals
- Raise the head end of the bed
- Lose weight if overweight
- Stop smoking and limit alcohol
2. Medications
Proton Pump Inhibitors (PPIs)
Most effective for healing and symptom relief.
- Omeprazole
- Pantoprazole
- Esomeprazole
- Lansoprazole
H2 Receptor Blockers
- Famotidine
- Ranitidine (limited use due to safety concerns)
Antacids
Useful for temporary relief of heartburn.
Prokinetics
Improve gastric emptying:
- Metoclopramide
- Domperidone
3. Surgical Treatment
Considered when medications fail or complications develop.
- Nissen fundoplication: Strengthens LES
- LINX device: Magnetic ring placed around the LES
7. Complications of GERD
- Esophagitis
- Ulceration
- Strictures (narrowing of the esophagus)
- Chronic cough or asthma
- Barrett’s esophagus (premalignant condition)
- Esophageal cancer (rare but serious)
8. Role of the Pharmacist
- Educate patients on lifestyle changes
- Guide proper use of PPIs and H2 blockers
- Identify drug interactions and inappropriate NSAID use
- Monitor for long-term side effects of PPIs
- Encourage adherence for best symptom control
- Refer patients with alarm symptoms to physicians
Detailed Notes:
For PDF style full-color notes, open the complete study material below: