Gastroesophageal reflux disease (GERD) is not just “acidity”. But most people are unaware of the condition, and dismiss it as indigestion. Dr Arun Prasad, senior consultant, gastroenterology and bariatric surgery, Indraprastha Apollo Hospitals, says: “It is possible for people to have GERD without realising it. GERD occurs when stomach acid frequently flows back into the oesophagus, causing irritation. While many people experience classic symptoms like heartburn or acid regurgitation, others may have ‘silent GERD’, where symptoms are less obvious or atypical.
For instance, some individuals may only experience chronic coughing, hoarseness, sore throat, or a sensation of something being stuck in their throat. Additionally, mild reflux episodes may go unnoticed until complications arise. Over time, untreated GERD can lead to damage to the esophagus, such as inflammation, strictures, or Barrett’s oesophagus, a precancerous condition. Silent GERD can be particularly dangerous because people may not seek treatment until the disease has progressed. It is important to pay attention to persistent symptoms like unexplained coughing, throat discomfort, or difficulty swallowing and consult a healthcare provider for evaluation. Early detection and management of GERD can prevent complications.”
What are the symptoms to watch out for?
GERD presents with a variety of symptoms that can range from mild to severe. The most common symptom is heartburn. Regurgitation, where stomach contents flow back into the throat or mouth, is another hallmark sign. Less obvious symptoms include chest pain, difficulty swallowing, a persistent sore throat, hoarseness, and chronic coughing. Some individuals may also experience a sensation of a lump in the throat or bad breath caused by acid reflux. Nighttime symptoms such as disrupted sleep due to acid reflux or waking up with a sour taste in the mouth are also common. In some cases, GERD can trigger respiratory issues like wheezing or worsening asthma symptoms due to acid irritating the airways. Persistent or worsening symptoms should never be ignored. If you notice these signs frequently, seek medical advice.
Can GERD cause ulcers, cancer?
Yes, untreated GERD can lead to serious complications such as ulcers and even increase the risk of cancer over time. Chronic exposure of the oesophagus to stomach acid can cause inflammation, which may progress to erosive damage and result in ulcers in the oesophagus lining. These ulcers can be painful and may lead to bleeding or scarring that narrows the oesophagus, making swallowing difficult. Another significant complication of long-term GERD is Barrett’s oesophagus, a condition where the normal lining of the oesophagus changes into tissue similar to that found in the intestines due to repeated acid exposure. Barrett’s oesophagus is considered precancerous because it increases the risk of developing oesophageal adenocarcinoma. While not everyone with Barrett’s oesophagus will develop cancer, regular monitoring through endoscopy is essential for early detection of any malignant changes. The risk of complications underscores the importance of managing GERD effectively with early intervention.
Is there a cure for GERD?
There is no permanent cure for GERD; however, it can be effectively managed through lifestyle changes, medications, and in some cases, surgical interventions. Lifestyle modifications are often the first step in managing GERD. These include maintaining a healthy weight, avoiding trigger foods, eating smaller meals, and avoiding lying down immediately after eating. Over-the-counter antacids can provide quick relief for occasional symptoms, while medications like proton pump inhibitors (PPIs) or H2 receptor blockers are commonly prescribed for long-term symptom control and healing of the oesophageal lining. For individuals whose symptoms persist despite medication and lifestyle changes, or those who wish to avoid lifelong medication, surgical options like fundoplication may be considered. This procedure strengthens the lower oesophageal sphincter to prevent acid reflux. While these treatments help control GERD effectively, they do not eliminate its underlying cause entirely; ongoing management is typically required.
Can it be tackled with diet? What is a safe diet?
Diet plays a critical role in managing GERD symptoms and reducing flare-ups. Certain foods are known triggers for acid reflux and should be avoided; these include fatty or fried foods, spicy dishes, citrus fruits, chocolate, caffeine-containing beverages, carbonated drinks, alcohol, garlic, onions, and tomatoes or tomato-based products like sauces. A safe diet for managing GERD typically includes lean proteins such as chicken or fish, non-acidic vegetables like broccoli, green beans, zucchini, and leafy greens; whole grains like oatmeal or brown rice; low-fat dairy products; and non-citrus fruits. Eating smaller portions throughout the day instead of large meals can also help reduce pressure on the stomach and minimise reflux episodes. Additionally, staying upright after meals for at least two hours is recommended to prevent acid from flowing back into the oesophagus. Drinking plenty of water throughout the day can also aid digestion.
While dietary adjustments alone may not cure GERD entirely, they are an essential part of symptom management when combined with other treatments like medications or lifestyle changes tailored by healthcare professionals. Endoscopic treatments for GERD provide less invasive alternatives to long-term medication and traditional surgery, utilising techniques such as transoral incisionless fundoplication (TIF), antireflux mucosal resection (ARMS), radiofrequency ablation, and bulking agent injections to enhance the function of the lower oesophageal sphincter (LES) and reduce acid reflux.
Surgical options primarily include fundoplication. Robotic surgery has also gained popularity for its enhanced precision, while incisionless techniques allow for fundoplication to be performed through the mouth, reducing recovery time and complications.