GERD or Acid Reflux or HeartBurn : Causes, Symptoms & Treatment

What is GERD (Gastroesophageal Reflux Disease)

Cause is Defective Lower Esophageal Sphincter Muscle

(GERD) Gastroesophageal reflux disease as the name indicates is the reflux of stomach contents back into the esophagus. Generally what happens, when we ingest food it passes through the esophagus, there is a valve at the lower end of esophagus which relax or opens and food enter into the stomach and after that valve gets closed. When this valve is not competent enough stomach contents reflux back

GERD Causes

Improper function of lower esophageal sphincter muscle as described above is the reason for gastroesophageal reflux

Symptoms of GERD

Heartburn (Burning sensation in chest, usually after eating, worsened at night)
Regurgitation of food contents
Difficulty swallowing
Chronic cough/ New or worsening asthma

Risk Factors

  • Obesity
  • Hiatus Hernia
  • Delayed stomach emptying
  • Pregnancy
  • Smoking
  • Alcohol/ Coffee
  • Eating a large meal


Esophagus ulcer is the first finding on endoscopy in simple reflux disease. Long standing reflux can cause Barretts esophagus which is a premaligant condition which predispose to esophagus cancer. Continuous reflux can cause benign esophageal stricture


Esophageal pH monitoring is the gold standard test to confirm the presence of reflux
Upper GI Endoscopy
Esophageal Manometry


First step in acid reflux treatment is life-style modification
Medical treatment include proton pump inhibitors which decrease the amount of acid produced by the stomach. these includes pantocid, rabeprazole. Another group of medicines which are beneficial include H2 blockers, Antacids, Prokinetics
Surgical management: Surgery is indicated if above methods fail, and lower esophageal sphincter muscle is weak, associated hiatus hernia. In these cases Niissen fundoplication is done


There is no special diet for GERD. Small frequent meal. Certain foods which trigger GERD symptoms should be avoided. These foods include coffee, alcohol, spicy foods, chocolate, peppermint


Stop alcohol & Smoking
Take small amount of meal at one time
Donot lie immediately after eating
Loose weight
Stop eating 2 to 3 hours before sleeping

Hiatus Hernia

Diaphragm is a muscular wall which separates chest cavity from abdomen cavity. Hiatus is an opening in the diaphragm through which esophagus enters from thorax into the abdomen. A hiatus hernia occur when stomach most commonly or other abdomen organs enters into thorax through this opening.

Types of Hiatus Hernia

There are two types of hiatus hernia one is sliding and other is para esophageal. In sliding hernia GE junction migrates into the thorax.In Para-esophageal hernia GE junction remains stable, stomach most commonly or other abdomen organs rolls into the thorax through side of esophagus
Most commonly patient present with features of acid reflux such as heartburn. Heartburn is defined as pressure sensation localized to epigastric and retrosternal area which does not radiate to back.As the disease become more severe patient complain of regurgitation of digested food. Dysphagia occur due to mechanical obstruction to food.Patient may complain of chest pain

Upper GI Endoscopy is first step to rule out other disorders whose symptoms mimics with hiatus hernia. It also grades the esophagus injury severity due to acid reflux. Esophagus manometery and Esophagogram are other investigations which are also done. CECT chest and upper abdomen is helpful in large paraesophagus hernia for management

Medical Treatment
Proton pump inhibitors and life style modification are first step. Pantoprazole will reduce the heartburn. Weight reduction is important. Eat small but frequent meal. Do not lie immediately after food intake

Surgical Management
Failed medical therapy, Large hiatus defect, Herniation of other abdomen organs are indications for surgery. The standard surgical procedure is reduction of hernia contents with repair of hiatus and fundoplication. It is done Laparoscopically


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