Gastroesophageal reflux describes a situation where the stomach’s contents return back up into the esophagus, causing discomfort. When everything is working as it should, the lower esophageal sphincter opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Reflux occurs when the sphincter relaxes inappropriately or is weak, allowing the stomach’s contents to flow up.
Gastro-esophageal reflux disease (GERD, or GORD in the British spelling) is becoming more prevalent in the Middle East and worldwide due to a variety of factors. The most important of these is increased body mass and obesity, particularly among the young.
GERD is usually experienced as retrosternal chest discomfort – in other words, pain or discomfort felt behind the sternum or breastbone. The pain could include a burning sensation (heartburn). This could strike at any time, but most often when you are bending over, or at night. Other common symptoms include nausea, difficulty swallowing, chest pain or the sensation of a lump in your throat.
While antacids will provide short-term relief, more powerful drugs such as omeprazole or lansoprazole would be needed for the long-term elimination of symptoms.
If you have had a recent onset of symptoms, particularly if you are in an older age group, it is important to be examined by a gastroentrologist to rule out other conditions such as esophageal dysplasia or cancer.
Currently the best way to investigate GERD and simultaneously rule out more serious conditions is through a gastroscopy. This is done after you have been given a sedative and involves passing a narrow tube with a camera at the end through your mouth and into your gullet (esophagus) and stomach. This will allow direct visualization of the lining of the esophagus and biopsies can be taken to aid diagnosis.
The aim of treatment is to reduce damage to the esophagus lining caused by refluxed substances, and also to decrease the amount of reflux (the flow-back of material). As a starting point, your doctor may suggest modifications to your lifestyle and diet, backed by over-the-counter medications when necessary. However, if you don’t experience relief after a few weeks, he could prescribe medication or recommend surgery.
If acid reflux is severe and prolonged, complications such as benign esophageal stricture can occur, which could impair your ability to swallow. Also the lining of the esophagus could change character from squamous to columnar, which means it takes on the characteristics of the intestine rather than the esophagus. This change in cell type is known as “Barrett’s Esophagus ” after the English surgeon who first described it.