Gastroesophageal reflux (GERD)

Gastresophageal reflux disease (GERD) is a very common disorder of the digestive system that occurs when the contents of the stomach flow back into the esophagus(food pipe).

Normally, the food we take passes through the mouth into the esophagusand then from the esophagusinto the stomach. There are two sphincters or valves which control the flow of food from esophagusinto the stomach – Upper esophageal sphincter (UES) and lower esophageal sphincters (LES).

GERD is caused due to a dysfunctioning LES. The LES either becomes weak or relaxes very frequently, allowing regurgitation of stomach contents into the oesophagus. As the stomach contains acid, backflow of its contents may irritate the food pipe, thereby producing intractable symptoms. GERD is also called as acid reflux. It usually causes a burning sensation in the chest (heartburn), which radiates from the stomach till the throat.

Some people can manage the symptoms by taking over-the-counter (OTC) medications, whereas, for some, it is so severe that their daily-life activities are affected. In such a case, immediate consultation with a doctor is required.


One single cause of GERD can’t be ascertained. Multiple factors lead to its development. A faulty LES can be because of the following factors:

  • Large meals: Stretching of stomach can cause loosening of LES temporarily
  • A hiatal hernia – pushing of stomach upwards through the diaphragm
  • Obesity
  • Stress (smoking)
  • Junk foods, such as chocolate, carbonated drinks, chewing gums, fatty foods, etc

If you observe heartburn only after taking certain foods, it is better to avoid them or eliminate them from the diet.


Most of the patients experience GERD symptoms like:

  • Burning sensation in the chest (heartburn), often radiating to throat
  • Feeling of a lump in the throat
  • Hoarseness of voice
  • Difficulty swallowing
  • Burping, associated with acid/bitter aftertaste in the mouth
  • Dental caries
  • Bad breath

The tightness in the chest produced by acid reflux is usually mistaken for a sign of heart attack. Therefore, it is necessary that one must know the difference between the two.

If the chest pain aggravates with physical exertion, then it is due to an underlying cardiovascular complication. Else, it is less likely that GERD produces chest pain upon physical activity.

Who is at risk?

Almost everyone experiences GERD at some or the other in their life. It is more common in adults and elderly people; also seen in infants and children.

Usually, children below 12 years of age do not experience heartburn as such, but they do experience one or more of the following symptoms.

  • Difficulty swallowing
  • Persistent/intermittent dry cough
  • Attacks of asthma
  • Inflammation of larynx (voice box)


Yes, heartburn can be managed very well and in fact can be prevented. To prevent heartburn, you must stick to the following habits –

  • Do not overeat; instead, have small and frequent meals
  • Quit smoking
  • Have adequate sleep
  • Maintain healthy weight
  • Avoid foods that are known triggers of heartburn
  • Do not sleep immediately after eating

Diagnosis of GERD is usually made on the basis of symptoms. However, if it doesn’t resolve after lifestyle modifications and treatment with medications, the doctor recommend one more of the following diagnostic tests:

Radiography: Commonly referred to as “Barium swallow test”. Here, the patient is given a solution of barium, after which X-ray of the upper GI tract is taken. This will help the radiologist in detecting any stricture/narrowing present in the oesophagus, stomach or small intestine.
Endoscopy: During this test, the doctor may insert a flexible tube with a small camera attached to its end, through the mouth into the oesophagus. This permits the doctor to look at the lining of the esophagusand stomach. Any inflammation of the esophageal lining may hint towards GERD.
Esophageal biopsy: During the endoscopy itself, the doctor may scrape the esophageal/stomach lining using a needle. The tissue sample is then sent for microscopic examination to detect the presence of cancerous cells.
Esophageal manometry: A small, flexible tube is inserted through the nose into the esophagusto know the motility. After ensuring that the tube is in position, the sensors on the tube record the contractions of the oesophagus; therefore, providing adequate information if problems in motility are contributing to GERD.
Using pH probe: A small tube with a pH sensor attached to its end is inserted through the nose into the oesophagus. The probe is connected to a digital recording system (computer). The patient should wear the probe for 24 hours. The tube is then removed and results collected from the computer are compared against the normal values. This shows the amount of acid exposure in a pathological state.

Generally taking OTC medications offers significant relief. But, if the symptoms still persist, you need to check with your doctor.

Doctors usually prescribe the following medications as acid reflux treatment

Drugs that neutralize the already produced acid: Antacid preparations such as Gelusil, Gaviscon, and Tums offer quick relief. However, chronic use produces side effects such as diarrhoea or constipation.

Drugs that decrease acid production:

  1. (a) H2 – receptor blockers: These drugs block the release of histamine - a stimulant of gastric acid secretion. These drugs block the acid secretion for 12 hours.

    Examples of H2 – receptor blockers: Cimetidine, Ranitidine, Famotidine etc. Use of these medications is associated with side effects such as, headache, nausea, flatulence (gas in the stomach) and dizziness.

  2. (b) Proton- pump inhibitors (PPI): These drugs block the acid production more effectively and for a longer duration. PPI’s are very effective if taken on empty stomach. Examples of PPI’s: Rabeprazole, Omeprazole, Esmoprazole, Lansoprazole, Pantoprazole, etc