Patient Guide

Gastro-oesophageal reflux disease (GERD)

GERD is a highly prevalent gastrointestinal disorder and it is one of the most common GI conditions encountered in our clinical practice. 

The term GERD refers to a combination of signs and symptoms resulting from the reflux of stomach and duodenal contents into the gullet, also known as the esophagus. These symptoms may be severe in nature and may occur frequently enough to have a negative impact on our quality of life. Patients with GERD frequently experience interrupted sleep at night. Their performance at work and their social life may also be affected.

The hallmark features of GERD are heartburn and regurgitation which frequently manifest as burning sensation in the chest and food being propelled upwards into the chest or throat. These symptoms are thought to correspond to gastric content and partially digested food being propelled upwards into the oesophagus. Other manifestations of GERD include sour taste and throat discomfort. Although most patients have typical symptoms, others may have unusual presentations including angina-like chest pain or airway related symptoms such as asthma.

Besides these disturbing symptoms, one major concern is the possible oesophgeal erosions cause by the gastric acid and the development of a pre-malignant condition call Barrett’s oesophagus related to the acid reflux in patients suffering from GERD.

The main reason for gastric contents to return to the oesophagus may be related to either an incompetent lower oesophageal sphincter or an abnormal relaxation of the sphincter. This, couple with any increase in the intra-abdominal pressure due to various conditions may result in a significant amount of gastric acid gushing back into the oesophagus. Depending on the frequency and extent of this regurgitation, oesophageal injury of varying degree may occur.

The most practical way to clinch the diagnosis of GERD is a thorough and accurate history. Typical symptoms of heartburn or regurgitation will provide the basis for diagnosis in most cases. In the absence of these symptoms, a short course of acid suppression treatment with proton pump inhibitors (PPIs) may be employed as a strategy to make the diagnosis. In more difficult cases, more elaborate investigations including a 24-hr pH and impedance study may be required to confirm acidic or weakly-acidic reflux.

Besides arriving at the diagnosis, one frequent challenge clinicians face in the management of GERD is to estimate the extent of oesophageal injury. This information is crucial in deciding the long term management plan. Unfortunately, the magnitude and duration of symptoms do not necessarily correlate well with the actual physical injury in the oesophagus. Patients with more severe symptoms may have minimal or no oesophageal injury while others with mild or minimal symptoms may have severe oesophageal erosions.

The other challenge is to have an effective way to sieve out those patients with higher risk of developing lower oesophageal cancer due to Barrett’s oesophagus for cancer surveillance. The gold standard to achieve the above two goals is upper gastrointestinal tract endoscopy; also know as gastroscopy or OGD in short. This is a simple and quick procedure which allows the clinicians to directly inspect the oesophagus and stomach to determine any injury that has already occurred due to the acid reflux.

Gastroscopy involves inserting a flexible video endoscope through patient’s mouth through the oesophagus into the stomach. This procedure can be completed within 10-15 minutes with minimal risk or discomfort. Being flexible and steerable, the gastroscope can inspect the oesophagus, stomach and the 1st 2 segments of the duodenum in a single setting. Tissue samples can also be taken via the working channel of the scope when necessary for histological analysis. This allows the extent of injury and presence of Barrett’s oesophagus to be confirmed to guide the subsequent management and surveillance strategy.

The goals in the treatment of GERD are to relieve and prevent recurring symptoms and minimise any complications. Simple measures including life style modifications such as raising the head of bed when sleeping and over the counter medication like antacids may help. In established cases, on-demand PPI treatment driven by patients’ symptoms may be one of the common strategies employed by health care professionals. In some cases, long term medicine may be required to alleviate symptoms and to prevent complications.

It is not uncommon for patients with GERD to undergo repeat upper endoscopy at regular intervals to exclude complications of acid reflux as well as to detect any malignant tissue transformation from Barrett’s oesophagus. This is usually done at intervals of 2-3 yrs depending on the clinical findings. In cases with early tumour transformation, endoscopical therapy or surgery may be required as part of the definitive treatment.

To find out more about GERD, visit GERD: The Burning Issue

Contact consultant 6357 3766/7

Related clinics