GERD stands for gastroesophageal reflux disorder. It is one of the most common benign condition of the stomach and esophagus. It is commonly seen in association with a hiatus hernia (condition in which part of the stomach migrates into the chest), obesity, pregnancy and some connective tissue diseases. The word GERD is self-explanatory, G-gastro stands for stomach, E-esophagus means food pipe and R-reflux means backward flow. Normally when we eat, the food moves forward from the food pipe to the stomach. In GERD, there is backward flow of stomach contents into the food pipe. Within our body there are natural antireflux mechanisms which prevent reflux of stomach contents (mostly acid) back in to the esophagus. These include a lower esophageal sphincter (LES) which is a rubber band like structure; and spontaneous esophageal clearance. Failure of these antireflux mechanisms leads to GERD. Reflux will happen if for example the LES becomes lax or if the pressure within the stomach is greater than that of esophagus. Some amount of reflux is normal (physiological) but it becomes pathological if the patient has symptoms like heart burn, vomiting, hiccups, regurgitation, water brash etc. Amongst these symptoms heartburn is the most common symptom. Sometimes the reflux contents can enter the lungs and cause cough, breathing difficulty, wheezing, change in voice, throat pain etc.
Evaluation of GERD includes upper GI endoscopy, barium swallow, ambulatory pH monitoring and esophageal manometry. Along with the above mentioned investigations , most importantly presence of typical symptoms aids in diagnosing a case of GERD.
For the management the patients are initially put on medical management which includes life style modification and medical therapy. When the symptoms are life-limiting despite maximum medical therapy antireflux surgeries are offered. These surgeries are done laparoscopically and are commonly referred to as LARS i.e laparoscopic antireflux surgeries. In this surgery the lax LES is strengthened by wrapping the lower end of esophagus with the stomach. Though the surgery is complex and requires an expert surgeon, it is safe and results are promising in an experienced hands. Patient is started on oral liquids on the same day and diet is gradually normalized. Hospital stay following surgery is one or two days and patients are then kept on follow up. They are also educated regarding life style changes and food eating patterns.