GASTRO ESOPHAGEAL REFLEX DISEASE (GEARD)

• Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach contents flow back into the oesophagus, causing irritation to the mucosa. The reflux is primarily caused by an inappropriate, transient relaxation of the lower oesophageal sphincter
• The typical reflex syndrome is defined by the presence of troublesome heartburn or regurgitation and/or oesophageal injury/complications
• Typical symptoms are retro sternal burning pain (heartburn) and regurgitation, but the presentation is variable and may also include symptoms like chest pain and dysphagia

• Transient Lower oesophageal sphincter relaxation
• Corrosiveness of the gastric juice
• Hiatus hernia

Risk factors

• Smoking
• Caffeine and alcohol consumption 
• Stress
• Obesity
• Pregnancy 
• Angle of His enlargement (> 60°) 
• Iatrogenic (e.g. after gastrectomy) 
• Scleroderma

Oesophageal syndromes

Typical symptoms

• Heartburn
• Burning sensation in the retrosternum
• Regurgitation

Atypical symptoms

• GERD is the most common oesophageal cause of chest pain
• Pressure sensation in the chest
• Dysphagia
• Belching, bloating
• Dyspepsia , nausea
• Halitosis

Extra Oesophageal syndromes

Established associations

• Reflux cough
• Reflux laryngitis
• Reflux asthma
• Reflux dental erosions

Proposed associations

• Sinusitis
• Pulmonary fibrosis
• Recurrent otitis media
• Pharyngitis

Alarming Signs & Symptoms

• Dysphagia
• Early satiety
• GI bleeding
• Odynophagia
• Vomiting
• Weight loss
• Iron deficiency anaemia

Complications

• Erosive oesophagitis
• Stricture
• Barrett’s oesophagus
• Adenocarcinoma

• Diagnosis is based on clinical history and response to medications
• Endoscopy - Oesophago-gastro-duodenoscopy (with biopsy if needed)
• Ambulatory pH monitoring
• Impedance-pH monitoring
• Barium swallow - Useful first diagnostic test for patients with dysphagia
• Oesophageal manometry - Assess LES pressure, location and relaxation

Lifestyle changes

Dietary recommendations

• Small portions
• Avoid eating at least 3 hours before bedtime

Physical recommendations

• Weight loss in patients with obesity
• Elevate the head of the bed (10–20 cm) for patients with night time symptoms

Reduce or avoid triggering substances

• Nicotine, alcohol, caffeine if the patient experiences a correlation with symptoms
• Medications that may worsen symptoms (e.g. diazepam)

Surgical therapy

• Fundoplication

Internal Medicines

• Guduchyadi kashaya
• Drakshadi kashaya
• Avipathi choorna
• Sanka vati
• Sutasekhara rasa
• Nalikera lavana
• Parushakadi lehya
• Kalyana guda

Procedure

• Virechana – Avipathi choorna /kalyana guda