Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease (GERD) can be either primary or secondary. In other words, reflux can be caused by primary failure of the lower oesophageal sphincter which is most often associated with an hiatus hernia. Alternatively other conditions can cause reflux in which case it is secondary. An example would be gastroparesis, in which the valve that normally prevents reflux from the stomach into the oesophagus (Lower Oesophageal Sphincter or LOS) is normal but the stomach doesn’t empty normally and so pressure builds up within the stomach overcoming the strength of the valve. Another secondary cause is obesity where the pressure in the abdomen exceeds that of a normal LOS.

Diagnosing GERD

Some clinicians will accept that any patient who experiences heartburn, and responds well to PPIs have pathological GERD, however at RefluxUK we believe that patients should undergo formal testing to identify whether they have GERD and, if so what type. These tests include:

• Gastroscopy (OGD)
• pH testing (24-hour pH/impedance monitoring or BRAVO study)
• High-resolution manometry
• Others include barium swallow, gastric emptying study, or other ENT/respiratory tests to rule out other causes

Some patients only experience this when lying down, such as when they are asleep, others may have non-acidic or weakly-acidic GERD events, rather than the more well known 'acid reflux', while others still may have no symptoms of GERD but present with a high amount of acid in the lower oesophagus which can cause other conditions such as Barrett's Oesophagus.

Treating GERD

There are a myriad of treatments for GERD, and patients often employ a mixture to get the best results:

1. Lifestyle/Diet Modications
   With mild symptoms, some patients find lifestyle adjustments, such as sleeping on the right hand side, or diet changes like avoiding trigger foods, is sufficient to alleviate their worst reflux symptoms.
2. Antacids
   Many people take over-the-counter antacid medications, which works by neutralising the acid in the stomach to reduce the symptoms of heartburn.
   It is important to note that this does not stop reflux events, and so has no affect on regurgitation, many LPR symptoms or hiatus hernias.
3. Prescription Medication
   Proton-pump inhibitors, such as omeprazole, and H2-antagonists are prescribed by clinicians and act by directly changing the cellular mechanisms of the stomach and reduce the acid production.
   It is important to note that this does not stop reflux events, and so has no affect on regurgitation, many LPR symptoms or hiatus hernias. Some patients can also develop Barrett's Oesophagus while taking these medications.
4. Interventional Treatment
   This is more invasive, but aims to correct the root cause of GERD rather than just the symptoms which appeals to patients who want a long-lasting treatment, do not want to take medication or for whom other treatments do not work.
   These can be endoscopic, such as the TIF procedure, or laparoscopic (keyhole surgery) such as LINX and RefluxStop procedures.
5. Other
   Some patients use supplements and other natural remedies, while there are also experimental devices available such as the IQoro device. Please be aware that, while these can (and have) brought relief to some people, the evidence behind them are limited and so RefluxUK do not encourage these to be a mainstay solution.

Page reviewed by: Mr Nick Boyle BM MS FRCS 01/09/24