AI Summary Overview
What is GERD?
GERD is a long-term condition in which the stomach acid or bile is repeatedly pushed back up into the esophagus, which is a tube connecting the mouth and the stomach. Acid reflux (acid flowing back into the food pipe/esophagus) causes damage to the esophageal lining, resulting in the condition's unusual heartburn and regurgitation.
What are the Types of GERD?
There are two types of GERD:
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Erosive GERD (Erosive Oesophagitis) In this condition, stomach contents burn and damage the lining of the esophagus, causing lesions, ulcers and damage visible at endoscopy. Symptoms are more likely to be more severe and frequent with this type, with an increased risk of complications such as strictures and Barrett's esophagus.
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Non-Erosive Reflux Disease (NERD) With NERD, the patient has typical reflux symptoms, i.e., heartburn and regurgitation. However, the lining of the esophagus appears normal and there are no visible lesions at endoscopy. This type is the most common of all the types.
Stages of GERD
GERD is clinically classified into stages based on its severity. Grades A and B generally indicate milder erosive esophagitis, while Grades C and D indicate severe esophageal damage that usually requires long-term treatment and follow-up.
These grades, along with their critical features, are given in brief in the table below:
| Grade | Features |
| Grade A | One or more small breaks in the esophageal lining, measuring 5 mm or less |
| Grade B | One or more breaks longer than 5 mm, without extending between the tops of two folds |
| Grade C | Breaks extend between two or more folds but affect less than 75% of the esophageal circumference |
| Grade D | Extensive damage affecting 75% or more of the esophageal circumference |
How Common is GERD in India?
GERD is the most common gastrointestinal disease in India, with a rapidly escalating burden. From a meta-analysis of 9 Indian studies, involving more than 20,000 patients, the pooled prevalence rate of GERD in the Indian population was estimated to be 15.6%. Individual studies reported prevalence rates anywhere between 5% to as high as 28.5%, depending on location and the population studied.
What are the Symptoms of GERD?
GERD symptoms vary widely, with some patients experiencing predominantly esophageal symptoms and others presenting with throat and respiratory complaints. Most symptoms are aggravated by sleep and/or after food. Check out the common early and advanced symptoms of GERD below:
| Early Warning Signs | Advanced Stage Symptoms |
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Diseases Similar to GERD
GERD or GORD can often be confused with other conditions that may exhibit similar symptoms related to the esophagus or the digestive tract. However, the conditions are distinct in terms of their causes, effects and treatment approaches.
A comparative overview of such conditions is given in the table below:
GERD Vs. Gastritis Vs. Peptic Ulcer Disease
| Feature | GERD | Gastritis | Peptic Ulcer Disease |
| How It Happens | Stomach contents repeatedly flow into the esophagus | Stomach lining becomes inflamed or irritated | An open sore develops in the stomach or duodenal lining |
| Location | Esophagus and lower esophageal sphincter | Stomach lining | Stomach or duodenum |
| Associated Symptoms | Heartburn, acid regurgitation, chest discomfort, difficulty swallowing | Upper abdominal pain, nausea, fullness, loss of appetite | Burning abdominal pain, bloating, nausea, early fullness |
| Severity | May cause esophageal inflammation or narrowing | Varies from mild irritation to bleeding | May cause bleeding, perforation or blockage |
| Can It Be Reversed? | Usually manageable but may recur | Often, depending on the cause | Often, with treatment of the underlying cause |
What Causes GERD?
GERD occurs when there is a problem with the mechanisms that normally stop stomach contents from going up into the esophagus. This can occur due to the following:
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Weak or Relaxed Lower Esophageal Sphincter (LES): A weak lower esophageal sphincter (LES) can allow stomach contents to come up into the esophagus. Particular drinks, drugs and lifestyle factors can also induce this relaxed state.
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Hiatal Hernia: A hiatal hernia is where the stomach slides up into the esophagus and can cause the LES to work inefficiently, increasing reflux. It is a structural cause of GERD that tends to affect the elderly population more.
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Obesity: The excess weight in obese people is concentrated in the abdominal area. This increases the pressure within the abdomen, forcing stomach contents upwards. This is the most important modifiable risk factor of GERD and is strongly associated with metabolic syndrome.
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Food Irritants: Foods and drinks can also affect it by relaxing the LES or increasing acid. These include fatty or fried food, spicy food, chocolate, caffeine, carbonated beverages, acidic food like tomatoes, oranges and lemons and alcohol.
What are the Complications of GERD?
If GERD is not controlled well for months or years, acid can cause serious damage to tissues other than the esophagus. The complications of untreated GERD can be:
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Esophagitis: Inflammation and ulceration of the esophageal lining from exposure to acid, resulting in pain on swallowing, bleeding, and ulcer formation.
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Esophageal Stricture: Repeated inflammation leads to the development of scarring, narrowing the esophagus. Patients become increasingly unable to swallow, and this will often require the passage of a bougie to dilate the esophagus.
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Barrett's Esophagus: The prolonged exposure to acid causes the normal squamous cell esophagus lining to change to an intestinal type of lining, called Barrett's esophagus.
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Esophageal Adenocarcinoma: In a few individuals, this pre-malignant change may progress to cancer, leading to esophageal cancer. Esophageal cancer is one of the most dangerous tumours of the gastrointestinal tract. Endoscopic surveillance in those with Barrett's Esophagus is of utmost importance.
When Should I See My Healthcare Provider?
Seek medical advice immediately if you experience any or a combination of these:
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Heartburn or acid regurgitation occurs on more than two days each week and consistently.
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The symptoms are not improving or worsening with the use of over-the-counter antacids.
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In case of Indigestion and dysphagia (trouble swallowing and the sensation of food sticking in the throat or chest).
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Unexplained weight loss.
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You vomit blood or pass black, tarry stools-signs that there is bleeding occurring within the esophagus.
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Persistent chest pain, chronic cough, or hoarseness associated with acid reflux symptoms.
How is GERD Diagnosed?
The diagnosis of GERD is usually clinical, based on symptoms and the response to therapy. However, several investigations can help to confirm the diagnosis, define the severity, and screen for complications. The various assessments used to diagnose GERD are:
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Clinical Assessment and PPI Trial Patients with symptoms of heartburn, regurgitation and absence of alarm features will often be put on an empirical course of proton pump inhibitors, and their subsequent improvement will lead to a clinical diagnosis.
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Upper Gastrointestinal Endoscopy (OGD Scope) Upper gastrointestinal endoscopy allows visualisation of the esophageal lining and detection of esophagitis, ulcers, erosions or strictures. A biopsy may be taken to rule out carcinoma of the esophagus or to identify intestinal metaplasia in Barrett's esophagus. OGD is appropriate in cases with alarming symptoms, symptoms unresponsive to treatment, or in patients with long-term GORD.
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Barium Swallow X-Ray In this assessment, the patient drinks a barium-containing fluid, which coats the esophagus and stomach. It can diagnose a hiatal hernia or identify strictures and marked esophagitis. However, the test has low sensitivity for early GORD.
Diagnostic Overview Table
| Test | Purpose | When Used |
| PPI Trial | Empirical treatment confirming clinical diagnosis | Typical symptoms without alarm features |
| Upper Endoscopy | Visualises esophageal lining; detects erosions, Barrett's esophagus | Alarm symptoms, refractory GERD, long-standing disease |
| 24-Hour pH Monitoring | Quantifies acid exposure in the esophagus | Uncertain diagnosis, pre-surgical assessment |
| Esophageal Manometry | Measures LES pressure and motility | Before surgery, when a motility disorder is suspected |
| Barium Swallow X-ray | Identifies structural abnormalities | Suspected stricture, hiatal hernia |
How is GERD Managed?
The management of GERD centres on alleviation of symptoms, healing of esophageal mucosa, prevention of complications and enhancement of quality of life in patients. Treatment is based on the severity of the disease. These include:
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Medications
Doctors may prescribe the following medicines to reduce acid production, relieve symptoms, and help the esophagus heal:
- Antacids: Relief of mild symptoms within a few minutes.
- H2 Blockers: Decrease acid production and are more effective at night.
- PPIs: The best treatment reduces acid and heals the esophagus.
- Prokinetics: Aid in the emptying of the stomach and LES function.
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Surgical and Procedural Options
In severe or long-term cases, the following procedures may be recommended when lifestyle changes and medicines do not provide enough relief:
- Laparoscopic Nissen Fundoplication: Strengthens the LES and causes it to close more effectively, thus preventing reflux.
- Trans-oral Incisionless Fundoplication (TIF): An endoscopic procedure to enhance the anti-reflux barrier.
- LINX Device: A magnetic ring fitted around the LES to halt reflux.
GERD During Pregnancy
Gastroesophageal reflux disease affects most pregnant women. Pregnancy hormones relax the LES, while increased pressure from the gravid uterus puts pressure on the stomach. Diet and lifestyle advice is the main management, such as small meals, avoiding specific trigger foods, remaining upright after meals, and raising the head of the bed.
An antacid safe for pregnancy can be chosen with medical advice. Prescribed medication should not be taken without medical approval. Symptoms tend to resolve after delivery, but whether further action needs to be taken should be seen medically.
Common Medicines Used to Treat GERD
Medicines for GERD reduce stomach acid, relieve heartburn and help heal irritation of the esophagus. The prescribed medicine depends on symptom frequency, severity and whether esophageal damage is present. Common medicines used to treat GERD include:
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Omeprazole: Omeprazole reduces stomach acid and is commonly prescribed for frequent GERD symptoms and reflux esophagitis.
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Pantoprazole: Pantoprazole helps control heartburn and heal acid-related damage to the esophagus.
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Esomeprazole: Esomeprazole may be prescribed for persistent GORD symptoms or erosive esophagitis.
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Rabeprazole: Rabeprazole reduces acid production and may provide relief from frequent heartburn and regurgitation.
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Lansoprazole: Lansoprazole may be used to control GORD symptoms and support healing of the esophageal lining.
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Famotidine: Famotidine may help manage occasional or mild heartburn and nighttime reflux symptoms.
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Aluminium Hydroxide with Magnesium Hydroxide: This combination provides short-term relief by neutralising stomach acid but does not heal severe esophageal inflammation.
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Sodium Alginate with Sodium Bicarbonate: This combination forms a protective layer over stomach contents and may reduce heartburn and acid regurgitation after meals.
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Sucralfate: Sucralfate coats and protects irritated tissue. It is not routinely used for GORD but may be considered in selected patients, including during pregnancy.
Note: Long-term acid-suppressing medications should only be continued under medical guidance.
Living with GERD: Daily Challenges and Patient Well-Being
Living with gastroesophageal reflux disease (GERD) can affect eating habits, sleep, work and social activities. Following the prescribed treatment and identifying personal triggers can help control symptoms and improve quality of life.
Some of the critical challenges relating to daily life and patient care include:
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Challenges
- Meal-Related Symptoms: Heartburn and regurgitation may worsen after large, oily or late-night meals.
- Sleep Disturbances: Acid reflux may interrupt sleep, particularly when lying down soon after eating.
- Work and Social Difficulties: Symptoms may affect travel, meetings, celebrations and eating outside the home.
- Persistent Discomfort: Chest burning, sour taste, coughing or throat irritation may interfere with daily activities.
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Patient Well-Being
- Meal and Trigger Management: Smaller meals and avoiding personal food triggers may help reduce reflux symptoms.
- Healthy Daily Habits: Maintaining a healthy weight, avoiding smoking and limiting alcohol may support symptom control.
- Sleep Adjustments: Avoiding meals close to bedtime and elevating the head during sleep may reduce nighttime reflux.
- Treatment and Follow-Ups: Taking prescribed medicines correctly and attending medical reviews can help prevent complications.
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Expenses
- Consultation Costs: Expenses may include visits to a physician or gastroenterologist for diagnosis and follow-up.
- Medicine Expenses: Patients may require antacids, acid-reducing medicines or long-term treatment for persistent GERD.
- Diagnostic Test Costs: Upper gastrointestinal endoscopy, pH monitoring or other tests may be required in selected cases.
What is the Prognosis for GERD? Can It Be Reversed?
GERD is often a lifelong problem, which may not always be curable. However, effective treatment is available with a change in lifestyle and adequate medication. Most people have good symptomatic relief and esophageal healing with medication, primarily proton pump Inhibitors (PPI's).
How Can I Prevent GERD?
It is not possible to prevent genetic tendencies or structural issues like a hiatal hernia. However, with some changes, you can decrease the risk of GERD or postpone its onset and progression for quite some time. Check out the ways to prevent GERD below:
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Substitute fried, fatty foods, processed foods with fiber-rich foods like vegetables, whole grains, legumes.
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Limit your coffee intake, tea intake, carbonated beverages, alcohol, chocolate, and citrus, as these relax the LES.
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Eat food at fixed times of the day and do not skip meals, as acid production is higher when the stomach is empty.
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Lead a healthy lifestyle, reduce weight with regular exercise of at least 30 minutes a day, at least five days a week.
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Avoid lying down immediately after eating, and wait at least 2 - 3 hours before sleeping.
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Quit smoking, as tobacco weakens the LES and increases acid reflux symptoms.
Treatment Cost of GERD in India
The cost of GERD treatment in India depends on symptom severity, medicines prescribed, tests required, hospital type and city. Most patients are initially treated through lifestyle changes and medicines. Diagnostic procedures or surgery may be recommended when symptoms persist, complications develop or the diagnosis remains uncertain.
An overview of the treatment costs of GERD is given below:
| Treatment Component | Approximate Cost in India |
| Gastroenterologist Consultation | ₹500 - ₹2,500 per visit |
| GERD Medicines | ₹200 - ₹1,000 or more per month |
| Upper GI Endoscopy | ₹2,000 - ₹10,000 |
| Endoscopy With Biopsy or Sedation | ₹5,000 - ₹15,000 or more |
| 24-Hour Esophageal pH Monitoring | ₹8,000 - ₹15,000 |
| Esophageal Manometry | ₹8,000 - ₹15,000 |
| Laparoscopic Fundoplication Surgery | ₹1,00,000 - ₹3,00,000 |
| Additional Hospital Stay | ₹5,000 to ₹15,000 per day |
Note: The above-mentioned figures are indicative and may vary across cities and hospitals. Patients should request a written cost estimate from their healthcare provider to know the cost of consultations, medicines, biopsy, anaesthesia, and hospital stay.
Does Health Insurance Cover GERD?
Yes, most health insurance policies in India cover the treatment of GERD, including hospitalisation expenses, surgery and endoscopy. It will also cover any serious complications from the disease. In case of OPD consultations, diagnostic tests and medicines, coverage will be available if the policy has an OPD covert. Coverage details may differ as per the policy, so check its terms and conditions carefully.
Besides, waiting periods of as long as 3 years may apply if GERD was diagnosed before policy purchase and is an existing illness. The exact waiting period may depend on the policy.
How Much Health Insurance Coverage is Needed for GERD Treatment?
Health insurance coverage of ₹5 to 10 lakh is often adequate to cover hospitalisation, diagnostic procedures, endoscopy and other regular treatments associated with GERD. However, in case of complications like Barrett's esophagus or esophageal cancer, the cost of treatment could be extremely high. In that case, a medical insurance coverage of ₹15 to 20 lakh should be suitable.
The ideal coverage amount ultimately depends on your age, overall health condition, medical history and healthcare needs.
Frequently Asked Questions (FAQs)
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Q1. What is the difference between acid reflux and GERD?
Ans: Acid reflux is the return of stomach acid up into the esophagus. Gastroesophageal reflux disease is a condition where acid reflux is persistent (usually 2 times per week or more), causing symptoms and possibly damage to the esophagus. Basically, it is ongoing acid reflux that requires treatment. -
Q2. What are the most common GERD symptoms?
Ans: Common signs and symptoms of GERD or GORD include heartburn and a burning pain in the chest, and regurgitation, where stomach contents flow back up into the throat or mouth. -
Q3. Can GERD be cured permanently?
Ans: No. It is a chronic condition that, in most patients, can not be permanently cured. However, it can be treated effectively with both lifestyle adjustments and medications.
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References
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https://link.springer.com/article/10.1007/s12664-020-01104-0
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https://irdai.gov.in/health-dept
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https://pubmed.ncbi.nlm.nih.gov/33409947/
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