–GPHC’s gastroenterologists advise

By Romila Boodram

MOST of us have experienced that occasional burning pain that moves from the stomach to the chest or a sour or bitter taste in our mouth. Heartburn is uncomfortable. But if it happens often enough, it might indicate a more serious condition known as gastroesophageal reflux disease (GERD).

GERD occurs when the muscle at the end of the esophagus does not close properly, causing stomach acid to repeatedly flow back into the esophagus. There are a number of factors that contribute to a patient experiencing chronic acid reflux, some of which include overeating, obesity, caffeine intake, smoking, alcohol and spicy food.

Left untreated, GERD can lead to more serious health problems of the esophagus including inflammation, bleeding and scarring, which can cause the esophagus to narrow, making swallowing harder. Stomach acid can wear away the esophageal lining, causing ulcers, Barrett’s esophagus and in some cases, esophageal cancer.

Doctors Yaritza Lopez, Consultant Gastroenterologist and Master Infectious Diseases and Oneka Daniels, Medical Registrar and Gastroenterologist from the Georgetown Public Hospital Corporation (GPHC) in a recent interview with the Sunday Chronicle, gave a detailed account of the difference between acid reflux and GERD and they advised when it’s time to visit your doctor.

Dr. Lopez explained that acid reflux is a frequent condition diagnosed at her clinic at the GPHC. In fact, daily, about 99 per cent of the patients seen, complain about reflux.
“Acid reflux is not a disease, it’s a symptom of what you ate. Someone may have acid reflux once a week or twice a month. It becomes a disease (GERD) when it starts to affect the quality of life; like you cannot eat, you are losing weight, chest pain, you cannot sleep because you are getting heartburn,” Dr. Lopez explained.

Most times, acid reflux can be relieved by taking regular antacids but when the reflux is several times a week and over-the-counter antacid is not working, then it can be GERD.
“Acid reflux is an isolated symptom but when it appears with other symptoms like heartburn, bloating, severe chest pain or retrosternal pain, nausea or vomiting, then it’s GERD,” Dr. Daniels explained.
In Guyana, many persons opt for self-treatment when they experience acid reflux. In 2023, there was a case where a man from Essequibo treated his acid reflux for 20 years but when it finally became overbearing, he went to a private hospital for a consultation. He was diagnosed with esophageal cancer.

“When patients with acid reflux start going to the doctor is when they start having chest pain leading to the back and that’s when they decide to go to the cardiologist. So, once they do an evaluation there, then they come to Gastro (clinic),” Dr. Daniels said.

She further explained that the inflammation of the esophagus caused by GERD can trigger heart palpitation and it is one of the reasons why patients visit the cardiologist. Gastro cases are said to be one of the most frequent causes of cariologist consultation.

How is GERD diagnosed?
GERD is typically diagnosed during a clinical visit where the doctor reviews the patient’s history of signs and symptoms and administers treatment. However, if the patient does not get any relief with the medication administered, further testing is done to determine the root cause of the continuous reflux.

According to Dr. Daniels, a barium swallow test or an endoscopy can be done to determine the root cause for the reflux, be it hiatal hernia, Hpylori or other causes. She further lamented, “Acid reflux doesn’t cause any lasting symptoms, what you have to look for is if the patient has esophagitis, meaning that the mucus lining is sore, it’s a bit inflamed or if it’s a hiatal hernia.”

A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm which is the muscle that separates the abdomen from the chest.
Dr. Daniels noted that most of their GERD patients are well controlled. In treating patients with acid reflux, she explained that her department would usually start with the simplest solution like having patients change their diet in addition to regular acid reflux medication.

When a patient’s acid reflux is not relieved by any form of treatment and no other condition is found to be the cause but GERD, they can undergo anti-reflux surgery.
At least 10 per cent of the patients seen at the hospital have moved onto surgery, but there are several steps and treatment methods patients need to undergo before they have surgery.

Living with and managing GERD symptoms
To manage your GERD symptoms, Dr. Lopez advised patients to lose weight, avoid foods that increase the level of acid in their stomach, including caffeinated and aerated beverages such as Diamond or mineral water, quit smoking and avoid alcohol and large meals.