28/09/2025
(معد ے کی تیزابیت )
GERD::
■ Retrograde flow of Stomach contents into esophagus..OR....
Reflux (acid or non-acid mediated) with symptoms or side effects is called GERD.
CAUSES:(وجوھات)
The pathology involves the lower esophageal sphincter. Transient relaxation occurs throughout the day, but those with pathological GERD have more frequent transient relaxation of the lower esophageal sphincter.
RISK FACTORS for GERD :
● Physical abnormalities
(diaphragm defects, hiatal hernia),
●Delayed stomach emptying ( Over eating, narcotic use, gastroparesis),
●Obesity( موٹاپا )and
●Pregnancy.
■ Symptoms/ علامات
●Heartburn/سینے کی جلن and/or
●Regurgitation /خوراک یا ترش پانی منہ میں آنا
Atypical symptoms include
●Nausea, متلی انا
●Hoarseness (اواز کا خراب ھونا)
●Enamel loss دانتوں کا خراب ھونا .
●Chronic Cough/ زیادہ عرصے تک رھنے والی کھانسی
●Pharyngitis...گلے کا بار بار خراب ھو جانا
●chest pain۔سینے مین درد
● Apthous Ulcers..منہ میں چالے پڑنا
Complications:
●Dysphagia or difficulty in swallowing is an alarm symptom that suggest reflux-induced ■Strictures/خوراک کی نالی کا تیزابیت کی وجہ سے تنگ ھو جانا
■Malignancy /کینسر , Notable weight loss (>5% body weight) in combination with dysphagia is also worrisome.
■TREATMENT:
First line drugs for treating GERD/تیزابیت include
▪Omeprazole,
▪Esomeprazole,
▪Pantoprazole.
▪Rabeprazole
▪Lansoprazole etc
(These are Called PPI OR Proton Pump Inhibitors)
If someone does not have a response to one type PPI, there is weak evidence that switching to a different type of PPI will help.
PPI for Life?
Indications for continuous PPI therapy include
▪Peptic stricture,(خوراک کی نالی کا تنگ ھونا)
▪Significant esophagitis (ie: ulceration of the distal esophagus seen through endoscopy),
and those with
▪ Barrett’s esophagus (even if asymptomatic).
Experts advise initial empiric PPI therapy for 8 weeks with follow-up afterwards to assess benefit for the patient’s symptoms.
●The PPI is taken once daily in the morning 30-60 minutes before a meal.
PPI therapy can be used intermittently or for short periods of time when patients know they will experience heartburn, such as when traveling or having restaurant food.
Monitoring Long Term PPI Usage :
clinicians can consider checking an annual creatinine level to assess renal function, a CBC, and serum ferritin for anemia. B12 levels can be checked every five years. Magnesium levels can be checked in symptomatic patients
Going Off PPI
If someone has been on daily therapy, they may have severe heartburn and reflux if they abruptly discontinue PPI therapy. Experts suggests tapering by taking every other day for a few weeks and then every 3rd day for a few weeks before fully discontinuing (expert opinion).
■ Lifestyle modifications
Weight loss can be helpful even in patients with a normal BMI, ● Elevation of the head of the bed at night with wedges can be helpful for those with nocturnal symptoms. Simply propping head up on pillows may not be helpful since it can put more pressure on the abdomen.
●Patients should not eat or drink for a few hours before bed (or even sooner, if they lay on the couch).
●Patients should be counseled to avoid recumbency immediately after meals.
There are foods that may aggravate symptoms (coffee, chocolate, mints, wine, spicy/citrus foods), but it is not always helpful to eliminate all these types of foods. If the patient has a clear pattern of reflux from a specific food type however, they should consider avoiding that .
Refractory GERD:
The Reflux Strikes Back
If a patient continues to have reflux symptoms despite
●PPI use, then lifestyle, medication compliance, time of administration, and dose should be assessed. Switching to another PPI or increasing to twice a day may be considered in adherent patients, Adding a nighttime H2 blocker can be beneficial in patients with breakthrough nocturnal symptoms initially but unfortunately, they tend to lose that benefit overtime due to tachyphylaxis. Severe refractory GERD after PPI therapy requires an endoscopic investigation and, if that is inconclusive, a pH and/or impedance study.
Dr.Dilaram Khan Salarzai
Assistant Professor Gastroenterology
Lady Reading Hospital Peshawar.
