​Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a digestive disorder which can affect people of all ages, even children. The disorder affects your lower oesophageal sphincter (LOS), which are ring of muscles located between your oesophagus and stomach and causes it to become weaker than normal, or relax inappropriately. This results in food acid flowing from the stomach back into the oesophagus (food pipe), which does not contain acid normally. This back flow is called a reflux.

GERD refers to instances where acid reflux happens more than twice a week and leads to the inflammation of the oesophagus. GERD also often causes heartburn. A lot of people, including pregnant women, suffer from heartburn as well as indigestion as a result of GERD.

The severity of the disease depends on the extent of LOS dysfunction, the type and quantity of acidic fluid that comes up ​from your stomach and also the neutralizing effect of saliva. Doctors often attribute GERD as a consequence of​ hiatal hernia​, as it is thought to weaken your LO​S.

The common symptoms and indicators of GERD include:

  • Heartburn, or a burning sensation in your chest 

  • Feeling like food is trapped in your throat​

  • Nausea, particularly after eating

  • Feeling unusually full or indigestion 

  • Regurgitation of food

  • Difficulty with swallowing

Symptoms may seem to worsen when you are bent over or are lying down, or after you have eaten. They may also appear to worsen at night.  ​

If you are experiencing symptoms of GERD, you can consult the family doctors at the Family Health Service Line at The Aga Khan University Hospital.

You can also visit the doctors working with the Children's Hospital​ or GI and Surgery Service Line​ at The Aga Khan University Hospital if if medication has not helped to alleviate symptoms after two weeks. ​
Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.​

If your symptoms are mild, you may not require any tests. However, if your symptoms are severe, persistent (beyond two weeks), or have returned after having being treated for them, your doctor may then perform some tests in order to make a proper diagnosis. These tests may include: ​

  • An upper gastrointestinal endoscopy – this will help to examine the lining of your oesophagus, stomach, and the beginning of your small intestine and hiatal hernia

  • Oesophageal manometry – this will examine the pressure inside the lower part of your oesophagus

  • Ambulatory 24-hour pH monitoring – this uses a device to measure your acid for a twenty-four hour period. This is a standard criterion that has been established to diagnose GERD.​

Mild or moderate symptoms of reflux can usually be alleviated with lifestyle and dietary adjustments. Medication may also help to treat symptoms. However, in some cases people still experience symptoms despite attempts of non-surgical treatment options. In this instance, surgery may be the only viable option. 

Surgery will aim to reinforce​ the lower oesophageal sphincter (LOS), which normally keeps acid from refluxing back to your stomach. There are a few different surgical options to treat the symptoms of GERD and curb the associated complications. Your doctor will best be able to give you advice and support about which form of treatment is best suited to your particular case.

A fundoplication is the most common form of surgical treatment for GERD. It involves tightening and reinforcing your LOS. This is done by wrapping a portion of your stomach around the outside of the lower part of your oesophagus in order to strengthen the sphincter. This surgery can be performed by using open surgical techniques or it may be performed as a laparoscopic procedure. This is considered the less invasive of the two techniques. 

If you have a hiatal hernia which has led to symptoms of GERD, this will usually be addressed alondside and be repaired surgically to prevent recurrent or further complications. ​

Please click here for some guidelines on “what to do before your surgery”​
Please click here for some guidelines on “what to do on the day of your surgery”​

Potential risks and complications associated with a fundoplication procedure include:

  • Difficulty with swallowing 

  • The oesophagus sliding out from the wrapped portion of the stomach, and the LOS no longer being supported

  • Heartburn recurrence

  • Bloating or discomfort related to a build-up of gas due to an inability to burp

  • Risks associated with anaesthesia, such as pain, bloating, gas or diarrhoea 

Visit your doctor as soon as possible if you are experiencing any negative consequences following surgery.​

Please click here for some guidelines on “what to do on after your surgery”​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​