 Hi, I am Dr. Suresh Sainay, working as associated professor in KMC hospital, we are Ambedkar Circle. Today, I am going to talk to you regarding a common disease called gastroesophageal reflect disease. What exactly this GERD or gastroesophageal reflect disease means? It is nothing but you have a reflex of either a acid or a bile or acidic material coming into the esophagus and here the patients usually come to you with the heart burn or retrosterna burning along with the regurgitation of the food, the food also coming into your mouth. And this is a common symptom what we come across in the OPD. If I see around 10 patients, 5 or 6 patients will be coming with this symptoms as such. Why is it common? Probably it may be because of the lifestyle changes commonly seen in obese people or because of the change in the lifestyle modification. Most of them have a sedentary lifestyle now or eating the junk foods especially spicy food or oily food, taking more and more coffee, smoking or alcohol drinks. This patients usually have an increased risk of having a gastroesophageal reflect disease. So, commonly they present with the retrosterna burning pain. Burning pain from here the throat up to the chest or they can have a regurgitation of the food along with what we say water brush when the acid comes up because we have a lot of salivary glands in the mouth what is given as some natural protective mechanism to negate or neutralize the acid. The salivary glands secrete some of the juices which is little bit of alkali that is the reason you may get what is known as water bath, salty taste in the mouth. This symptoms may be while taking the food or after the food especially after a heavy fatty meal or in the night when the patient goes to the sleep. Usually when the patient comes to the symptoms we always have to look whether it is really a GRD or it may be some other event especially a patient having hypertension or a diabetic we always need to rule out what not a cardiac disease chest pain always you need to roll out a heart problem the myocardial infarction or an angina. So, if the pain is bit of a severe and it increases on a walking it is not a reflex disease it may be related to the heart where you need to look a consult a cardiologist immediately. There are atypical symptoms some of the patients may come with a recurrent episodes of a ear and nose symptoms like throat pain, poisonous of the eyes or sometimes from the dental you may get a consultation telling the patient as a significant dental erosions as such or you may get a consultation from a respiratory this one where the patient having a nocturnal cough patient having a bees or recurrent aspiration pneumonia these are some of the extra esophageal symptoms which may come across this patient need to diagnose whether really the patient having a gastroesophageal reflex disease or some other complication. As I told you patient who are obese or a pregnant lady taking much of a spicy food or irregular food habits junk eating junk food they are at a high risk when the patient comes to you we usually think that this may be a gastroesophageal reflex disease give a trial of what the proton pump inhibitor and look for a run observe for a run two weeks if they do not improve or if there are any alarm symptoms having a new onset of the retrosterone burning pain after around 50 years of age or having a dysphagia dysphagia means having a difficulty in a swallowing the food may be to the liquid or to the solid recent onset dysphagia or oderophagia where the patient have a pain while a swallowing which may be because of a recently it may be because of the medications also some other medication for tetracycline or deryphiline some other HIV medications can cause this type of symptoms or recent weight loss or having a omitting of the blood or having a black tar restore what you know as malina or a family history of a esophageal manignancy having a cancer in the esophagus or the stomach this type of patient say as a alarm symptoms these patients have a immediate need immediate evaluation then a trial of a medications has said why this usually happen usually when we swallow the food the lower esophageal spinter where the lower end of the esophageal usually will relax and the food goes into the stomach and that there may be mild what known as transient lower esophageal relaxation as a some type of reflex but we say the reflex usually happens when it really troubles some or is causing a symptom then only we need to put them on the medications as such usually when the food goes down into the stomach much of the food does not come up or a regurgitate if there is a defect in the lower esophageal spinter which is usually formed by the muscles at the lower end of the esophagus and the what an across of the diaphragm or if there any increase in the intraabdominal pressure which usually come in a patient with our intraabdominal obesity or a pregnancy or following some abdominal surgeries or in the elderly or the patient with the diabetic having gastroparesis where there is delayed gastric emptying this type of patient or a patient having defect in the esophagus where the peristalsis may be low or there is a defect in the lower esophageal spinter height as hernia these type of patient are at the increased risk of developing a gastroesophageal reflect disease how do you diagnose this gastroesophageal reflect the purpose of the diagnosis is the patient does not improve with the trial of proton pump inhibitor or having a alarm system mainly to look into what the severity of the disease sometimes doing an endoscopy may give a relief to the patient that he does not having a severe disease or we may look into what the severity we usually grade by the Los Angeles grading a b c d look into what the severity and just decide we can how long the patient is a treatment or there may be complications of that of the gastroesophageal reflect disease like a septic structure where there have been narrowing into the lumen watching a block to a flow of the food or the water as such or a adenocarcinoma of the lower end of the esophagus or into the proximal stomach so mainly to diagnose and to rule out any complication we need to do a gastroscopy if the patient does not respond to the usual trial of medication or we does not have a severe disease then in that case we may have to go for a esophageal manometer high result esophageal manometer look into the mobility of the esophageal are we dealing with some other complication or a pH battery mainly to see whether it's a acid or a bile which is causing the reflex mostly by changing the lifestyle modification by doing the lifestyle modification only taking small quantity of the food once in two to three hours avoiding spicy and oily food avoid in bending immediately after taking the food or while if you have the symptoms at night usually lying down with the two pillows and avoiding carbonated food avoiding coffee or increase coffee or alcohol just with the medication the symptoms can be subside symptoms do not subside sometimes if it's a patient very obvious sometimes we may have to go for a bariatric surgery or a disarm fund or placations these are some of the common symptoms of a gastrolysis reflect the same