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GERD stand for gastro esophageal reflux disease. It is a medical condition when increased amount of gastric acid goes upwards into the esophagus and causes symptoms and injury. The normal swallowing mechanism involves the food travelling from the esophagus into the stomach through a one way valve present at the lower end of the esophagus. This valve is closed at rest but opens during swallowing to allow the food to enter the stomach and then closes again to prevent the food from refluxing back. The cause of this condition is mainly due to weakness or dysfunction of the valve or increase in the size of esophageal opening present within the diaphragm. Certain factors such as over distension of the stomach, a recumbent posture and certain foods like garlic, chocolate, coffee, etc increase the chances of acid reflux. Smoking and alcohol consumption also increase GE reflux as do carbonated beverages. Increased intra abdominal pressure from obesity or pregnancy also increases the chances of reflux. The esophageal lining is very delicate as compared to the thick and resistant gastric wall and even a small amount of acid can cause damage to this lining. The symptoms of this condition include heartburn, gas bloat and pain felt in the upper abdomen and retrosternal area. There might be increased belching and salivation, vomiting after food and sour taste in the mouth. This can sometimes present as chronic cough and asthma. The symptoms are usually aggravated after taking spicy and oily food and are worse on lying down. If the reflux becomes severe, it can cause permanent damage to the esophageal lining causing scarring and narrowing of the esophagus which can lead to difficulty in swallowing food. It can also lead to hoarseness of voice and respiratory conditions like asthma and bronchitis. Sometimes, chronic reflux changes the cells of the esophageal lining which become more prone to development of cancer. The diagnosis of this condition is based on the clinical history. Usually there are no findings on physical examination. The diagnosis can be confirmed with the help of an upper GI endoscopy which shows telltale sign of acid reflux such as esophageal erosions or ulcers present near the GE junction. Endoscopy may also reveal gastritis and presence of infection in the stomach or duodenum. It also helps in assessment of the hiatus and can detect the presence of a hiatal hernia. Sometimes, the endoscopy may not reveal any particular findings and the documented presence of GERD can be done by 24 hour pH study. The first line treatment of GERD is medical management. The patients are prescribed a combination of acid suppressing medication along with antacid gels. They should also follow some dietary restrictions and lifestyle changes. Avoiding spicy and oily foods and taking small frequent meals goes a long way in suppressing acid production. The patients should be told to avoid large meals particularly late in the evening, to avoid lying down immediately after meals and to raise the head end of the bed to minimise reflux of gastric acid. These measures are mostly successful in suppressing the acid production and ameliorating symptoms. In those patients who have chronic symptoms refractory to medical management, in patients with significant lifestyle impairment due to the disease, complications arising out of GERD like stricture and Barrett’s esophagus and those who are not willing for long term medication, surgical treatment of GERD can be considered. Surgery is successful only if the patients have documented large hiatal hernia (Grade 3 or 4) and endoscopic evidence of lower esophageal damage. The surgery for GERD and hiatal hernia is known as fundoplication. The surgery is mostly done by the laparoscopic approach and involves repair of the hiatal opening and wrapping the upper portion of the stomach around the lower esophagus to create an antireflux mechanism. The surgery has good results with few complications and patients can be started liquid diet after a few hours and discharged the next day. They are placed on a soft diet for 2 weeks and can have a normal diet following this period.