Your neighbor gets a brand new car – or a brand new wife –or both; your rival gets your job and that club membership you were eyeing for years – these are all situations where you may suffer, justifiably from “literary” heartburn. But this article is written for those unfortunate millions who are crunched by “literal” heartburn, a disease otherwise known as reflux oesophagitis.

Everything we eat and drink – the good, the bad and the ugly, goes from our mouths, right down a long tube, or gullet, called the oesophagus.

The oesophagus normally contains only mucus secretion and accumulation of saliva, therefore its net chemical level is quite alkaline, and its lining adapted to the same.

Consider, then the havoc engendered by an acid splurge from the stomach that washes the (normally alkaline) lining with vicious effect!

Yes, this is what happens in this distressing condition, now known by the acronym “GERD” (Gastro-Oesophageal Reflux Disease).

Why do some unfortunates suffer with this? The answer lies in a unique valve endowed by the Creator, which is actually a high-pressure zone that acts like a gate, between the lower end of the oesophagus and the upper end of the stomach. This valve is known as the LOS, or the lower oesophageal sphincter, failure of function of the LOS leads to reflux disease.

Several items in our diet like fatty, oily and spicy items and smoking & alcohol cause a relaxation of this valve, with a resultant acid backwash into the oesophageal tube. Remember the vicious heartburn that a burger or a cheese pizza might have brought on in some of you? Or the taste of the "2 hours ago pakoras" in your throat after you downed your two neat ones in the club lawn? All those rather unnerving experiences are because of the effect of the fatty content of the cheese, or the oil in the burger, upon your valve. Drinking lots of water at meals, a uniquely Indian habit is actually quite bad for you because the water fills up the stomach, climbs above the valve, and encourages the acid to corrode the gullet lining.

Apart from heartburn, which is the commonest complaint of patients, other symptoms may dominate; for e.g. spasm of the oesophagus may cause chest pain indistinguishable from a heart attack. Thus, I have personally seen many patients who have undergone treadmill testing, echocardiography, and even coronary angiography, before they were referred to me as cause of reflux!

Other atypical presentations of this disease are, a chronic dry cough (because of acid trickling into the wind pipe), hoarseness of voice (because of acid injury to the voice-box), and repeated chest infections, esp. in children. Another common problem is multiple ulcers in the palate (roof of the mouth) or the tongue and cheek and it’s quite often that I seen refluxes with ulcers that have gobbled up tons of B-complex Vitamins.

The diagnosis of GERD is made by an endoscopy. Yucky as this may sound to some of you, I must reassure you that this is not exactly a medieval torture instruments. With modern hi-tech video endoscopes, the procedure is over in a few minutes. This test helps us to assess the degree of acid unexposure damage, see if there is an associated “hiatus hernia” (which means the junction of the gullet and stomach is pulled up into the chest area – this quite commonly accompanies reflux disease). Rarely, complications of reflux disease may be seen as well. For the extremely faint hearted patients scared of endoscopy, contrast X-rays with Barium, or radio-nuclide scanning, are two non-invasive methods of evaluating reflux disease.

In the nest issue, we will have details of how to cope with this or minimize the reflux.