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What is GERD?

Normal acid reflux is a natural and occasional occurrence that happens to everyone. However, it becomes a disease when symptoms develop, leading to inflammation at the end of the food pipe. GERD (Gastroesophageal Reflux Disease) is characterized by the abnormal reflux of gastric content, mainly acid, in the food pipe, causing troublesome symptoms. In advanced cases, food can also flow back into the food pipe, resulting in a condition known as FERD (Food-Esophageal Reflux Disease).

At ALSA Pakistan, Dr. Tahir Yunus performs Laparoscopic Anti-reflux surgery to provide a precise and efficient approach to managing gastroesophageal reflux disease.

Mechanism of Action

GERD (Gastroesophageal Reflux Disease) is caused by an increased acid reflux in the chest due to abnormalities in the valve between the food pipe and stomach,

This valve has two parts;

These two parts of the valve need to work together in harmony to maintain the proper functioning of the valve and prevent the backflow of stomach contents into the esophagus. Any damage or dysfunction in either part can disrupt this coordinated mechanism and lead to the development of GERD.

1 Hiatal hernia

In some cases, the hiatal valve becomes wide open, and the upper part of the stomach protrudes into the chest through it. This disruption in alignment obstructs proper function of the valve, leading to GERD symptoms.

2 Lax LES

When the LES is relaxed, it allows stomach acid to flow back into the esophagus, causing acid reflux and contributing to GERD.

3 Hiatal hernia and LES dysfunction

The combination of these two factors can also occur, leading to increased risk of acid reflux into the esophagus.

4 Motility disorders

Normally, the coordinated movements in the food pipe help clear acid that have entered into the esophagus. However, when these coordinated movements are impaired, acid remains in the food pipe, leading to GERD.

Other conditions may mimic GERD symptoms, such as neuromuscular disorders or indigestion, so careful evaluation is necessary to accurately diagnose and manage it effectively. Laparoscopic Anti-reflux surgery is the standard procedure that offers patients lasting relief from acid reflux and related discomfort.


GERD can look different from person to person. Although it can comprise a broad spectrum of symptoms, these symptoms can be categorized into two main groups: typical and atypical. This classification helps in understanding the diverse ways in which this condition can affect different patients.

Typical symptoms

Typical symptoms occur when acid goes up and irritates the food pipe. These include;

As the severity of the diseases increases, the symptoms can become more pronounced and bothersome. Acid reflux moving further up the esophagus can lead to the following sensations:

When this stomach acid travel further up the food pipe and reaches the windpipe, it causes;

Discomfort in ear: The connection between the ear and throat is through the Eustachian tube, which is a narrow passage that runs from the middle ear to the back of the throat. In some cases, acid reflux from the throat can reach the opening of this tube and cause irritation. This irritation can lead to a feeling of itching or discomfort in the ear, commonly referred to as “ear itching” or “ear itching due to throat connection.” Additionally, in some cases, it may contribute to a mild hearing impairment or cause sounds to be perceived differently, referred to as “ear congestion.”

Common habits in people
with typical symptoms;

Symptoms tend to worsen after eating because the opening between the stomach and the food pipe widens, allowing more acid to flow back up. Lying down straight creates a straight alignment of the food pipe, which further widens the opening and facilitates stomach acid movement upward. To manage their condition effectively, these individuals adopt certain practices, including:

By making these adjustments to their lifestyle and dietary habits, they aim to minimize acid reflux and alleviate the discomfort. Patients seeking long-term relief from acid reflux find relief in Laparoscopic Anti-reflux surgery, a specialized approach offered at ALSA Pakistan.

Atypical symptoms

Atypical symptoms of GERD are more related to the respiratory system. These individuals may experience less chest pain or other food pipe symptoms. Instead, they are more likely to present with symptoms related to the lungs such as;


It is a disease with symptoms that can overlap with other conditions. While the symptoms are typically associated with the food pipe, motility disorders or neuromuscular disorders can cause similar manifestations when normal peristaltic movements are disrupted.

Dyspepsia symptoms can also mimic those of GERD, making it challenging to differentiate between the two.
To diagnose GERD, several tests are performed, including:

Upper endoscopy

This helps identify issues like a weakened LES, hiatal hernia, esophageal erosions from acid reflux, or any other reasons, such as tumors, that may be causing the symptoms.

Motility study

This assesses the proper functioning of the food pipe’s motility, helping to rule out or confirm any abnormalities.

pH study

This test is used to gather additional evidence to confirm whether symptoms are related to acid reflux or caused by other factors.

Based on the results of these tests, a diagnosis can be established.

It is essential to conduct thorough evaluations and diagnostic tests to ensure an accurate diagnosis and provide appropriate management. Differentiating GERD from other conditions with overlapping symptoms is crucial to determine the most effective treatment plan. Laparoscopic Anti-reflux surgery may be considered if indicated by the test findings.

Relationship between GERD and Obesity

GERD and obesity are closely linked, and understanding this connection is crucial in managing patients with both conditions effectively. Obesity, characterized by excess body weight, can lead to increased pressure in the abdominal area. This heightened pressure puts added stress on the lower esophageal sphincter (LES), the valve that separates the stomach from the esophagus.

When the LES is exposed to increased abdominal pressures, it may become weaker or relaxed, allowing stomach acid to flow back into the esophagus more easily. As a result, individuals with obesity are at a higher risk of experiencing acid reflux, heartburn, and other GERD symptoms.

Furthermore, obesity can contribute to the development of hiatal hernia, a condition where a portion of the stomach pushes through the diaphragm into the chest cavity. This hernia disrupts the alignment and function of the LES, making it less effective in preventing acid reflux and exacerbating GERD symptoms.
Shedding excess weight can help reduce abdominal pressure, leading to improved LES function and decreased acid reflux. For individuals dealing with obesity and GERD, the most effective and optimal solution is often recommended to be Laparoscopic Anti-reflux surgery combined with RYGB (Roux-n-Y gastric bypass).

Treatment Options

At ALSA Pakistan, Dr. Tahir Yunus takes a holistic approach when guiding his patients through the treatment journey for GERD. Recognizing the complexity of the condition, he emphasizes the significance of lifestyle modifications, tailored medication regimens, and, when necessary, surgical options. This well-rounded approach ensures that patients receive personalized care and a comprehensive strategy to effectively manage and alleviate their symptoms.

We believe the treatment approach for GERD should be tailored to each individual’s specific condition and needs. A multidisciplinary approach involving lifestyle modifications, medications, and, in some cases, surgical interventions can lead to successful outcomes in managing the condition effectively. Laparoscopic Anti-reflux surgery offers patients a minimally invasive solution to address acid reflux and improve their quality of life. At ALSA Pakistan, Dr. Tahir Yunus performs this procedure, aimed at ensuring the optimal health and comfort of his patients. Your well-being is our priority!