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GERD & Acid Reflux Treatment in Mumbai

Acid reflux that happens occasionally is common and manageable. GERD - gastro-oesophageal reflux disease - is what it becomes when stomach acid repeatedly flows back into the oesophagus, eroding its lining, triggering inflammation, and damaging quality of life week after week. At Shree Hospitals Ghatkopar East, our gastroenterology team treats GERD at every stage - from lifestyle-responsive mild reflux through to complicated disease with oesophagitis, Barrett's oesophagus, and reflux that fails medical treatment and requires surgical correction.

Chronic, untreated GERD carries a measurable risk of oesophageal cancer, and the single most important step is accurate diagnosis followed by a treatment plan matched to the severity of your disease. We do not treat all reflux with antacids and hope - we investigate, stratify, and manage every patient based on what their oesophagus actually shows.

(24×7 Emergency Care)

1800-268-4000

(24×7 Emergency Care)

1800-268-4000

Our Approach in Managing GERD (Acid Reflux)

Managing GERD at Shree Hospitals goes well beyond prescribing antacid medication. Our five-step approach moves from accurate diagnosis through risk stratification, targeted pharmacological therapy, endoscopic surveillance where indicated, and surgical referral for patients who do not achieve durable control with medication. No two patients with acid reflux have identical pathology - some have no visible mucosal damage despite daily symptoms, while others have advanced oesophagitis or Barrett's oesophagus with no symptoms at all. Only a structured approach that investigates before prescribing and stratifies risk before discharging achieves both symptom control and cancer prevention.

Step 1 - Accurate Diagnosis: Endoscopy, pH Testing & Symptom Mapping

The first step in our GERD evaluation is determining whether classic symptoms - heartburn and regurgitation - are truly caused by acid reflux or by one of the many conditions that mimic it, including functional heartburn, eosinophilic oesophagitis, achalasia, and cardiac chest pain. A detailed symptom history maps frequency, severity, relationship to meals, posture, and sleep disruption. Upper GI endoscopy (OGD - oesophagogastroduodenoscopy) visualises the oesophageal mucosa and grades oesophagitis using the Los Angeles Classification from Grade A (small mucosal breaks) to Grade D (extensive circumferential erosion). In patients with normal endoscopy but persistent symptoms, 24-hour ambulatory pH-impedance monitoring measures the actual acid burden reaching the lower oesophagus and confirms whether symptoms and acid episodes correlate - providing objective evidence of reflux where endoscopy alone cannot.

Step 2 - Risk Stratification: Identifying Alarm Features and Barrett's Oesophagus

Not all GERD carries equal risk. Alarm features - dysphagia (difficulty swallowing), progressive weight loss, persistent vomiting, haematemesis (blood in vomit), iron-deficiency anaemia, or first onset of symptoms after age 50 - demand urgent endoscopy to exclude malignancy. Barrett's oesophagus - the replacement of normal oesophageal lining with intestinal-type mucosa (intestinal metaplasia) - develops in 10–15% of chronic GERD patients and carries a 0.5–1% per year risk of progression to oesophageal adenocarcinoma. At Shree Hospitals, every patient with long-standing GERD undergoes endoscopic screening to identify or exclude Barrett's. Confirmed Barrett's is graded using the Prague C&M criteria and entered into a structured endoscopic surveillance programme with biopsies guided by the Seattle protocol.

Step 3 - Medical Therapy: PPIs, H2 Blockers & Adjunctive Agents

Proton pump inhibitors (PPIs) - omeprazole, pantoprazole, esomeprazole, rabeprazole - remain the mainstay of GERD pharmacotherapy, reducing gastric acid secretion by 90% or more and healing oesophagitis in the majority of patients within 8 weeks. We prescribe PPIs at the optimised dose, at the right time (30 minutes before the first meal of the day), and for the correct duration - because incorrect PPI use is the single most common reason for apparent treatment failure in GERD. Patients with predominantly nocturnal reflux, post-meal symptoms, or incomplete PPI response receive adjunctive therapy: alginate-based preparations (such as Gaviscon) for physical barrier protection after meals, H2-receptor antagonists at night for breakthrough nocturnal acid, and prokinetics where gastroparesis or delayed gastric emptying contributes to reflux burden.

Step 4 - Lifestyle Modification: The Structural Changes That Reduce Reflux

Medication controls acid but does not correct the underlying structural defect in GERD - lower oesophageal sphincter (LOS) incompetence made worse by obesity, large meals, a high-fat diet, and posture after eating. Our team provides specific, evidence-based lifestyle guidance for every GERD patient: weight reduction (the single most effective lifestyle intervention, with each unit decrease in BMI reducing reflux frequency measurably), elevation of the bed head by 15–20 cm for nocturnal reflux, eating small frequent meals and avoiding the supine position for 3 hours after eating, and eliminating specific refluxogenic triggers - coffee, alcohol, high-fat meals, chocolate, tomato products, citrus, and carbonated beverages. These modifications are not optional additions to drug therapy - in overweight patients they are as important as PPI treatment.

Step 5 - Surgical and Endoscopic Options for Refractory or Complicated GERD

Patients who require lifelong high-dose PPIs for symptom control, who develop significant side effects from long-term PPI use, who have a confirmed large hiatus hernia on barium swallow or CT, or who have progressed to high-grade dysplasia in Barrett's oesophagus are assessed for surgical or endoscopic intervention. Laparoscopic Nissen fundoplication - where the gastric fundus is wrapped around the lower oesophagus to recreate the anti-reflux barrier - is the gold-standard surgical treatment for GERD, producing durable reflux control in 85–90% of carefully selected patients at 10-year follow-up. The LINX magnetic sphincter augmentation device is an alternative for patients who wish to retain the ability to vomit or belch. High-grade dysplasia in Barrett's oesophagus is treated endoscopically with radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR) rather than oesophagectomy.

Happy Patients & Their Case Stories

"I had been taking antacids every single night for three years. A friend told me to see a specialist. At Shree Hospitals they did an endoscopy and found Grade C oesophagitis - I had no idea my throat was that damaged. On the right dose of PPI taken at the right time, I was symptom-free within six weeks."

Mr. Ramesh K.

"My GERD wasn't responding to medication and I kept waking up at 3am with acid in my mouth. The doctor at Shree Hospitals did a pH test which confirmed severe nocturnal acid reflux. After laparoscopic surgery I have not needed a single antacid tablet in two years."

Mrs. Anjali S.

How To Identify GERD (Acid Reflux)?

The two cardinal symptoms of GERD are heartburn - a burning sensation rising from the upper abdomen into the chest and sometimes reaching the throat - and regurgitation, the effortless return of sour or bitter stomach contents into the mouth without nausea or retching. These symptoms are typically worse after large meals, after lying down, when bending forward, and at night. Waterbrash - a sudden flood of watery saliva into the mouth triggered by oesophageal acid - and globus sensation - a persistent feeling of a lump in the throat that cannot be swallowed away - are less well-known but common GERD symptoms that often go unrecognised and are attributed to anxiety.

Beyond these classic oesophageal symptoms, GERD frequently causes extra-oesophageal manifestations that are not initially identified as acid reflux. Chronic dry cough - particularly worse when lying down or after meals - is the most common extra-oesophageal GERD symptom and is frequently misdiagnosed and treated as asthma, post-nasal drip, or idiopathic chronic cough for years before the acid cause is identified. Reflux laryngitis presents as hoarseness, frequent throat clearing, and a sensation of throat irritation - symptoms attributed to voice strain or viral laryngitis rather than the acid bathing the larynx nightly. Reflux-triggered bronchospasm worsens asthma control. Dental enamel erosion on the palatal surfaces of the upper teeth, identified by the dentist before the patient reports any heartburn, can be the first sign of significant nocturnal acid reflux.

When Symptoms Demand Urgent Gastroenterology Assessment:

The following features should prompt immediate referral - they are alarm symptoms that can indicate complications of GERD or an alternative serious diagnosis:

Dysphagia (difficulty swallowing, food sticking in the chest or throat) - could indicate oesophageal stricture or cancer
Odynophagia (painful swallowing)
Unexplained weight loss of more than 5% body weight over 3–6 months
Haematemesis (blood in vomit) or melaena (black tarry stools indicating upper GI bleeding)
Iron-deficiency anaemia without obvious cause
New onset of reflux symptoms after the age of 50 in a patient with no previous history
Persistent vomiting unrelieved by standard reflux therapy
Palpable upper abdominal mass on examination

Any of these alarm features requires urgent endoscopy and should not be attributed to simple reflux without investigation. Contact Shree Hospitals immediately on 1800-268-4000.

Important FAQs: GERD (Acid Reflux)

Is GERD a permanent condition or can it be cured?

GERD is caused by a structural weakness of the lower oesophageal sphincter - the valve between the oesophagus and stomach - that allows stomach acid to reflux upwards. This structural problem does not resolve spontaneously. However, in many patients, lifestyle modification - particularly weight loss - significantly reduces reflux frequency and severity, sometimes to the point where medication is no longer required. For the majority of patients, long-term PPI therapy provides effective symptom control and mucosal healing. For patients who require lifelong high-dose PPIs or who have a significant hiatus hernia, laparoscopic fundoplication provides durable mechanical correction. The distinction is between controlling reflux symptoms and correcting the underlying anatomical defect - only surgery achieves the latter.

Is it safe to take PPIs long-term?

PPIs have an excellent safety profile across decades of clinical use and are one of the most extensively studied drug classes in gastroenterology. Long-term use is associated with small risks of hypomagnesaemia, vitamin B12 and calcium malabsorption, a modest increase in Clostridioides difficile infection risk, and, based on some observational studies, a potential association with chronic kidney disease and dementia - though causality in the latter associations remains unproven. For patients with confirmed GERD and oesophagitis or Barrett's oesophagus, the risk of untreated GERD - oesophageal cancer - substantially outweighs the risks of PPI therapy. At Shree Hospitals, we review the indication for PPI therapy annually and use the lowest effective dose for each patient.

What is Barrett's oesophagus and how dangerous is it?

Barrett's oesophagus is the replacement of the normal squamous cell lining of the oesophagus with intestinal-type columnar cells - a change driven by chronic acid exposure. It develops in approximately 10–15% of people with long-standing GERD. Barrett's oesophagus is a pre-malignant condition that carries a risk of approximately 0.5–1% per year of progressing to oesophageal adenocarcinoma. The vast majority of people with Barrett's oesophagus will never develop cancer, but the ones who do develop it generally do so without warning symptoms - which is why structured endoscopic surveillance with regular biopsies is essential. High-grade dysplasia detected in Barrett's oesophagus is now treated endoscopically (radiofrequency ablation or EMR) with excellent outcomes, eliminating the abnormal tissue before it becomes invasive cancer.

My endoscopy was normal but I still have daily heartburn. What does that mean?

A normal endoscopy in a patient with persistent heartburn suggests one of two diagnoses: non-erosive reflux disease (NERD) or functional heartburn. In NERD, acid reflux is occurring at abnormal levels but the oesophageal mucosa has not been visibly damaged - confirmed by 24-hour pH-impedance monitoring showing elevated acid exposure. In functional heartburn, acid exposure is normal but the oesophageal sensory nerve system is hypersensitive, perceiving normal levels of acid as painful (visceral hypersensitivity). These two conditions require different treatment approaches - optimised PPI therapy for NERD, and neuromodulatory agents (low-dose tricyclics or SSRIs) alongside gut-brain axis therapy for functional heartburn. The 24-hour pH-impedance test performed at Shree Hospitals distinguishes between these diagnoses reliably.

What foods should I completely avoid with GERD?

The foods with the strongest evidence for worsening GERD by reducing lower oesophageal sphincter pressure or increasing gastric acid secretion include: coffee (both caffeinated and decaffeinated), alcohol (particularly wine), high-fat meals, chocolate, peppermint, tomato products, carbonated beverages, onions, and citrus fruits. In Indian diets, large heavy meals eaten close to bedtime - a culturally common pattern - are a major reflux driver, as are fried foods, rich curries, and spicy foods in susceptible individuals. The clinical impact of dietary triggers varies substantially between individuals. We recommend a 4-week elimination trial of the highest-risk foods, followed by systematic reintroduction to identify each patient's specific personal triggers rather than applying a generic restriction list.

Can GERD cause chronic cough or asthma?

Yes - and this association is substantially underdiagnosed. Acid refluxing into the lower oesophagus triggers a vagally mediated reflex arc that stimulates cough receptors and can cause bronchospasm, even when acid does not reach the larynx or trachea. Micro-aspiration of acid into the airway - particularly during sleep - directly irritates the bronchial mucosa and can worsen asthma that is otherwise difficult to control. Reflux laryngitis - caused by acid vapour or micro-droplets reaching the larynx - produces chronic hoarseness, throat clearing, and a sensation of a lump in the throat. If you have unexplained chronic cough, voice hoarseness, or worsening asthma despite optimised inhaler therapy, GERD should be actively investigated rather than assumed to be absent because classic heartburn is not present.

Treatments for GERD

Diagnostic Endoscopy & 24-Hour pH-Impedance Monitoring

At Shree Hospitals, upper GI endoscopy examines the oesophagus, stomach, and duodenum to identify oesophagitis, Barrett’s oesophagus, hiatus hernia, strictures, and early malignancy. It is performed under conscious sedation and usually takes 15–20 minutes. For persistent symptoms despite normal endoscopy, 24-hour pH-impedance monitoring can confirm acid reflux and correlate symptoms with reflux episodes.

Optimised PPI Therapy & Medical Reflux Management

At Shree Hospitals, GERD treatment begins with reviewing PPI choice, dose, timing, and duration. PPIs are usually taken 30 minutes before the morning meal. Treatment may include alginates or other medicines for breakthrough symptoms, along with reviewing reflux-triggering medications. Diet and lifestyle changes are also advised for better long-term control.

Barrett's Oesophagus Surveillance & Endoscopic Treatment

Patients with Barrett’s oesophagus at Shree Hospitals receive regular endoscopic surveillance based on dysplasia grade. Non-dysplastic Barrett’s is usually monitored every 3–5 years, while dysplasia may require closer follow-up or treatment. High-grade dysplasia can be treated with endoscopic therapies such as RFA or EMR, reducing the risk of progression to oesophageal cancer.

Laparoscopic Anti-Reflux Surgery (Fundoplication)

For selected GERD patients who remain dependent on high-dose PPIs, have a large hiatus hernia, or prefer surgery, laparoscopic Nissen fundoplication can provide long-term reflux control. The LINX procedure is another option that uses magnetic sphincter augmentation. Both are considered after careful evaluation and patient selection.