A Patient’s Story
James had been struggling with frequent heartburn for several months. One evening, after a particularly large dinner, he experienced sudden vomiting. Alarmed, he wondered if this could be related to his GERD.
Â
At LSDC, a thorough evaluation revealed that while vomiting is not a common primary symptom of GERD, it can occur in severe or complicated cases. Understanding the potential connection helps patients like James manage symptoms more effectively and prevent complications.
Understanding GERD
Gastroesophageal Reflux Disease (GERD) is a common gastrointestinal disorder where stomach acid flows back into the oesophagus, causing irritation. Typical symptoms include:
Heartburn
Regurgitation of food or acid
Chest discomfort
Cough or throat irritation
While these are the hallmark signs, some patients also experience nausea and vomiting, which may indicate more severe reflux or related complications.
Why Vomiting Can Occur in GERD
Vomiting is not usually a primary symptom of GERD, but several mechanisms can contribute:
Â
Severe Reflux Episodes: Intense or prolonged acid reflux can irritate the oesophagus and trigger the body’s defence mechanisms, including vomiting.
Aspiration of Gastric Contents: In rare cases, refluxed stomach contents may enter the airways, stimulating the gag reflex and leading to vomiting.
Delayed Gastric Emptying: GERD can sometimes slow the stomach’s emptying, causing fullness, nausea, and vomiting.
Hiatal Hernia: An anatomical change where part of the stomach pushes into the chest cavity can exacerbate reflux and induce vomiting.
At LSDC, we see patients with varying severities of GERD, and identifying the underlying cause is essential to prevent recurrent vomiting and complications.
When Vomiting Warrants Further Investigation
Persistent or severe vomiting may signal complications of GERD or overlapping conditions:
Â
Esophagitis: Inflammation of the oesophagus due to chronic acid exposure.
Barrett’s Oesophagus: A precancerous change in the oesophageal lining in response to long-standing acid exposure.
Peptic Strictures: Narrowing of the oesophagus from chronic damage, making swallowing and vomiting more likely.
Medication Side Effects: Some medications used to manage reflux can occasionally affect gastric motility.
Diagnostic tests that may be considered at LSDC include:
Â
Upper endoscopy (gastroscopy) to visualise oesophageal and gastric lining.
24-hour pH or pH-impedance monitoring to assess acid exposure.
Gastric emptying studies if delayed motility is suspected.
Managing Vomiting Related to GERD
Management involves a multimodal approach, tailored to the patient’s symptoms and underlying causes:
Lifestyle Modifications
Maintain a healthy weight to reduce abdominal pressure.
Elevate the head of the bed during sleep.
Avoid large meals close to bedtime.
Limit trigger foods such as citrus, spicy dishes, coffee, and alcohol.
Avoid smoking, which worsens reflux.
Medications
Antacids for quick relief of heartburn and minor nausea.
H2 receptor blockers to reduce stomach acid.
Proton pump inhibitors (PPIs) for more severe or persistent symptoms.
Prokinetic agents in select cases to improve gastric emptying.
Procedural or Surgical Options
For patients with refractory GERD or complications contributing to vomiting, interventions may be considered:
Fundoplication surgery to reinforce the lower oesophageal sphincter.
Endoscopic procedures to reduce reflux episodes.
At LSDC, patients receive a personalised treatment plan that combines lifestyle, medication, and procedural options to manage both reflux and associated vomiting effectively.
