• Oesophagitis - inflammation of the lower gullet
  

• Barrett's esophagus - changes to the cells of the lower oesophagus, due to the damage done by the long standing acid reflux. Patients with Barrett's oesophagus have higher risk of oesophageal cancer compared to the general population.
  

GERD can be diagnosed by symptoms and the response to medication.

In some cases of GERD, inflammation of the gullet may be seen on endoscopy (a procedure when a flexible tube is placed via the mouth into the gullet and stomach).

• Alcohol
  
• Chocolate
  
• Coffee 
  
• Spicy food
  
• Tea
  
• Citrus fruits
  

• Avoid overeating for each meal
  
• Avoid eating within 2-3 hours before bedtime
  
• Avoid lying down after meals
  
• Eat regular meals
  
• Raise the head of the bed if there is night-time symptoms
  
• Lose weight if you are obese
  

• Antacids acts by neutralising the acidic gastric juice
  
• Prokinetics, refering to drugs that improves the stomach emptying
  
• Histamine-2-receptor antagonists reduces acid production
  
• Proton pump inhibitors (PPI) also decrease acid production, and is more effective than histamine-2-receptor antagonists
  

• Endoscopic and/or symptomatic failure of medical treatment of GERD
  
• Recurrence despite PPI therapy
  
• Volume regurgitation, dysphagia (difficulty swallowing)
  
• Atypical oesophageal and extra-esophageal symptoms
  
• Large hiatal hernias (>4 cm) (upper part of the stomach moves above the diaphragm)
  
• Barrett's oesophagus
  
• Stricture formation (narrowing of the gullet lumen)
  
• Poor oesophageal peristalsis
  
• Prolonged reflux episodes (>5 min) on pH study
  
• Pathological bile testing