What Is GERD?
Gastroesophageal reflux disease (GERD), also referred to as chronic acid reflux, is a digestive disorder that occurs when stomach acid flows back into the esophagus. When this happens repeatedly, then lining of the esophagus becomes irritated and inflamed.
GERD is among the most common gastrointestinal disorders. The prevalence of GERD is between 18.1% to 27.8% in the United States according to the National Center for Biotechnology Information. The prevalence of this condition is higher in men than in women.
What Causes GERD?
Acid reflux occurs due to the weakness or constant relaxation of the lower esophageal sphincter (LES). When working properly, the LES opens when allowing the food into the stomach and closes once the food has been taken in. This prevents the food and stomach acid from flowing back. When someone has GERD, the LES relaxes when it should not and stomach acid flows backwards into the esophagus.
Here are some factors that could lead to acid reflux:
- Diet. Certain types of foods, such as spicy, greasy, or dairy, may increase the risk of developing GERD.
- Too much pressure on the abdomen. GERD is common during pregnancy because of the increased pressure to the stomach.
- Obesity. Excess belly fat can also cause pressure in the abdominal area.
- Medications. Some over-the-counter and prescription drugs may cause GERD. These medications may include antidepressants, sedatives, painkillers, asthma medications, antihypertensive agents, and antihistamines.
- Hiatal hernia. A bulge in the upper part of the stomach may affect the area around the diaphragm.
Other factors that can trigger GERD are:
- Eating large meals or eating right before going to bed
- Smoking or secondhand smoke
- Drinking soda, coffee, and/or alcohol
What Are the Symptoms of GERD?
The symptoms of GERD may vary from person to person. However, the classic symptom of this disease is acid reflux. This is often described as an uncomfortable feeling in the chest area that can move up to the throat or neck, commonly called “heartburn”. Incidents of acid reflux may last for up to two hours.
Among the common GERD symptoms are as follows:
- Upper abdominal pain or chest pain
- Sour and/or bitter taste at the back of the mouth
- Trouble swallowing or pain when swallowing
- Feeling that there is something stuck somewhere in the throat
If the acid reflux occurs at night, you may also experience:
- Persistent cough
- Laryngitis or inflammation in the vocal cords
- New or worsening asthma
- Sleep problems
Pediatric patients may experience other additional symptoms. These are:
- Frequent vomiting
- Excessive crying
- Not wanting to eat
- Breathing difficulty
- Feeling of choking
How To Diagnose GERD
To confirm a GERD diagnosis, the doctor may recommend undergoing one or more of the following procedures:
- Ambulatory 24-hour pH probe. This is the gold standard for the diagnosis of GERD. It is done by inserting a small tube into the nose down to the esophagus. The tip can measure the pH exposure in the esophagus for an entire 24-hour period.
- Upper endoscopy. This procedure can be done with a biopsy, a flexible tube inserted via the mouth and down the throat. This tube is equipped with a light and a camera. This can help detect inflammation in the esophagus.
- X-ray of the upper gastrointestinal (GI) tract. You will be asked to drink a chalky liquid called barium solution so that the silhouette image of the esophagus and stomach are seen clearly when x-rayed.
- Esophageal manometry. This diagnostic test is done to measure the rhythmic contraction of the lower esophageal sphincter when you swallow.
How To Treat GERD
Commonly, the goal of GERD treatment is to lessen the amount of reflux and prevent damage to the lining of the esophagus. If your acid reflux is not severe, your healthcare provider may start with conservative forms of treatment.
Diet and lifestyle changes are usually suggested to decrease the symptoms of GERD. Here are some of the changes that you may follow:
- Eating small, frequent meals
- Eating slowly and chewing the food thoroughly
- Avoiding food and beverages that can trigger acid reflux, such as spicy and fatty foods, alcohol, and carbonated beverages
- Avoiding tobacco and smoking
- Maintaining a healthy weight
- Elevating the head when sleeping
There are also many available prescription and non-prescription medications used for the management of GERD. The common medications used for acid reflux are:
- Antacids – this type of medication provides quick relief for heartburn by neutralizing the acid in the stomach
- Magnesium hydroxide
- Calcium carbonate
- Aluminum hydroxide
- Magnesium and aluminum hydroxide mixture
- Proton pump inhibitors (PPI) – These medications reduce the production of stomach acid by inhibiting the stomach’s “proton pump”. These are among the most potent drugs prescribed for GERD.
- Histamine-2 receptor blockers – These medications can help decrease the production of acid in the stomach.
Most cases of GERD can be managed by medications and lifestyle changes, yet if they cannot, then your physician may recommend surgery, such as laparoscopic antireflux surgery, LINX device implantation, and transoral incisionless fundoplication.
Once you experience heartburn or acid reflux twice a week over a period of a few weeks despite the use of over-the-counter medications, it is best to see a doctor. Diagnosing GERD early usually makes it easier to manage.
Most people respond well to GERD treatment. However, if acid reflux is left untreated, it could cause serious and potentially life-threatening conditions. Chronic acid reflux may lead to tooth enamel erosion, esophageal stricture, esophagitis, Barrett’s esophagus, and esophageal cancer. To lower the risk of complications, people with GERD should consistently comply with the forms of treatment advised by their doctor.