Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). Food travels from your mouth to the stomach through your esophagus. GERD can irritate the food pipe and cause heartburn and other symptoms.

Causes

When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter (LES).

When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus. Being pregnant is a major risk factor for GERD due to increased pressure on the abdomen and hormonal changes.

Some pregnant women experience heartburn as often as every day. Other causes and risk factors:

• Consuming alcoholic, caffeinated, or carbonated beverages
• Eating certain foods, such as chocolate, citrus fruits, onions, peppermint, tomatoes, spicy, or fried foods
• Eating large meals
• Eating before bed
• Lying flat soon after eating
• Taking certain medications like aspirin, other medications including certain drugs for asthma, high blood pressure, allergies, depression, sleep disorders, and pain.

Symptoms

Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth, or have heartburn. However, if these GERD symptoms interfere with your daily life it is time to see your physician.

Other symptoms that occur less frequently but can indicate that you could have GERD are:

• Acid regurgitation 
• Difficulty or pain when swallowing
• Sudden excess of saliva
• Chronic sore throat
• Laryngitis or hoarseness
• Inflammation of the gums
• Cavities
• Bad breath
• A recurrent or chronic cough
• Chest pain

Diagnosis

Usually, your provider can tell if you have simple acid reflux (not chronic) by talking with you about your symptoms and medical history. You and your provider can talk about controlling your symptoms through diet and medications. If these strategies don’t help, your provider may ask you to get tested for GERD. Tests for GERD include:

• Upper gastrointestinal GI endoscopy and biopsy: Your provider feeds an endoscope (a long tube with a light attached) through your mouth and throat to look at the lining of your upper GI tract (esophagus and stomach and duodenum). The provider also cuts out a small bit of tissue (biopsy) to examine for GERD or other problems.
• Upper GI series: X-rays of your upper GI tract show any problems related to GERD. You drink barium, a liquid that moves through your tract as the X-ray tech takes pictures.
• Esophageal manometry: A manometry tests the functionality of the lower esophageal sphincter and esophageal muscles to move food normally from the esophagus to the stomach. Your provider inserts a small flexible tube with sensors into your nose. These sensors measure the strength of your sphincter, muscles, and spasms as you swallow.

Treatment

To prevent and relieve symptoms of GERD, your doctor might encourage you to make changes to your eating habits or other behaviors.

They might also suggest taking over-the-counter medications, like:

• Antacids
• H2 receptor blockers
• Proton pump inhibitors (PPIs)

In some cases, they might prescribe stronger H2 receptor blockers or PPIs. If GERD is severe and not responding to other treatments, surgery might be recommended.

When To See A Doctor

Seek immediate medical care if you have chest pain, especially if you’re experiencing shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you:

• Experience severe or frequent GERD symptoms
• Take over-the-counter medications for heartburn more than twice a week

Summary 

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backward flow of stomach contents into the esophagus, leading to symptoms such as heartburn and irritation of the esophageal lining. According to the National Institutes of Health, approximately 20% of adults in the United States experience. GERD symptoms regularly, with an estimated 7-10% of the population suffering from the condition daily.

The lower esophageal sphincter (LES), a ring of muscle at the lower end of the esophagus, typically prevents this reflux. When the LES does not close properly, it allows stomach acids to escape, causing discomfort. Major risk factors for GERD include pregnancy, which affects 48-50% of pregnant women due to increased abdominal pressure and hormonal changes, and lifestyle choices such as consuming alcohol, caffeine, or certain foods like chocolate and spicy dishes.

Common symptoms of GERD include heartburn, acid regurgitation, difficulty swallowing, and chronic sore throat, among others. The prevalence of these symptoms leads many individuals to seek medical help; studies indicate that nearly 60% of people with GERD experience heartburn at least once a month. Although occasional reflux is normal, persistent symptoms warrant medical evaluation. Diagnosis usually involves discussing symptoms and medical history with a healthcare provider. If necessary, tests such as upper gastrointestinal endoscopy, X-rays, or esophageal manometry may be conducted to assess the condition.

Treatment options typically focus on lifestyle modifications, such as dietary changes, weight management, and avoiding lying down after meals. Over-the-counter medications, including antacids, H2 receptor blockers, and proton pump inhibitors (PPIs), are often recommended to alleviate symptoms. Research indicates that PPIs can provide relief for about 80% of patients with GERD. In severe cases that do not respond to medication, surgical intervention may be considered, with a reported success rate of 85-90% for procedures like fundoplication.

Patients should seek immediate medical attention if they experience chest pain accompanied by shortness of breath or arm pain, as these symptoms may indicate a heart attack. Additionally, individuals experiencing frequent or severe GERD symptoms or relying on over-the-counter medications more than twice a week should consult their doctor for further evaluation and treatment options.

Disclaimer

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about gerd or any other medical condition, please see a doctor for an accurate diagnosis and personalized treatment suggestions.