Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal reflux disease (GERD) refers to the condition that occurs when stomach acid frequently flows back into your esophagus. It affects people of all ages, with 20 percent of people in the U.S. suffering from the condition, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). GERD can result in serious complications such as Barrett’s esophagus if it goes untreated.

What Causes GERD?

When you swallow, a ring of muscle around the lower end of your esophagus (lower esophageal sphincter) usually relaxes to let food flow into your stomach. It then closes to prevent the backward flow of stomach contents into your esophagus.

However, the sphincter may become weak or relax abnormally, allowing stomach acid to move up into your esophagus.

Risk factors for GERD

Acid reflux is a common occurrence due to factors such as eating certain foods, drinking certain beverages, eating large meals, and lying down soon after eating. However, you’re more likely to have recurrent acid reflux, i.e., GERD, if you:

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Are overweight or obese
Are pregnant
Smoke or regularly inhale secondhand smoke.
Take certain medications, including painkillers and calcium channel blockers.
Have certain conditions such as a hiatal hernia and connective tissue disorders like lupus and scleroderma
Have delayed gastric emptying

Gastroesophageal Reflux Disease Symptoms

The most common symptom of gastroesophageal reflux disease (GERD) is heartburn. Heartburn refers to that burning feeling you experience in your chest just behind your breastbone. The pain may sometimes radiate in your neck or throat. However, you may have GERD without heartburn.

Other common symptoms of GERD include:

Regurgitation of food or liquids, causing a sour or bitter taste in your mouth
Bad breath
Nausea that may result in vomiting
Difficulty swallowing or painful swallowing
Respiratory problems, such as asthma, dry, chronic cough, chest congestion, and pneumonia
Dental erosion, i.e., the wearing away of your teeth surface
Chest pain

GERD Diagnosis

If you suspect you have GERD, make an appointment with your doctor to avoid further complications. He/she may, in turn, refer you to a gastroenterologist to diagnose and treat GERD. A gastroenterologist is a doctor who specializes in the diagnosis and treatment of digestive disorders.

Your doctor or gastroenterologist may diagnose GERD by conducting a physical exam and reviewing your symptoms. They may also use several tests to confirm a GERD diagnosis, including:

Upper endoscopy. In this procedure, an endoscope (a thin, flexible tube with a small camera mounted on it) is inserted down your throat to examine your esophagus, stomach, and duodenum. Your doctor may also use an endoscope to perform a biopsy by collecting a tissue sample from your esophagus lining.
Upper gastrointestinal (GI) series. An X-ray examination of your upper gastrointestinal tract, i.e., your mouth, esophagus, stomach, and duodenum.
Esophageal pH and impedance monitoring. The procedure identifies when acid comes up your esophagus and measures the amount that refluxes while you eat, sleep, or perform other regular activities.
Esophageal manometry. A gastroenterologist uses this test to measure muscle contractions in your esophagus and measure your LES’s strength.

GERD Treatment

Lifestyle changes

Following a GERD diagnosis, your doctor will likely recommend you first try making lifestyle changes to reduce your GERD symptoms. These may include:

Losing weight if you’re obese or overweight to avoid putting pressure on your abdomen
Limiting your meal sizes to avoid overeating; try eating small frequent meals in place of three large meals.
Eating slowly and chewing your food thoroughly.
Avoiding foods and drinks that trigger or aggravate acid reflux. These include spicy foods, fatty/fried foods, chocolate, citrus fruits and juices, caffeinated drinks, alcohol, carbonated beverages, peppermint, onions and garlic, and tomato products.
Waiting at least 3 hours after eating to go to sleep or lie down
Elevating the head of your bed 6 to 8 inches using blocks or foam wedge to prevent the backward flow of stomach contents while you sleep
Wearing loose-fitting clothes since those that fit tightly around your waist put pressure on your stomach and lower esophageal sphincter.
Quitting smoking and avoiding exposure to secondhand smoke as smoking relaxes your LES

Over-the-counter and prescription medicines

If your symptoms persist despite lifestyle and dietary changes, your doctor may recommend trying over-the-counter medications or prescription medications. Options include:

Antacids (e.g., Mylanta, Rolaids, Maalox, and Tums): these medications help neutralize stomach acid. Side effects may include diarrhea and constipation.
H-2-receptor blockers: the medications help reduce stomach acid production. Examples include cimetidine (Tagamet HB), nizatidine (Axid AR), and famotidine (Pepcid AC).
Proton pump inhibitors (PPIs): PPIs work by blocking and decreasing stomach acid production, allowing any damaged esophageal tissue time to heal. Available types of PPIs include lansoprazole (Prevacid), esomeprazole (Nexium), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and rabeprazole (AcipHex).
Prokinetics: these speed up stomach emptying and include bethanechol (Urecholine) and metoclopramide (Reglan). However, they may cause side effects such as diarrhea, nausea, fatigue, anxiety, depression, and delayed or abnormal physical movement.
Antibiotics: Antibiotics, such as erythromycin, can also help with faster gastric emptying. Erythromycin has fewer side effects than prokinetics, but diarrhea is a possible side effect.

Surgery

If lifestyle changes and medications fail to control your GERD symptoms, your gastroenterologist may recommend the following surgical procedures:

Fundoplication. A minimally invasive surgery where the upper part of your stomach is wrapped around your lower esophageal sphincter to tighten it and reduce or prevent reflux. Fundoplication uses a technique called laparoscopy.
LINX surgery. In this procedure, the surgeon wraps a band of tiny magnetic beads (LINX device) around your LES to strengthen it. The surgery is also minimally invasive.
Transoral incisionless fundoplication (TIF). An alternative to fundoplication, which involves partially wrapping the top of your stomach around the LES using durable plastic fasteners. No incisions are required, just an endoscope that gets inserted through your mouth.

Summary

GERD can be defined as chronic acid reflux. It may lead to symptoms such as heartburn, regurgitation, respiratory problems, and nausea. If left untreated, it may cause severe complications.

These may include esophagitis, Barrett’s esophagus, asthma, laryngitis, esophageal stricture, and esophageal ulcers. To help control your GERD symptoms, a gastroenterologist may recommend lifestyle changes, OTC and prescription medication, or surgery.

References ⌵

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