Gastroesophageal Reflux Disease
Gastroesophageal reflux disease, or GERD, is also called chronic acid reflux. GERD is a common gastrointestinal disorder that affects about 20% of Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
While occasional heartburn is normal, frequent and untreated GERD can lead to a range of serious complications.
What Is GERD?
The lower esophageal sphincter, or LES, is a strong ring of muscle where the esophagus connects to the stomach. Normally, the lower esophageal sphincter relaxes to allow food to pass, then closes to prevent digestive fluids from leaking, or refluxing, back into the throat. A weakened or damaged lower esophageal sphincter leads to reflux, which irritates and erodes esophageal tissue, resulting in frequent reflux or heartburn, the most common symptom of GERD.
Causes of GERD
While the exact causes of GERD are unknown, several factors increase the risk of developing GERD, including:
- Abnormal LES function: such as transient LES relaxations, in which the LES spontaneously relaxes outside the usual swallowing triggers
- Dietary Choices: eating certain foods known to trigger GERD symptoms can worsen the condition
- Hiatal Hernia: When a portion of the stomach bulges through an opening in the diaphragm, the muscle that divides the chest and abdomen, it can contribute to GERD
- Obesity: Excess body weight increases the likelihood of GERD
- Physical inactivity: A sedentary lifestyle can exacerbate the condition
- Smoking: Tobacco use is a known risk factor
- Certain medications: use of certain medications such as nonsteroidal anti-inflammatory drugs or calcium channel blockers used in high blood pressure medicines may increase the risk of GERD
Signs and Symptoms of GERD
Occasional heartburn is normal, but frequent heartburn that happens more than twice a week may be a sign of GERD. Additional symptoms may include:
- chest pain
- chronic cough
- difficulty swallowing
- hoarseness or raspy voice
- nausea or vomiting
- sleep disturbances
- red, inflamed gums and bad breath
- regurgitating sour or bitter-tasting fluid
- sore throat
- trouble swallowing
- wearing of tooth enamel
How Is GERD Diagnosed?
GERD is diagnosed based on a physical examination and review of symptoms. To confirm a diagnosis of GERD and evaluate any complications, additional tests may be performed, including:
- Endoscopy: in which a flexible, lighted tube is used to examine the esophagus and upper stomach for abnormalities
- Esophageal impedance test: evaluates the movement of acidic and non-acidic fluids in the esophagus
- Esophageal pH (acid) monitoring: a test that tracks how often acid reflux enters the esophagus
- Esophageal X-ray: also called a barium swallow test or esophagogram, an imaging study to check the esophagus for GERD-related damage
The Risks of Long-Term GERD
Living with untreated GERD poses significant risks, even if symptoms are managed with medications like Proton Pump Inhibitors, or PPIs. The potential consequences of long-term GERD include:
Esophagitis: The repeated contact between stomach acid and the esophageal lining can cause erosions, leading to pain, inflammation, and ulcers.
Barrett’s Esophagus: In about 10% of patients, chronic GERD can lead to Barrett’s Esophagus, a precancerous condition. This increases the risk of developing adenocarcinoma cancer of the esophagus, a potentially fatal condition. Around 1 in 300 people who develop Barrett's Esophagus will develop esophageal cancer.
This condition can be diagnosed by doing an upper endoscopy or EGD.
Esophageal Strictures: As GERD persists, scar tissue may accumulate, resulting in strictures. These strictures can lead to difficulty swallowing, eating, and drinking.
A new, revolutionary implant called the LINX can be a long-term solution that enhances the lower Esophageal sphincter. The LINX is placed laparoscopically around the outside of the esophagus, which assists in holding back stomach acid from flowing back up into the esophagus or throat.
Treatments for GERD
Early diagnosis and prompt treatment for GERD can help prevent a variety of serious complications.
Treatment for GERD focuses on managing symptoms and minimizing complications. Options depend on the severity of symptoms and the extent of any esophageal damage. Initial treatment for GERD typically involves changing behaviors and habits that may be making symptoms worse.
- Eat more than two hours before bedtime.
- Get more physical activity.
- Limit portion sizes.
- Maintain a healthy weight.
- Quit smoking if applicable.
- Raise the head of the bed by 6 to 10 inches to prevent reflux
- Wear loose-fitting clothing.
Avoid GERD food triggers, including:
- Coffee, citrus fruits and tomatoes
- Carbonated drinks
- Chocolate, garlic, and peppermint
- Fatty or fried foods
- Spicy foods
If lifestyle changes are not effective at managing GERD symptoms, additional treatment options may include:
- Medications. Over-the-counter antacids help relieve heartburn. Prescription medications including H2 blockers or proton pump inhibitors reduce the production of stomach acid.
- Surgery. Fundoplication is the most common surgical procedure for GERD. Several types of fundoplication are available to prevent acid reflux, reinforce the LES, and repair related problems such as hiatal hernia, which can cause GERD.