Gastroesophageal reflux disease (GERD): Causes, symptoms and treatments

Gastroesophageal reflux disease (GERD), also known as chronic acid reflux, is a condition in which acid-containing contents from the stomach leak back into the esophagus, the tube that connects the throat to the stomach.

Acid reflux occurs when a valve called the lower esophageal sphincter (LES), located between the lower end of the esophagus and the stomach, fails to close properly when food enters the stomach.

This causes some stomach content, along with acid, to flow back up the esophagus and into the throat and mouth, leaving you with a sour taste.

 Prevalence of gastroesophageal reflux disease

Almost everyone experiences acid reflux at some point in their lives. The term acid reflux is often used interchangeably with gastroesophageal reflux disease, but they don't exactly mean the same thing.

You experience acid reflux if stomach content flows back occasionally into the esophagus. But, if this happens more often, you may be diagnosed with GERD, a condition that can cause complications, such as inflammation and narrowing of the esophagus.

Determining the number of people with GERD can be challenging because many people with this condition do not consult a doctor. This means there are many undiagnosed cases of GERD.

However, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 20% of people in the United States live with this condition. It is also estimated to affect up to 20% of the population worldwide.

If you experience acid reflux/heartburn more than twice a week for several weeks, it is best you consult a healthcare provider for treatment and medications like antacids and probiotics.

 Causes of GERD

The major cause of GERD is weakness or relaxation of the lower esophageal sphincter. Normally, after food enters your stomach, this valve closes tightly. If it relaxes when it shouldn't, the contents of your stomach flow back into the esophagus.

Factors that can contribute to this include:

• Excessive abdominal pressure, which is common in pregnant people
• Specific foods and eating habits, e.g., eating foods like diary and fried meals
• Medications, such as those for treating asthma, high blood pressure, allergy medications, and pain
• A hiatus hernia (occurs when the upper part of the stomach bulges into the diaphragm, impeding normal food intake)

 Symptoms of GERD

GERD affects people in different ways. The most common symptoms of GERD are:

• Heartburn
• Night sweat
• Retardation (food comes back into your mouth from the esophagus)
• The sensation of food becoming stuck in your throat
• Coughing and chest discomfort
• Difficulties swallowing
• Vomiting
• A scratchy throat and hoarseness

Infants and children can also experience GERD symptoms such as:

• Frequent small vomiting episodes
• Excessive crying and inability to eat (in babies and infants)
• Other respiratory (breathing) problems
• Frequent sour acid taste, particularly when lying down
• Sore throat
• A choking sensation that may cause the child to wake up
• Sleeping difficulties after eating, particularly in infants

 Risk factors of GERD

Factors such as higher BMI or obesity, bulging of the top of the stomach above the diaphragm (hiatal hernia), pregnancy, and connective tissue disorders, such as scleroderma, can all increase the risk of GERD.

Here are some other risk factors of acid reflux:

• Prolonged stomach emptying
• Smoking
• Late-night eating, especially in large quantities
• Consuming certain foods (triggers), such as fatty or fried foods
• Consuming certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin

 Complications

Chronic esophageal inflammation can lead to the following complications over time:

• Esophageal tissue inflammation (esophagitis): Stomach acid can cause tissue breakdown in the esophagus, resulting in inflammation, bleeding, and, in some cases, an open sore (ulcer). Esophagitis can cause pain and difficulty swallowing.
• Esophageal stricture: GERD can cause scar tissues to form in the lower esophagus due to stomach acid damage. The scar tissue narrows the food pathway, causing swallowing difficulties.
• Precancerous esophageal changes (Barrett's esophagus): Acid damage can cause changes in the tissue that lines the lower esophagus. These changes are linked to a higher risk of esophageal cancer.

 Diagnosis

By discussing your symptoms and medical history, your provider can usually tell if you have simple acid reflux (not chronic). Then, your doctor can further discuss managing the symptoms through diet and medication.

If these strategies do not work, your doctor may recommend running other diagnoses to check if you have GERD. Diagnostic methods doctors use to check for GERD include:

 Upper GI endoscopy and biopsy

Here, an endoscope (a long tube with a light attached) is inserted into the mouth and throat to examine the lining of the upper GI tract (esophagus, stomach, and duodenum). A small piece of tissue (biopsy) may also be extracted to be examined for GERD or other health conditions.

 Upper GI series

This involves an X-ray of the upper GI tract to reveal any GERD-related issues. You may be instructed to consume barium, a liquid that moves through your digestive tract, while the X-ray technician takes pictures.

 Esophageal pH and impedance monitoring and Bravo pH test

Both of these tests assess the pH levels in your esophagus. A thin tube is inserted into your stomach through your nose or mouth. Then, you're sent home with a monitor that measures and records your pH while you eat and sleep.

The esophageal pH and impedance monitor will be worn for 24 hours, while the Bravo system will be worn for 48 hours.

 Esophageal manometry

This procedure assesses the ability of the lower oesophagal sphincter and oesophagal muscles to transport food normally from the oesophagus to the stomach. Here, a small, flexible tube with sensors is inserted into your nose. As you swallow, these sensors measure the strength of your sphincter, muscles, and spasms.

 Treatment for GERD

Health practitioners may use the following to help treat or manage GERD:

• Advice on avoiding triggers ( e.g., certain types of food, changing infant formulas) that may be causing or worsening GERD symptoms.
• Medications available without a prescription, i.e., over-the-counter (OTC) medications. However, it is important to speak with a healthcare professional before taking any medication, including OTC medications.
• Probiotics and supplements
• Prescription medications
• Information on proper body positionings, such as remaining upright after eating meals or feeding.
• Surgical procedure (reserved as a last resort or when certain surgical correctable causes are identified).

 When to see a doctor

Seek immediate medical attention if you are experiencing heartburn and acid reflux, especially when accompanied by other symptoms, such as shortness of breath and jaw or arm pain. These could be symptoms of a heart attack. You should also make an appointment with your doctor when you:

• Have severe or frequent GERD symptoms
• Use over-the-counter heartburn medications more than twice a week

 Conclusion

GERD is a common condition that is often diagnosed via a physical examination, checking medical history, and running some tests. Over the years, several risk factors, such as smoking and obesity, have been identified in the pathogenesis of GERD.

Some people experience mild symptoms of GERD, while others experience severe symptoms. Whether your symptoms are mild or severe, it is advisable to speak with a doctor about how you feel so you can get an appropriate diagnosis and treatment.