GERD (gastroesophageal reflux disease) is a chronic condition in which stomach contents go up into the esophagus, causing the condition called acid reflux. This abnormal acid reflux could irritate the lining of the esophagus, causing a burning feeling in your chest commonly known as heartburn.
What is GERD? Acid reflux and heartburn causes
In normal circumstances, a circular band of muscle at the low end of the esophagus (called lower esophageal sphincter) relaxes and opens when you swallow so that food can enter the stomach. It also acts as a valve to prevent stomach contents from rising up into the esophagus from the stomach.
Occasional acid reflux, which is quite common, is often related to eating habits, for instance, lying down right after a meal. However, if you have recurrent acid reflux (e.g. occurs more than twice a week), it is usually defined as GERD which can be caused by other reasons and lead to serious complications.
Acid reflux happens when the lower esophageal sphincter does not work properly due to muscle weakness or relaxation. Heartburn is therefore caused when persistent regurgitation of acid irritates the lining of your esophagus.
Signs and Symptoms of GERD
The major symptom of GERD is heartburn, though other signs and symptoms can also develop:
Typical signs and symptoms of GERD:
- Heartburn: A burning sensation in your chest usually after meals, lying, stooping, or straining.
- Regurgitation: It happens when gastric juices (and sometimes undigested food), rises back up the esophagus and into the mouth.
- Waterbrash: It is a condition in which excessive saliva is produced and mixed with gastric acid in your throat during reflux. It usually causes a sour taste in the mouth.
- Belching: Expelling excessive air from the stomach through the mouth.
Atypical signs and symptoms of GERD:
- Difficulty or painful swallowing
- Sore throat and hoarseness
- Chronic cough
- Chest pain
- Non-allergic asthma
- Dental erosions
Sometimes, heartburn (or chest pain) might be confused with the symptoms of a heart attack. If you experience symptoms like shortness of breath, irregular heartbeat, or pain that spreads to the shoulders, neck or arms, you should seek medical help immediately.
Risk factors of GERD
Acid reflux is common, but when the condition is chronic, it can be diagnosed as GERD which can lead to serious complications if untreated. The followings are some contributing factors to acid reflux or GERD:
- Alcohol use
- Delayed gastric emptying
- Connective tissue disorders, such as scleroderma
- Hiatal hernia: It is a condition in which the upper part of your stomach bulges through the diaphragm.
- Medications: Certain drugs can increase the risk of acid reflux, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and calcium channel blockers.
- Eating certain foods: Foods that are high in fat, salt or spice can trigger acid reflux.
- Eating habits: Eating large meals and going to bed or lying down soon after eating increases the risk of acid reflux.
Complications of GERD
GERD itself is not serious or life-threatening. However, chronic GERD can occasionally lead to serious complications if left untreated, including:
- Esophagitis/Esophageal ulcer: Esophagitis is the inflammation in the lining of the esophagus caused by gastric acid. Chronic acid irritation can corrode the tissue in the esophagus and forms an open sore (esophageal ulcer). It can eventually lead to pain, bleeding, and difficulty swallowing.
- Esophageal stricture: Constant irritation of the esophagus by acid can cause scarring on the esophageal lining. Hence, it would narrow the tube, making swallowing difficult.
- Barrett’s esophagus/Esophageal cancer: Barrett’s esophagus is a precancerous condition in which the damage from acid can cause changes in the cells lining the esophagus that resembles the lining of the intestines. Though uncommon, Barrett’s esophagus can sometimes lead to esophageal cancer.
Diagnosis of GERD
Diagnosis of GERD is primarily based on a physical examination and acid reflux symptoms. To confirm a diagnosis or check for GERD’s complications, available tests include:
- Upper endoscopy: A tube with a camera attached is inserted down your throat to examine the lining of your esophagus, stomach and first part of the small intestine (duodenum). A sample of tissue (biopsy) may also be taken to check for any complications.
- Esophageal pH-impedance monitoring: This test is used to measure the amount of acid in your esophagus during everyday life. A thin tube with an acid-sensitive tip is inserted through your nose or mouth into your esophagus. The monitor should be worn for 24 hours.
- Bravo wireless esophageal pH monitoring: Similar to esophageal pH-impedance monitoring, this test measures the pH level of your esophagus. A small chip is placed in your lower esophagus during an endoscopy. The chip records the acid level in your esophagus for 48 – 72 hours and passes through the digestive tract in several days.
GERD / acid reflux treatments
Most of the time, GERD can be well-managed by lifestyle modifications and over-the-counter medications. Seldomly, surgical procedures are needed for severe cases of GERD.
Medications for GERD treatments:
All GERD medications are recommended to accompany lifestyle modifications. Although some of the drugs can be purchased over-the-counter, please consult your doctor or pharmacist before taking any medicines for treating GERD. Medications for GERD treatment include:
- Antacids: Antacids are used to neutralize the acid in the stomach. They are used for quick relief of GERD with mild symptoms only. Examples include Gastrogel® and gastrocaine. Although they are available over-the-counter, overuse of antacids can cause side effects such as constipation and diarrhea. If symptoms are not relieved in 2 weeks, you should seek medical attention.
- H2-receptor antagonists (H2RA): H2RA, which is also known as H2-blockers, can reduce acid production by the stomach. They do not work as quickly as antacids, but they can provide long-term symptomatic relief. Examples are cimetidine, ranitidine, and famotidine.
- Proton pump inhibitors (PPIs): PPIs provide stronger inhibition of acid secretion than H2RA so they are recommended for patients with moderate-to-severe symptoms. Some of them can be purchased without a prescription from a pharmacy, while other PPIs require a prescription from a doctor. PPI examples include pantoprazole, omeprazole, esomeprazole, lansoprazole and rabeprazole.
- Prokinetic agents: Sometimes, metoclopramide and cisapride are used to increase the strength of the lower esophageal sphincter and promote gastric emptying.
Surgery for GERD treatments:
Most GERD cases do not require surgery. However, if lifestyle modification and medications are not effective, or you have developed serious complications of GERD, your doctor might suggest a surgery that includes:
- Nissen fundoplication: This is a minimally invasive procedure for GERD. The surgeon would wrap the upper part of the stomach around the lower part of the esophagus to strengthen the lower esophageal sphincter so as to prevent reflux.
- Transoral Incisionless Fundoplication (TIF): A device (EsophyX) is inserted through the mouth by an endoscope to tighten the lower esophageal sphincter. TIF, which doesn’t require a surgical incision, usually has fewer side effects than traditional fundoplication surgery.
- Use of LINX® device: A ring of tiny magnetic beads called LINX® is implanted to wrap around the lower esophageal sphincter and strengthen it. The device is flexible enough to allow foods to pass through but prevent stomach fluids from refluxing into the esophagus. This is also a minimally invasive surgery and causes less pain.
Home remedies for GERD: Lifestyle modifications
To prevent and relieve the signs and symptoms of GERD, lifestyle modification and medications are typically good enough. Here are some tips of home remedies for acid reflux or GERD:
- Quit smoking
- Achieve and maintain a healthy weight
- Avoid tight clothing
- Elevate the head of the bed 6-8 inches by placing wood or cement blocks under the feet of your bed. (Note that extra pillows do not work.)
- Avoid eating 2-3 hours before sleep or lying down
- Avoid large or fatty meals
- Avoid foods that can trigger and worsen the symptoms, such as chocolate, coffee, peppermint, spicy foods, onions, garlic, tomato products, citrus juices, and alcohol.
Yes, GERD is curable. Most of the time, GERD can be well-managed by lifestyle modifications and over-the-counter medications. Seldomly, surgical procedures are needed for severe cases.
This article was medically reviewed by Dr. Ernest Han Fai Li. Dr. Li is a specialist in gastroenterology and hepatology practicing at the Central Gastroenterology & Hepatology Center currently. Dr. Li served in the public hospital for 12 years after his graduation from the Chinese University of Hong Kong in 2004. At the same time, Dr. Li is a medical consultant to the Hong Kong Fire Service Officers Association, a medical advisor to the Board of Chung Shak-Hei (Cheung Chau) Home for the Aged and the chairperson of the District 303 Lions Club Organ Donation Committee.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.