GERD

What Is Gastroesophageal Reflux Disease (GERD)?

You, like many people, may experience gastroesophageal reflux disease or GERD. The condition can irritate the lining of your esophagus when the contents from your stomach flow back upward into your esophagus – a tube that typically carries food from your mouth to your stomach. Many people have acid reflux, or acid ingestion and heartburn occasionally, and it’s not usually a cause for concern. However, if someone experiences persistent acid reflux more than twice a week, it may be diagnosed as gastroesophageal reflux disease (GERD).

According to a report by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), twenty percent of the population suffers from GERD in the United States. If this condition is left untreated, it can cause some serious long-term complications.

Signs & Symptoms of GERD

Patients suffering from GERD may regularly experience heartburn pain in the stomach or chest region. The pain may last for a couple of hours. You may notice your heartburn gets worse after eating a meal.

Regurgitation happens when food or liquid containing stomach acid comes back up into your throat. However, like acid reflux and heartburn, occasional regurgitation is common for everyone.

GERD

GERD patients can experience frequent heartburn pain. | Photo credit: freepik.com

Other common symptoms of GERD include:

  • Burning chest pain
  • Trouble swallowing
  • Sore throat
  • Hoarse voice
  • Dry cough
  • Bad breath
  • Feeling of burping acid into the mouth
  • Bending over or lying down worsens the sensation
  • The frequent sour taste of acid

If you suffer from night-time acid reflux, the symptoms may include:

  • Disrupted sleep
  • Chronic cough
  • Laryngitis
  • New or worsening asthma

What Causes GERD?

Gastroesophageal Reflux Disease Anatomy

The backwash of stomach content into the esophagus is the characteristic feature of GERD. The esophageal and stomach spaces are separated by a small anatomical muscle called the esophageal sphincter. The sphincter opens and lets the food enter the stomach from the esophagus and is responsible for preventing the backflow of food. GERD happens when the sphincter muscles relax at the wrong time or fail to close properly. This can happen due to numerous reasons:

  • In some individuals, the esophageal sphincter naturally doesn’t close properly.
  • In others, the muscles are not well-coordinated and don’t close quickly enough, allowing the stomach contents to spill back into the esophagus.
  • If people consume too much food, their stomach may be so stretched that the esophageal sphincter can’t work correctly.

Risk Factors for GERD

It is still unclear why people get GERD. However, some conditions that may potentially increase your risk of GERD include:

  • Pregnancy
  • Obesity
  • Connective tissue disorders (scleroderma)
  • Hiatal hernia
  • Delayed stomach emptying

Pregnancy

Pregnancy is one risk factor behind GERD. | Photo credit: freepik.com

Some of the factors that can worsen acid reflux and aggravate GERD are:

  • Smoking
  • Intake of certain foods (triggers) e.g., fried food, spicy food
  • Eating large meals
  • Eating late at night
  • Drinking alcohol or coffee
  • Going to sleep shortly after eating
  • Using NSAIDs such as aspirin or ibuprofen

If any of these risk factors are present, taking appropriate steps to modify them can help you prevent or effectively manage GERD.

Long-term Complications of GERD

Gastroesophageal reflux disease doesn’t cause severe complications in most people. But in rare cases, GERD may lead to severe or even life-threatening health problems. Some of the potential health complications of GERD include:

  1. Barrett’s esophagus: involves permanent changes to the lining of your esophagus.
  2. Esophagitis: inflammation of the esophagus.
  3. Esophageal cancer: affects a small number of people suffering from Barrett’s esophagus.
  4. Esophageal stricture: a condition in which the esophagus narrows down and tightens up.
  5. Respiratory problems:  continued breathing of stomach acid into your lungs may lead to chronic cough. Other potential disorders include chest congestion, hoarseness, asthma, and laryngitis.
  6. Dental problems: tooth enamel erosion, gum disease, and other dental diseases.

To lower the severe complications of GERD, you need to take immediate precautions to prevent and treat the clinical symptoms. Seek immediate medical attention to avoid long-term health complications.

How Is GERD Diagnosed?

There are a wide variety of tests, procedures, and evaluation of symptoms to diagnose patients with GERD. A gastroenterologist is a health professional who specializes in gut health. They may ask several questions and perform some tests to diagnose potential GERD.

  • Esophageal pH & impedance monitoring: measures the acid quantity in your esophagus while you are eating, sleeping, or performing other activities.
  • Upper gastrointestinal (GI) endoscope: a fine tube with a camera attached that is used to inspect the inside of your esophagus. It may also take a small tissue sample at the same time for a biopsy.
  • Esophageal manometry:  measures the muscle contractions in your esophagus during the event of swallowing. It estimates the muscle strength of your esophageal sphincter.
  • Upper GI series: a type of specific x-ray that shows certain anatomical abnormalities that might cause GERD.
  • Bravo wireless esophageal pH monitoring:  a small tube is attached to your esophagus, which continually measures acidity for about 36-48 hours.

Doctor

Your gastroenterologist may perform some tests to confirm the diagnosis of GERD. | Photo credit: freepik.com

What Are Treatment Options for GERD?

The treatment plan for GERD depends on the severity of the disease. For some patients, changes in lifestyle and dietary habits is appropriate treatment. Others may need to opt for medications. In very rare cases, especially when GERD is in severe form, a doctor will recommend surgery.

The following changes in lifestyle and dietary habits can help ease the symptoms of GERD:

  • Avoid alcohol
  • Quit smoking
  • If overweight, lose weight
  • Avoid carbonated drinks
  • Avoid clothing that is tight around your abdomen
  • Eat small meals
  • Avoid overeating
  • Don’t lie down shortly after meals
  • Sleep with your head slightly elevated

If your healthcare provider considers that your condition demands medication, they may prescribe drugs to relieve your symptoms. The proton pump inhibitors are the main pharmaceutical treatment methodology for treating patients with GERD. These drugs decrease the amount of acid secreted by your stomach and hence lower the adverse symptoms of acid reflux.

Other medications include:

  • H2 blockers: help to lower the acid production in the stomach.
  • Antacids: counteract the acid produced by your stomach with alkaline chemicals.
  • Erythromycin: an antibiotic that helps in the emptying of the stomach.
  • Prokinetics: help the stomach to empty faster.

Surgical Treatment Options

Surgeon

Surgery is the last resort in any treatment protocol. If the patient’s condition is not improving after making amendments in lifestyle, dietary habits, and taking medications – the gastroenterologist may recommend surgery. Some of the most prominent surgical treatment options include:

  • Fundoplication: a surgical procedure in which the surgeon sews the top of your stomach around the esophagus. It adds pressure at the lower portion of your esophagus, which is generally successful in reducing the reflux.
  • LINX device: a device that is implanted via minimally invasive surgery. A ring of small magnetic beads is installed around the junction of the esophagus and stomach. The magnetic attraction between the tiny beads helps in keeping the junction closed to the refluxing acid but allows food to pass through.
  • Transoral incision-less fundoplication (TIF): uses polypropylene fasteners that are wrapped around the lower esophagus to tighten the junction near the lower esophagus and stomach. TIF is a new procedure and is performed through the mouth with an endoscope.

Bottom Line

GERD is not a very alarming condition by itself. If it is diagnosed early and appropriate treatment is started shortly after, you can effectively manage this illness. However, a delay in diagnosis and necessary medical intervention may lead to more serious long-term complications that can deteriorate your quality of life.

FAQs


Is gastroesophageal reflux disease (GERD) serious?

Yes, if you do not treat it in time. Reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. Long-lasting and untreated GERD can cause cancer or cause permanent damage to the esophagus (for adults).

Can gastroesophageal reflux disease (GERD) be cured?

Yes, it is common to cure acid reflux, though serious complications may come up if it is not treated properly. 

How long does gastroesophageal reflux disease (GERD) take to heal?

The key to healing GERD is to not ignore it. Depending on the stage, 2 to 8 weeks is required for repairing the damage. Keep in mind, the healing rate improves as acid suppression increases. Early diagnosis and treatment may help reduce or even stop uncomfortable symptoms.

How does gastroesophageal reflux disease (GERD) affect the digestive system?

GERD occurs when the upper portion of the digestive tract is weakened or functions abnormally. It causes stomach contents to flow back up into your esophagus.

How can I treat gastroesophageal reflux disease (GERD) naturally?

7 ways to heal acid reflux naturally:
  1. Lose weight if you have extra weight.
  2. Quit smoking (and drinking).
  3. Don’t lie down after eating. The healthiest option would be to walk a bit after a meal.
  4. Eat slowly and take smaller portions. The more you eat at once, the higher chance of acid reflux.
  5. Avoid fast-food, spicy foods, chocolate, tomatoes, garlic, sparkling water, coffee/tea, and alcohol.
  6. Don’t move too fast. Avoid workouts and lifting heavy things for 2-3 hours after a meal.
  7. Head should be higher than your feet during sleep (6 to 8 inches).

What is the main cause of gastroesophageal reflux disease (GERD)?

GERD is caused by frequent acid reflux, which is caused by the weakened lower esophageal sphincter. The sphincter is a bundle of muscles at the lower end of the esophagus. If it relaxes abnormally or weakens, stomach acid flows back into the esophagus.

Is gastroesophageal reflux disease (GERD) permanent?

If not healed – yes. Proper treatment most often will heal acid reflux in 2 to 8 weeks.

How do you cure gastroesophageal reflux disease (GERD) permanently?

The following changes in lifestyle and dietary habits can help ease the symptoms of GERD permanently:

  • Avoid alcohol
  • Quit smoking
  • If overweight, lose weight
  • Avoid carbonated drinks
  • Avoid clothing that is tight around your abdomen
  • Eat small meals
  • Avoid over-eating
  • Don’t lie down shortly after meals
  • Sleep with your head slightly elevated

Bonus video: Gastro-esophageal reflux disease (GERD) – causes, symptoms, diagnosis, treatment, pathology


References:

  1. American College of Gastroenterology. Acid Reflux. Accessed 07/20/2020.
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). Accessed 07/20/2020.
  3. Antunes, C., Curtis, S.A. Gastroesophageal Reflux Disease. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  4. Cruickshank, H. (2019, March 22). Everything You Need to Know About Acid Reflux and GERD. Retrieved on July 18, 2020. From https://www.healthline.com/health/gerd

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