What Is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease (GERD) is a common condition that occurs when stomach contents or stomach acid move back up into the esophagus. Acid reflux becomes GERD when it causes chronic or severe symptoms. GERD may cause damage to the esophagus, pharynx, or respiratory tract. Most cases of GERD can be managed with lifestyle changes and medications. Less commonly, surgery may be recommended to alleviate more severe symptoms.

Symptoms

There are many symptoms of GERD. The most common symptoms include:

• Burning sensation: This is more common at night or worse after eating or when laying down. The stomach acid burns the tissues in your esophagus, causing a burning sensation. If it is closer to your stomach, it is called acid indigestion. If it is closer to your chest, it is called heartburn.
• Backwash: This occurs when food, acid, or liquids backwash from the stomach into your throat after eating (also known as regurgitation). This can cause a sour taste in your mouth.
• Nausea: The backwash of acid and stomach contents may cause nausea and a loss of appetite. Sometimes even if you have eaten several hours prior, you may feel the sensation as if there is still more food to digest.
• Noncardiac chest pain: Some people may experience GERD symptoms similar to heart-related pain. This is because esophagus pain triggers the same nerves as heart-related pain does.
• Asthma symptoms: Sometimes GERD can cause symptoms of asthma, such as coughing, wheezing, and shortness of breath. If the acid particles get into the airways, it can cause them to contract.
• Sore throat: The acid backwashing into the throat can sometimes cause a sore throat. It may also feel like you have a lump in your throat or that it is difficult or painful to swallow.

Things that may make GERD symptoms worse:

• Time of day (nighttime is usually worse)
• Laying down, specifically at night or after a large meal
• Eating a large or fatty meal
• Bending over
• Smoking or drinking alcohol

Other conditions that can worsen symptoms of GERD include:

• Anxiety
• Pregnancy
• Asthma
• Irritable bowel syndrome

Causes

GERD is caused by chronic acid reflux or reflux of nonacidic content from the stomach. Specifically, GERD occurs when the contents of the stomach get back up through the valve at the bottom of your esophagus. This happens when the valve, known as the lower esophageal sphincter (LES), weakens or relaxes too often and does not keep the food from coming back up into the esophagus. Lying down after a large meal can often relax your LES.

Other conditions that may contribute to weakening the LES include:

• Occasional acid reflux that becomes chronic
• Hiatal hernia
• Pregnancy
• Obesity
• Smoking
• Birth defects (esophageal atresia and hernias)
• Connective tissue diseases (scleroderma, rheumatoid arthritis, lupus, or Ehlers Danlos Syndrome)
• Prior surgery (surgery in your chest or upper abdomen)
• Certain medications (benzodiazepines, calcium channel blockers, tricyclic antidepressants, NSAIDs, theophylline, or hormone therapy medications for menopause)

What Is the Most Common Cause of GERD?

The most common cause of GERD is when the contents of your stomach back up into your esophagus. This is caused by the lower esophageal sphincter (LES) not functioning appropriately and allowing stomach contents to flow back up into the esophagus.

What Foods Trigger GERD?

There are many foods that can trigger GERD. The most common food triggers include:

• Chocolate
• Coffee
• Alcohol
• Onions
• Garlic
• Mint
• Fatty or fried foods
• Spicy foods
• Certain fruits (tomato, pineapple, or citrus)
• Carbonated drinks

Complications of GERD

There are several complications that can arise from GERD. Complications include:

• Esophagitis: This occurs when there is inflammation of the tissue in the esophagus. Stomach acid breaks down the tissue in the esophagus, which can lead to inflammation, bleeding, or ulcers. Esophagitis can be painful, making swallowing difficult.
• Esophageal stricture: This condition occurs when there is a narrowing of the esophagus. The narrowing can be caused by scar tissue that has formed because of stomach acid. The scar tissue causes a narrowing of the food pathway, which makes it more difficult to swallow.
• Barrett's esophagus: This condition occurs when there are precancerous changes to the esophagus. Damage from stomach acid can develop changes in the tissue lining of the lower esophagus. The changes create an increased risk of developing esophageal cancer.

Barrett’s Esophagus

Barrett’s esophagus is a condition that occurs when there are precancerous changes to the esophagus. When there has been damage to the tissue lining of the lower esophagus from the stomach acid, it causes an increased risk for developing esophageal cancer.

Dental Erosion

Chronic acid reflux or GERD can cause tooth enamel erosion, gum disease, and other dental problems.

Diagnosis of GERD

There are several ways GERD can be diagnosed. To begin, your healthcare provider will conduct a physical examination and take a history of your symptoms. Additionally, your healthcare provider may recommend further testing to confirm a diagnosis of GERD, check for complications, or rule out other conditions. Tests may include:

• Upper endoscopy
• Ambulatory acid (pH) probe test
• X-ray of the upper digestive system
• Esophageal manometry
• Transnasal esophagoscopy

Treatment of GERD

GERD can be managed with several different treatments. The first level of treatment your healthcare provider may suggest includes lifestyle changes, such as changing the foods you consume, limiting alcohol and smoking, and losing weight.

In addition to lifestyle changes, your healthcare provider may recommend medications that help to reduce your stomach acid, which prevents the reflux from being as damaging. Medications include:

• Over-the-counter medications:
  • Antacids (Tums, Rolaids, Pepcid)
  • Alginates (naturally occurring sugars from seaweed)
• Prescription medications:
  • Histamine receptor antagonists (H2 blockers)
  • Proton pump inhibitors (PPIs)
  • Baclofen (muscle relaxant)

Medication usually reduces the symptoms and effects of GERD, but it does not stop it from happening. More severe cases of GERD may require surgery. Typically, these types of surgery are minor outpatient procedures. Surgeries for GERD include:

• Nissen fundoplication: This is the most common surgery for GERD. Typically, it is performed as a laparoscopic surgery. During the surgery, your surgeon will wrap the top of your stomach around the lower esophagus and bind them together with stitches, securing the connection between them.
• LINX device: This is a newer procedure that implants a device called LINX into the space between your stomach and esophagus. The device is a ring of tiny magnets that work to keep the valve or connection between the stomach and esophagus closed.

Preventing GERD

There are several preventative measures a person can take to try to prevent developing GERD. A person is diagnosed with GERD only after symptoms of acid reflux become chronic or severe. Most people experience acid reflux from time to time. Preventative measures include:

• Maintain a healthy weight
• Avoid eating foods that may trigger acid reflux
• Limit alcohol intake
• Stop smoking
• Reduce stress
• Using antacids