Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a digestive condition affecting the bundle of muscles at the low end of the esophagus, where it meets the stomach. These muscles form what is called the lower esophageal sphincter (LES), which constricts to keep stomach contents in the stomach. People with GERD have a weakened LES, resulting in acid indigestion or heartburn when acids and food back up into the esophagus.
Definition & Facts
A chronic digestive disease, gastroesophageal reflux disease occurs when the esophageal lining becomes irritated due to stomach acid backwash into the esophagus. Sometimes stomach content also flows back into this area.
While heartburn and acid reflux are commonly experienced by adults, frequent occurrence of these issues can lead to a GERD diagnosis. Gastroesophageal reflux disease is usually diagnosed when visible damage is present in the esophagus or heartburn and reflux are experienced a few times per week or more.
Symptoms & Complaints
- Burning in the chest and sometimes the throat
- Chest pain
- Dry coughing
- Difficulty swallowing, also known as dysphagia
- Sore throat or hoarseness
- Sour tasting liquid in the mouth
- Regurgitation of food
- Feeling of a lump in the throat
Chest pain is a symptom of GERD. However, chest pain can be an indication of more serious problems, such as a heart attack. When shortness of breath, jaw pain or arm pain are also present, it is important to seek immediate medical attention.
Many people with undiagnosed GERD take over-the-counter heartburn medication frequently. When these types of medicines are used more than a few times each week, it is important to talk to a doctor. Uncontrolled gastroesophageal reflux disease and associated chronic inflammation of the esophageal lining can cause the following:
- Esophageal stricture, which is the narrowing of the esophagus when scar tissue forms. This can cause problems with swallowing.
- Esophageal ulcer, which is when stomach acid causes an open sore that may bleed. Pain and problems with swallowing result.
- Barrett's esophagus, in which changes to the esophageal lining may be a pre-indicator of cancer.
Gastroesophageal reflux disease is caused by frequent backup of stomach acid. This acid reflux results from weakening of the lower esophageal sphincter, a band of muscles that constrict around the entry to the stomach. These muscles form a sphincter responsible for managing flow of food and liquid into the stomach, then closing to keep stomach contents inside. When the muscles are damaged or become weak, stomach acid backflows into the esophagus and heartburn occurs. There are some conditions that may increase the possibility that GERD will occur. Those include:
- Hiatal hernia
- Dry mouth
- Delayed emptying of the stomach
- Scleroderma and other connective tissue disorders
Diagnosis & Tests
Doctors are able to diagnose gastroesophageal reflux disease based upon symptoms like heartburn. A device called an ambulatory acid pH probe test can also be used to measure acid presence in the esophagus over 24 hours. Patients diagnosed with GERD who are being considered for surgery to correct their problems may undergo several tests. These may include:
- An upper digestive system X-ray, also known as an upper gastrointestinal series
- Endoscopy to view the inside of the esophagus
- Biopsy by endoscopy
- Esophageal motility testing, which measures pressure and movement of the esophagus
Treatment & Therapy
GERD symptoms may be treated through use of over-the-counter acid control medications. For people not able to gain relief from these medications, their doctor may prescribe other medications or possibly surgery. There are three primary types of over-the-counter medications used for GERD. These are:
- Antacids that quickly neutralize heartburn-causing stomach acid
- H-2 receptor blockers, which decrease production of stomach acid for up to 12 hours
- Proton-pump inhibitors, medications that block production of acid while also healing the esophagus, such as lansoprazole and omeprazole
If these over-the-counter medications are ineffective, the doctor may provide for prescription-strength versions of H-2 receptor blockers or proton-pump inhibitors. The negative effects of these drugs are that they can increase the risk of fractured bones and vitamin B12 deficiency.
Medications to help the lower esophageal sphincter become stronger while decreasing gastroesophageal reflux can also be prescribed. Fatigue and confusion are commonly experienced side effects of these medications.
If medications do not provide beneficial results, surgery is another option. Laparoscopic surgery to tighten the lower esophageal sphincter or surgical implantation of a ring of magnetic titanium beads to strengthen the sphincter may solve the GERD problem.
Prevention & Prophylaxis
- Fatty foods
- Caffeinated beverages, including colas, coffee, energy drinks and tea
Foods and beverages that irritate the esophageal lining, making gastroesophageal reflux disease more severe, include the following which should be avoided:
- Fruit juices
- Tomato juice
- Tomato sauce
- Citrus fruits
- Carbonated beverages
- Spicy foods
Other measures which can be taken to reduce acid reflux include:
- Quitting smoking
- Eating lighter meals
- Remaining upright for at least three hours after eating
- Losing weight if obese or overweight
- Raising the head of the bed using six-inch blocks for prevention of night acid reflux
- Sleeping on a wedge shaped pillow to elevate the upper body
- Sleeping on the left side of the body
Medications can also cause heartburn or acid reflux, as part of GERD. Medications which can be avoided to prevent acid reflux may include: