Gastroesophageal Reflux Disease (GERD) Latest Facts: Causes, Risk Factors, Symptoms Diagnosis and Treatment

GERD is short for gastroesophageal reflux disease (GERD), a condition in which the contents of the stomach (including acids) back up into the esophagus (the tube through which food passes from the mouth to the stomach and which is located behind the breastbone). The stomach is lined with a mucous membrane that protects it from the action of stomach acid. Because the esophagus has no such protective lining, the acidic contents of the stomach back up (reflux) causing heartburn (also known as dyspepsia).

Esophagus. Courtesy of Olek Remesz

Many people experience occasional heartburn; however, people with GERD are those who experience constant heartburn or other symptoms of GERD. GERD is the most common heartburn-related disorder in the US, affecting between 18.1% to 27.8% of the population. Adults, children, and even infants can suffer from GERD.

Causes

Gastroesophageal reflux occurs when the valve at the bottom of the esophagus (called the lower esophageal sphincter or LES), which normally blocks acid from leaving the stomach, does not work properly. Acids returning from the stomach damage the wall of the esophagus, causing inflammation and pain.

Risk factors for GERD are characteristics that can increase the risk of developing this disease. Among them are:

Being over 50 years old
Taking certain medications (e.g., NSAIDs, antidepressants, calcium channel blockers, corticosteroids)
Being overweight or obese
Asthma
Smoking
Ingesting certain types of foods or beverages
Excess abdominal fat
Pregnancy

The following foods may cause GERD symptoms, but not necessarily GERD itself:

Peppermint
Garlic
Onions
Coffee
Tea
Cola
Chocolate
Highly acidic foods (e.g., tomatoes, orange juice)
Spicy foods
Fried or fatty foods
Alcoholic beverages

Sometimes GERD is associated with a condition called hiatal hernia, in which the upper part of the stomach bulges through the diaphragm into the chest cavity. People with severe GERD almost always have a hiatal hernia.

Symptoms and complications

The main symptom of GERD is heartburn, which may move into the throat. The pain can last up to 2 hours and is worse if the patient eats, lies down, or bends over. Infants with GERD show signs of irritability, vomiting, and poor appetite.

Because heartburn and a heart attack have similar symptoms, it is important to recognize the differences. In a heart attack, the burning pain gradually moves to the end of the left arm or both arms. With GERD, the burning sensation occurs in the upper chest. In addition, exercise can worsen chest pain in a person with a heart attack (or heart disease), while rest and some medications can relieve it. However, physical activity does not affect the burning pain associated with GERD. In any case, even people who have symptoms characteristic of GERD should probably undergo tests to determine that the symptoms are not caused by a heart attack.

Other symptoms of GERD include regurgitation (when swallowed food or liquids back up into the throat or mouth), a sour or bitter taste in the throat or back of the mouth, excessive saliva production, gagging, upset stomach, or vomiting. Adults and children who breathe acid reflux may cough, be hoarse or wheeze. GERD symptoms are often worse after a meal.

If GERD is not properly controlled, other complications may develop over time. These include:

Esophageal stricture (scarring of the esophagus), which reduces the diameter of the esophagus and makes swallowing difficult
Esophagitis (inflammation of the esophagus), which can make swallowing painful
Pharyngitis, which affects the vocal cords and can cause vocal changes
Dental problems, such as an increased risk of tooth decay or damage to teeth due to acid reflux
Asthma or chronic cough, especially in adults
Barrett’s esophagus or Barrett’s hyperplasia occurs when abnormal healing occurs in a part of the lining of the esophagus that has been destroyed by an ulcer (the normal lining is replaced by tissue similar to that of the stomach or intestines). People with this condition may have an increased risk of esophageal cancer)

Diagnosis

A doctor usually diagnoses GERD by evaluating the symptoms. A doctor will only order tests to confirm GERD in people with severe, chronic heartburn. Tests may include a series of x-rays of the stomach to detect other possible problems (for example, the presence of stomach ulcers). A blood or breath test may be done to rule out the presence of a bacterium called Helicobacter pylori.

There are also tests that measure the pH (acidity) of the esophagus and the internal pressure of the lower esophageal sphincter (LES). In some cases, a diagnostic instrument called an endoscope may be used. This is an optical tube inserted into the throat that allows the doctor to look into the esophagus (a procedure called endoscopy).

People who have had regular or daily heartburn for 5 years or more should have a diagnostic test for Barrett’s esophagus. Many doctors regularly examine people with this condition for changes that could eventually develop into a cancerous growth.

Treatment and Prevention

Most GERD symptoms can be treated with a combination of medications and lifestyle changes. Surgery is reserved for those with serious complications but is rarely necessary.

Medications* that can be used to neutralize stomach acid are antacids (e.g., aluminum or magnesium hydroxide, calcium carbonate, bismuth subsalicylate). Gastric acid production can be reduced with medications such as H2 receptor antagonists (e.g. cimetidine, ranitidine, famotidine, nizatidine) and proton pump inhibitors (e.g. dexlansoprazole, omeprazole, lansoprazole, pantoprazole, esomeprazole, rabeprazole). Your doctor may put you on trial for 8 weeks after the prescription of proton pump inhibitors and then determine your symptoms.

In addition to taking medications, you can further reduce your GERD symptoms by making one or more of the following lifestyle changes:

Stop smoking
Avoid eating chocolate, juices that contain citric acid, and large, fatty meals
Do not lie down for 2 to 3 hours after a meal
Try not to wear tight clothing
Exercise regularly
Lose weight if obese
Eat your meals earlier, especially in the evening
Reduce your intake of alcohol and caffeine
Consider eating smaller, more frequent meals instead of 2 or 3 large meals a day.

Most people who modify their diet and lifestyle while taking their medication will recover fully.