The 411 on Gastroesophageal Reflux Disease (GERD)
What exactly is GERD? What causes it? How will I know when it's happening? And then what - how do I treat it, and more importantly - how do I avoid it altogether? Follow this simple breakdown to get the 411 on GERD.
What is GERD?
Gastroesophageal reflux is the passage of gastric contents into the esophagus. It is a normal physiologic process, with most episodes being brief and may not result in symptoms or damage to the esophageal lining. GERD is a disorder where the reflux into the esophagus causes symptoms or other complications.
What are the causes?
Various factors work together to cause GERD:
- Abnormal relaxation of the muscular connection between the lower esophagus and stomach, or lower esophageal sphincter (LES), resulting in back-flow of gastric contents into the esophagus
- Alteration in barrier function which decreases the LES pressure and lowers the threshold for LES relaxations to occur, as seen with a hiatal hernia
- Impaired peristalsis due to abnormal esophageal motility or other medical disorders
- Increased intra-abdominal pressure causing increased backwards pressure on the LES
- Decreased saliva production due to medications or medical conditions, which could result in a delay in clearance of acid from the esophagus and affect neutralization of gastric acid
What are the symptoms of GERD?
The most common symptoms of GERD are heartburn, or a burning sensation moving up the chest to the neck, and acid regurgitation, or reflux of acidic stomach contents in the throat or mouth. Other common symptoms include belching, chronic cough or throat clearing, and sour taste.
Less common symptoms suggestive of GERD are nausea, atypical chest pain, excessive salivation, dysphagia (difficulty swallowing), wheezing, hoarseness of the voice, neck or throat pain, globus sensation in the throat, and bronchospasm.
How can I improve symptoms?
Lifestyle modifications alone may result in resolution of symptoms in 25 percent of people, provided they continue such life changes long-term. There are various changes you can make to help with GERD symptoms.
We do not routinely recommend dietary changes to all patients with GERD. However, in those who can correlate symptoms with certain trigger foods, elimination of those foods is recommended. Common culprits include fatty foods, milk/dairy products, spicy foods, tomato products, acidic/citrus products, caffeine, chocolate, and carbonated beverages.
Reducing abdominal girth can decrease the pressure on the LES and decrease reflux.
Eating frequent, small meals can decrease the pressure on the LES and reduce back-flow of gastric contents into the esophagus. Also, remaining upright for at least two hours after meals will promote forward movement of food and decrease reflux.
Smoking and alcohol cessation can decrease reflux symptoms. Both have been shown to weaken the LES.
What types of medications are used to treat it?
Aside from lifestyle modifications, medications with different mechanisms of action are used to treat symptoms.
These neutralize the acid contents of the stomach and include antacids (tums) and chewing gum.
These include H2 blockers (block histamine stimulation in specific cells of the stomach lining) and proton pump inhibitors (irreversibly bind to channels in specific cells of the stomach lining blocking acid production).
Various surgical and endoscopic therapies can be used when reflux is not responsive to medications.
Do I need an upper endoscopy and how often?
Upper endoscopy (or an esophagogastroduodenoscopy (EGD)) is a common test used to further evaluate symptoms suggestive of GERD. The decision to perform and EGD on initial presentation of symptoms is complicated, and includes factors such as age, presence of any alarming features, and efficacy of medication trials. As long as GERD is controlled with a particular medication regimen, there is no need to repeat an EGD at any specified interval. In other words, GERD does not need periodic monitoring with endoscopy. An EGD may be recommended, however, if reflux symptoms are no longer controlled with your treatment regimen or if you start to experience symptoms suggestive of complications of GERD.
What are the possible complications?
Constant exposure of the lining of the esophagus to the caustic acidic stomach contents can lead to more significant damage. Ulcers and erosions with inflammation and possible bleeding called esophagitis can occur and result in significant pain. Strictures and rings, or scarring of the lower esophagus can form, causing narrowing of the lower esophagus. This may lead to trouble swallowing or food impactions. Dilation of this scar tissue through endoscopy may be required. Damage to the esophageal lining can also cause a transformation of the lining to a precancerous condition called Barrett’s esophagus.
What do I need to know about Barrett’s esophagus?
Barrett’s esophagus is a condition where the esophageal lining transforms into lining similar to that of the intestines. It is thought to be a complication of GERD and is a risk factor for esophageal cancer. In this condition, repeat endoscopy at specified intervals is recommended. The degree of changes to the esophageal lining determine the frequency of EGD tests and any interventions to treat Barrett’s changes.
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