Understanding Gastroesophageal Reflux

Health Professional

Gastroesophageal reflux is the passage of gastric contents into the esophagus.   Gastroesophageal reflux disease, or GERD, is a disorder where the reflux into the esophagus causes symptoms or damage to the lining of the esophagus. GERD can cause long-term symptoms, such as heartburn or regurgitation, or cause direct damage to the esophagus or other organs due to backflow.   Various factors work together to cause GERD, including the condition of the muscle sphincter at the lower esophagus, presence of a hiatal hernia, the ability of acidic contents to pass through the esophagus, and decreased flow of saliva.

Factors contributing to GERD

Under normal conditions, the lower esophageal sphincter (LES) relaxes, helping to prevent reflux of gastric contents into the esophagus.   There are periods when this muscle relaxes, allowing for venting of the stomach or passage of food into the stomach.   During these relaxations, backflow of gastric contents not just air can occur.   A hiatal hernia can affect normal barrier function by decreasing the LES pressure and lowering the threshold for LES relaxations to occur.

The clearance of acidic contents from the esophagus involves mechanical movement of contents into the stomach, called peristalsis, and neutralization of the acidic contents with saliva.   Reflux can occur when peristalsis is impaired due to abnormal esophageal motility or other medical disorders. Various medical conditions and medications can cause a decrease in saliva production, which could result in a delay in clearance of acid from the esophagus.

How common is GERD?

GERD occurs more commonly with increasing age.   Forty percent of adults in the United States experience GERD symptoms monthly, while 18 percent of adults have symptoms weekly.   GERD occurs more in areas that have adopted a Western diet. It remains unclear if GERD is becoming more common or if it is now being diagnosed more frequently.   Complications from GERD, including strictures, pre-cancerous changes of the LES (referred to as Barrett's esophagus), and esophageal cancer may be more common in males, Caucasians and older individuals.

What are the symptoms?

The most common and classic symptoms of GERD are heartburn, or a burning sensation moving up the chest to the neck, and acid regurgitation where patients experience reflux of gastric contents or acid in their throat or mouth. Other symptoms suggestive of GERD are nausea, chest pain, excessive salivation, dysphagia (difficulty swallowing), coughing, wheezing, hoarseness of the voice, belching, repetitive throat clearing, neck or throat pain, globus sensation in the throat, and bronchospasm.

Tests used to diagnose GERD

Patients who have typical symptoms and no alarm features (vomiting, weight loss, dysphagia, or bleeding) are given a trial of acid-blocking medication.   If symptoms resolve and come back after stopping medication, then the diagnosis of GERD is confirmed, suggesting a need for long-term management.   If symptoms do not improve with medications alone, further testing is needed. Such tests can include an upper endoscopy, radiographic studies to look for any abnormal narrowing of the esophagus or a hiatal hernia, or 24-hour pH studies where a probe is placed 5-6cm above the LES and measures the degree of GERD and its timing.

For the most part, GERD is easily managed.   Treatment often requires a combination of diet and lifestyle modifications, along with the use of acid-blocking medications.   However, left untreated, serious damage to the esophagus can occur. It is important to communicate any and all symptoms with your doctor and work together to control your GERD.