Gastroesophageal reflux disease (GERD)

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At some point or another, many people will experience what is often referred to as ‘heartburn’, which can be a symptom of gastroesophageal reflux disease. You begin to feel a burning sensation in the centre of your chest which can radiate up your throat, even leaving a bitter or sour taste in your mouth. It can last a few minutes to a few hours, and usually happens after eating (especially if you lay down right away). Heartburn is usually a symptom of acid reflux, which is a backflow of stomach acid up and into the esophagus (Kashyap, 2019).

What is Gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux disease is frequent and severe acid reflux, occurring more than two times a week. The word ‘gastroesophageal’ means that the stomach and food pipe (the esophagus) are connected. The passage between the esophagus and the stomach is closed most of the time – it only opens when chewed food, saliva, and fluids arrive. Once the contents have passed into the stomach, ensuring that the contents of the stomach don’t flow back.

If the stomach is significantly stretched (which can occur after a large meal) the circular muscle at the entrance of the stomach (the lower esophageal sphincter) might loosen temporarily. This can allow gas and stomach contents to leak up into the esophagus. This leakage is even more likely to occur if the person is laying down horizontally, as the contents of the stomach need only move sideways to exit the stomach, instead of up. The digestive fluids from the stomach irritate the lining of the esophagus, causing heartburn. If the juices remain for some time, inflammation and further pain will occur along the esophagus (IQWiG, 2012).

Symptoms

For some, stomach contents regularly leak into their esophagus, or it may happen in large amounts. This is when a diagnosis of GERD is often made – frequent or severe heartburn or acid reflux that affects the quality of life or has caused inflammation of the esophagus. While heartburn is the main symptom of GERD, another common symptom is difficulty swallowing. Other signs and symptoms can include regurgitation of food or sour liquid, coughing, wheezing, a husky or hoarse voice, nausea, a feeling of being too full, and chest pain — especially while lying down at night (Kashyap, 2019).

When to See a Doctor

Having heartburn occasionally after a large (or a heavily fried or spicy) meal is fairly normal and shouldn’t be cause for concern. This can usually be eased with a simple over-the-counter antacid. If the heartburn occurs more frequently, or isn’t relieved by over-the-counter medication, it’s time to see a doctor.

You should also see a doctor if you have symptoms that could be related to GERD complications or other serious health problems, such as

  • chest pain
  • loss of appetite
  • persistent vomiting
  • problems swallowing or pain while swallowing
  • signs of bleeding in the digestive tract, such as
    • vomit that contains blood or looks like coffee grounds
    • stool that contains blood or looks black and tarry
  • unexplained weight loss (NIDDK, n.d.)

Diagnosis

Your doctor will often diagnose GERD by reviewing both your symptoms and medical history. If the symptoms suggest GERD, they may recommend medicine or lifestyle changes. However, if your symptoms indicate you might have complications resulting from GERD, or symptoms don’t improve after treatment with medicine and lifestyle changes, they may recommend additional medical testing. They may also refer you to a gastroenterologist for further diagnosis and treatment (NIDDK, n.d.).

Gastroesophageal reflux disease causes

Your lower esophageal sphincter generally prevents the backflow of stomach contents into the esophagus, but most people experience acid reflux and heartburn occasionally. GERD may develop if the sphincter becomes weak or begins to relax when it shouldn’t. Some medications, such as benzodiazepines and sedatives that make you calm or sleepy, may cause GERD or make GERD symptoms worse. Certain asthma medications and tricyclic antidepressants may have the same effect.

A hiatal hernia can also increase the chance of getting GERD or make GERD symptoms worse. A hiatal hernia is a condition in which the opening in your diaphragm lets the upper part of the stomach move up into your chest (Weatherspoon, 2019).

Treatment options

Treatment options for GERD vary’s depending on the severity in each patient. Your doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal reflux disease if the symptoms are not severe. In some cases, doctors may also recommend surgery, especially if there may be indications of further complications (NIDDK, n.d.)

Lifestyle Changes

A change in lifestyle can often reduce symptoms or get rid of them completely. Your doctor may recommend:

  • losing weight if you are overweight or obese
  • elevating your head during sleep slightly, to minimize stomach contents travelling sideways through the lower esophageal sphincter
  • quitting smoking
  • changing your eating habits or diet
Man holds chest in pain from heartburn or gastroesophageal reflux disease

Medications

Over-the-counter GERD medications can often help, but if symptoms persist, your doctor may prescribe further medications.

  • Antacids may be recommended for mild symptoms and are available over-the-counter. These should not be used every day, or to deal with severe symptoms.
  • H2 blockers lower the amount of acid the stomach makes and can also help heal the esophagus. They are available over the counter and as a prescription.
  • Proton pump inhibitors act similarly to H2 blockers as they lower the amount of stomach acid, but they are far more efficient in healing the esophageal lining in people with GERD.

Surgery

Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes and medicines, or if you wish to stop taking long-term GERD medicines to manage symptoms. You’re more likely to develop complications from surgery than from medicines.

  • Fundoplication is the most common surgery for GERD and leads to long-term improvements of symptoms. During the operation, the surgeon sews the top of your stomach around the end of your esophagus, adding pressure to the lower esophageal sphincter and helping prevent reflux.
  • Bariatric surgery is used to help with weight loss and reduce GERD symptoms.

Gastroesophageal reflux disease in children and infants

In infants, GERD is a less common, more serious form of spitting up. Children and adolescents may be diagnosed with GERD if they show symptoms and experience other complications. The potential complications of GERD include respiratory problems, difficulty gaining weight, and inflammation of the esophagus, or esophagitis.

The symptoms of childhood GERD are more serious than the occasional stomachache or infrequent act of spitting up. GERD may be present in infants and preschool children if they are:

  • refusing to eat or not gaining any weight
  • experiencing breathing difficulties
  • starting with vomiting at 6 months of age or older
  • fussy or having pain after eating

GERD may be present in older children and adolescents if they have symptoms similar to what an adult with GERD may experience, as described above.

Researchers aren’t always exactly sure what causes GERD in young people. Several factors may be involved, including:

  • how long the esophagus is inside of the abdomen
  • the angle where the stomach and esophagus meet
  • the condition of the muscles at the esophagus’s lower end
  • pinching of the fibers of the diaphragm

Some children may also have weak valves that are particularly sensitive to certain foods and beverages or inflammation in the esophagus that’s causing the problem (Story, 2012).

Risk Factors

Certain conditions can greatly increase your risk of developing GERD, such as obesity, pregnancy, hiatal hernia, and connective tissue disorders.

Lifestyle behaviours can also raise the risk of developing GERD, such as:

  • smoking
  • eating excessively large meals
  • lying down or sleeping shortly after eating
  • eating certain types of foods, like spicy or deep-fried foods
  • drinking certain beverages, like soda, alcohol, or coffee
  • using nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Weatherspoon, 2019).

Potential Complications

When left untreated, GERD can lead to serious complications, including:

  • Adult-onset asthma
  • Esophagitis (Inflammation, irritation, or swelling of the esophagus)
  • Stricture (Narrowing of the esophagus)
  • Barrett’s Esophagus (Pre-cancerous changes to the esophagus)
  • Regurgitation of acid into the lungs
  • Sinusitis
  • Ulcerations/bleeding (Clarett, 2019)

Diet and Lifestyle changes for people with GERD

There are several lifestyle changes and home remedies that may help relieve GERD symptoms. For example, it might help to:

  • quit smoking
  • lose excess weight
  • eat smaller meals
  • chew gum after eating
  • avoid lying down after eating
  • avoid foods and drinks that trigger your symptoms
  • avoid wearing tight clothing
  • practice relaxation techniques

In some people, certain types of foods and beverages trigger symptoms of GERD. Common dietary triggers include:

  • high-fat foods
  • spicy foods
  • chocolate
  • citrus fruit
  • pineapple
  • tomato
  • onion
  • garlic
  • mint
  • alcohol
  • coffee
  • tea
  • soda (Weatherspoon, 2019)

Alcohol and GERD

In some people with gastroesophageal reflux disease, certain foods and drinks can make the symptoms worse. Those dietary triggers can include alcoholic beverages. Depending on your specific triggers, you might be able to drink alcohol in moderation. But for some people, even small amounts of alcohol trigger symptoms of GERD. If you combine alcohol with fruit juices or other mixers, those mixers might also trigger symptoms.

Th best way to avoid alcohol-based complications is simply to avoid alcohol completely. Speak with your doctor is the idea of abstaining from alcohol seems challenging or worrisome (Nall, 2017).

What is the difference between gastroesophageal reflux disease and heartburn?

Heartburn is a common symptom of acid reflux. Most people experience it from time to time, and in general, occasional heartburn isn’t a cause for concern. But if you get heartburn more than twice a week, you might have GERD. GERD is a chronic type of acid reflux that can cause complications if left untreated (Kinman, 2020).

Can GERD lead to Barret’s esophagus?

Barrett’s esophagus is a condition in which the cells that make up your esophagus begin to look like the cells that make up your intestines. This often happens when cells are damaged by exposure to acid from the stomach. This condition often develops after years of experiencing GERD. In some cases, Barrett’s esophagus can develop into esophageal cancer.

The exact cause of Barrett’s esophagus is not yet known. However, the condition is most often seen in people with GERD. It’s believed that the cells in the esophagus can become abnormal with long-term exposure to stomach acid. Barrett’s esophagus can develop without GERD, but patients with GERD are 3 to 5 times more likely to develop Barrett’s esophagus.

Approximately 5 to 10 percent of people with GERD develop Barrett’s esophagus. It affects men almost twice as often as women and is usually diagnosed after the age of 55 (Wint, 2018).

References

Clarrett, D. 2019. Gastroesophageal Reflux Disease (GERD). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/

IQWiG. 2012. Heartburn and GERD: Overview. https://www.ncbi.nlm.nih.gov/books/NBK279254/

Kashyap, P. 2019. Is acid reflux the same as GERD? https://www.mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894

Kinman, T. 2020. What Are the Differences Between Heartburn, Acid Reflux, and GERD? https://www.healthline.com/health/gerd/heartburn-vs-acid-reflux

Nall, R. 2017. Best Alcoholic Beverages for People with GERD. https://www.healthline.com/health/gerd/alcohol

NIDDK, n.d. Diagnosis of GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/diagnosis

NIDDK, n.d. Symptoms & Causes of GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes

NIDDK, n.d. Treatment for GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

Story, C. 2012. Gastroesophageal Reflux Disease (GERD) in Children. https://www.healthline.com/health/gerd/children

Weatherspoon, D. 2019. Everything You Need to Know About Acid Reflux and GERD. https://www.healthline.com/health/gerd

Wint, C. 2018. Barrett’s Esophagus. https://www.healthline.com/health/barretts-esophagus