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- What causes GERD?
- What are the symptoms of GERD?
- What are the treatments for GERD?
- What are the complications of GERD?
- How to prevent GERD?
GERD (Gastroesophageal Reflux Disease)
GERD (Gastroesophageal reflux disease) is a condition that occurs when gastric juices, acids, or gases in the digestive tract repeatedly reflux into the esophagus. This irritation of the esophageal mucosa, epigastric region, or throat causes a burning sensation in the middle of the chest, a sour or bitter taste in the back of the throat, or a feeling that food is stuck in the throat, resulting in esophageal inflammation. GERD symptoms usually appear at night or while lying down. Those experiencing symptoms of GERD should seek medical attention before the condition progresses to a stage of chronic gastroesophageal reflux disease, which can lead to esophageal cancer.
What causes GERD?
Gastroesophageal reflux disease (GERD) is caused by dysfunction of the lower esophageal sphincter muscle, or the spherical LES muscle, which allows the sphincter to open more frequently than usual and not close tightly, allowing gastric juices, acids, or gases in the digestive tract to backflow into the esophagus, causing gastroesophageal reflux disease. The most common cause of such disorders is the consumption of alcoholic beverages, caffeinated beverages such as tea and coffee, soft drinks, a high-fat diet, sour food, or smoking. Other risk factors of gastroesophageal reflux disease include:
- Hiatus hernia, a condition in which the upper stomach moves above the diaphragm, causes some food and gastric juices to backflow to the chest.
- Esophageal peristalsis disorders cause food to move into the stomach more slowly than usual or gastric juices to reflux from the stomach and remain in the esophagus for longer than usual.
- Eating too much food causes the upper stomach to expand and stretch, resulting in lower pressure on the distal esophageal sphincter, or LES muscle, causing the sphincter to loosen close.
- Abnormalities in stomach contraction cause stomach food retention, resulting in excessive consumption of high-fat foods, fried foods, oily foods, or chocolate.
- Eating food close to bedtime causes food retention in the stomach until bedtime, facilitating gastric juices to backflow into the esophagus and throat, causing a burning sensation and irritation.
- The use of certain medications, such as asthma drugs, aspirin, blood pressure medications, or antidepressant medications.
- Stress can precipitate acid reflux by increasing stomach acid production, weakening the LES muscle, delaying gastric emptying, and increasing esophageal sensitivity.
- Other factors include obesity, scleroderma, and pregnancy.
What are the symptoms of GERD?
- A burning sensation in the middle of the chest, epiglottitis, or throat after eating or while lying down.
- A persistent cough
- Having a sour taste in your mouth or throat
- Sensing food backing into the throat.
- The feeling of colic, distension, flatulence, and indigestion
- Belching acidic or bitter gastric juices backflows up the throat and mouth
- Feeling nauseous and vomiting after eating.
What are the symptoms of chronic GERD?
- Chest pain, like heart disease symptoms
- Chronic cough, hoarse voice
- Laryngitis, hoarseness, voice change
- Trouble swallowing (dysphagia)
- Bad breath, tooth decay
- For those with asthma, the symptoms may worsen
- For those who have severe gastric regurgitation, food may cause aspiration in the lungs and pneumonitis.
Symptoms of GERD in young children and infants
- Frequent vomiting, choking.
- Crying frequently, lack of appetite
- Difficulty breathing
- A sour taste in the mouth or throat, particularly while lying down.
- Hoarse voice
- Trouble falling asleep frequently after eating, especially in infants.
How is GERD diagnosed?
The physician will make a diagnosis of gastroesophageal reflux disease (GERD) by taking a history, performing a physical examination, examining the patient's symptoms if they are related to GERD, and determining whether the disease is in the early or the chronic stages. However, if the physician cannot determine the cause of the disease after the initial assessments, the physician will request additional diagnostic investigation as follows:
- Esophagogastroduodenoscopy (EGD: upper gastrointestinal endoscopy) is a procedure to examine the esophagus, stomach, and duodenum by inserting an endoscope through the mouth, throat, and esophagus into the stomach and duodenum to detect abnormalities in the upper gastrointestinal tract. If abnormal lesions are found, the physician might suggest a biopsy to further determine the underlying pathology.
- Upper GI x-rays are examined by swallowing Barium to coat the upper gastrointestinal tract, which allows the physician to visualize ulcers or narrowing of the esophagus, stomach, or duodenum to determine the cause of gastroesophageal reflux disease.
- Checking the esophagus pH to measure the degree of gastric acid reflux through a catheter. The pH value will be shown on the screen to aid in diagnosing the severity of the disease.
- Nuclear imaging examination of the internal organs functions to diagnose and differentiate between diseases by detecting abnormalities at the molecular level. Therefore, disease abnormalities can be detected in the early stages.
- Esophageal manometry is an examination to assess the function of the upper and lower esophageal sphincter muscles to determine the strength of the esophageal sphincter while swallowing food (dysphagia) or chest pain, including any abnormality of the esophagus.
What are the treatments for GERD?
There are 4 treatment options for GERD treatment, as follows: 1.) Medication in conjunction with 2.) Lifestyle modification, 3.) Surgery, and 4.) Transoral Incisionless Fundoplication (TIF) procedure in cases where gastroesophageal reflux disease (GERD) cannot be treated with medication or has severe GERD symptoms.
Medications: Gastric acid suppression or ulcer-coating drugs may be used to reduce acid production, or prokinetic agents to strengthen the esophageal sphincter may be used to inhibit gastric acid secretion, reduce inflammation of the esophagus, or prevent acid from flowing back up into the esophagus. This group of medications is efficacious in quickly relieving the symptoms of gastroesophageal reflux disease and helps patients recover quickly from symptoms after the drug is taken.
Lifestyle modification
- Eat on time daily and avoid eating close to bedtime.
- Maintain a minimum 4-hour gap between meals and sleep.
- Avoid eating too much food.
- Those who are overweight or those with a high body mass index (BMI) should lose weight.
- Avoid drinking beverages containing caffeine, such as tea, coffee, and soft drinks.
- Avoid spicy food, fried food, and high-fat foods.
- Avoid foods that are very acidic, very spicy, very salty, and very sweet.
- Avoid drinking alcohol.
- Stop smoking and refrain from inhaling secondhand smoke.
- Adjust the pillow to be at least 6 inches high.
- Avoid wearing too-tight clothing.
- Relax your mind; don’t be overly stressed.
- Exercise regularly
Esophageal sphincter surgery is performed to repair the esophageal sphincter by using a portion of the stomach to wrap around the lower esophageal sphincter and squeeze it shut.
Transoral incisionless fundoplication (TIF) is endoscopic suturing of the esophageal sphincter of patients with severe symptoms of gastroesophageal reflux disease who are not responsive to medication or who cannot tolerate the side effects of GERD medications. The physician may determine TIF esophageal sphincter treatment, in which an endoscope is inserted through the mouth into the esophagus to re-suture the esophageal sphincter. This prevents acid from flowing back up into the esophagus from the stomach. This treatment is considered safe, has quick recovery, and delivers good results without leaving unsightly surgical scars.
What are the complications of GERD?
- Esophagitis, or inflammation of the esophagus, where stomach acid damages esophageal tissue, causing inflammation, bleeding, or ulcers. Esophagitis is a common cause of dysphagia, painful swallowing, and chest pain.
- Esophageal stenosis, or the inflammation of the distal esophageal mucosal lining due to stomach acid, can cause scarring and narrowing of the lower esophagus, causing trouble swallowing (Dysphagia).
- Barrett's esophagus and esophageal cancer: Chronic GERD causes abnormalities in the cellular lining of the esophagus, predisposing to Barrett's esophagus and esophageal cancer.
How to prevent GERD?
- Eat on time or eat at the same time daily, and avoid eating too close to bedtime.
- Maintain a normal body weight.
- Avoid eating foods that are too sweet, too sour, too salty, too oily, or too spicy.
- Avoid alcohol, caffeine, soft drinks, and smoking.
- Wear clothing that fits comfortably, not too tightly.
- Exercise regularly to relax your mind.
GERD, a Treatable Burning Sensation
Gastroesophageal reflux disease (GERD) is curable and preventable by dietary, sleep, and lifestyle changes. Avoid risk factors that lead to gastroesophageal reflux disease and that may negatively affect your physical health and daily life.
Early GERD is treatable with medication. However, if you experience severe GERD symptoms more than twice a week and have joint symptoms such as jaw pain, chest pain that radiates to the arm, difficulty swallowing, or difficulty breathing, you should quickly consult an experienced and skilled gastrointestinal and liver physician to quickly diagnose, identify the causes, and promptly treat the uncomfortably aforementioned GERD symptoms at bay.
