What Is Gastroesophageal Reflux Disease?
Gastroesophageal Reflux Disease (also known as GERD) is a disease of the digestive tract in which acid from the stomach - or, occasionally, bile - flows back into the lining of the esophagus. The constant influx of hydrochloric acid (the acid found in the stomach) into the esophagus can cause the esophagus to become inflamed and irritated as the tissue the esophagus is comprised of does not have the same features as the tissues lining the stomach to protect it from the harsh acid erosion.
The lower esophageal sphincter, the ring of muscle located at the bottom of the esophagus, usually prevents acid from entering the esophagus as it relaxes during swallowing and tightens after the food passes.
For people who have GERD, the lower esophageal sphincter relaxes between swallowing, which allows the corrosive stomach acids to rise and cause damage to the esophagus.
The influx of acid into the esophagus leads to the symptoms of GERD: acid reflux and heartburn, both of which are common digestive problems that most people have experienced. However, GERD becomes a chronic condition when it happens twice a week or interferes with activities of daily living.
Most people who have gastroesophageal reflux disease are able to manage their symptoms by using over-the-counter medications coupled with lifestyle changes, but people who have GERD may find that these at-home remedies may only provide a temporary comfort and may require stronger treatments. Up to 40% of the adult US population has some degree of GERD; however, not just adults are affected by GERD - children and infants may also have GERD.
What Causes Gastroesophageal Reflux Disease?
While there have been no definitive causes for GERD, there are a number of factors that can contribute to the development of acid reflux. These following factors can lead to the relaxation or weakening of the lower esophageal sphincter:
- Medications - medications, like antihistamines, theophylline, calcium channel blockers and nitrates can contribute to gastroesophageal reflux disease.
- Dietary Issues - eating a diet high in fried and fatty foods, spicy foods, chocolate, garlic, onions, caffeine, and foods with high acidic content can contribute to GERD.
- Eating Habits - eating large meals, or meals close to bedtime can increase the likelihood of developing reflux disease.
- Lifestyle Choices - drinking alcohol, having poor posture, being obese, and/or smoking cigarettes can lead to gastroesophageal reflux disease.
- Medical Conditions - a number of medical conditions can cause reflux. These include: pregnancy, diabetes, rapid weight gain, or having a hiatal hernia are some of the medical conditions that cause acid reflux.
What Are The Symptoms Of Gastroesophageal Reflux Disease?
While there are a number of symptoms associated with GERD, the most common and persistent symptom is "heartburn," although it should be clear that not all people with GERD suffer from heartburn.
Heartburn (often called acid indigestion) is a symptom that can last up to two hours, of burning in the center of the chest somewhere behind the breastbone, that often starts in the upper area of the abdomen and spreads to the neck. Heartburn often becomes worse upon eating, lying down, or bending over, but does not begin or worsen with physical activity.
Other possible symptoms of GERD may include the following:
- A bitter taste in the mouth.
- Persistent, dry cough.
- Hoarseness in the morning.
- A sensation of tightness in the throat.
- Regurgitation of a bitter acid while sleeping or bending over.
How Is Acid Reflux Diagnosed?
A general care physician is often the first doctor to consult if symptoms of GERD appear, and he or she may suggest dietary and lifestyle changes - in addition to over-the-counter antacids - to see if the acid reflux persists. If, in fact, the symptoms of GERD do not change with these modifications, a gastroenterologist may be consulted.
A gastroenterologist may perform a series of tests to diagnose GERD. These diagnostic tests include the following:
- An Upper GI Series (also called "Barium Swallow") - this diagnostic test involves a series of x-rays of the esophagus, stomach and part of the intestine after ingesting a contrast medium. An Upper GI Series is often used to rule out conditions such as ulcers, or any esophageal blockages.
- An Upper GI Endoscopy (otherwise known as an EGD or esophagogastroduodenoscopy) - this test involves a mild sedation while a tiny probe with a camera is passed down the throat to examine the esophagus for signs of damage, which can be used to diagnose GERD, rule out other complications, and see how serious the case of GERD is. During this diagnostic test, biopsies may be performed to assess the level of damage, and treat certain problems.
- Esophageal Manometry - this test measures the function of the lower esophageal sphincter as well as the function of the esophagus, by passing a tube down the throat to the esophagus.
- 24-Hour pH Probe Study - this test is often performed in conjunction with Esophageal Manometry, and measures the levels of acid reflux during the day and overnight.
How Is Acid Reflux Treated?
The primary goals for treatment of GERD include reduction of acid reflux, alleviation of symptoms while preventing damage to the esophagus. The treatments of GERD fall into several categories: self-care, medical treatment, and surgical treatment.
1) Self-Care For GERD:
A great number of people who suffer from gastroesophageal reflux disease can manage their condition quite well with proper self-care. These measures for living with GERD can include the following:
- Do not lie down after eating.
- Avoid large meals - ingestion of large amounts of food increases the amount of acid produced in the stomach required to digest it.
- Eat smaller and frequent meals throughout the day.
- Limit fatty, greasy foods, chocolate, caffeine, citrus, tomato-based foods, and mints.
- Avoid alcohol and tobacco.
- Lose any excess weight - overweight people are more prone to acid reflux.
- Don't eat within three hours of going to bed, which allows the stomach to empty and the production of acid to decrease.
- Elevate the head of the bed six inches, which uses gravity to prevent reflux of acid into the esophagus.
- Maintain proper body posture, stand upright, which allows food and stomach acid to pass down through the intestines rather than up through the lower esophageal sphincter.
- Talk with your physician about over-the-counter remedies, like antacids and H2-Blockers.
2) Medical Treatment of Acid Reflux:
In the event that home care remedies and lifestyle changes do not correct GERD, it's likely that prescription-strength medications will be prescribed for a short or long duration. These medications may include:
- Coating Agents - these drugs coat the mucous membranes to create a protective barrier that can combat the acid from the stomach.
- Proton Pump Inhibitors (PPI's) - these drugs block the production of an enzyme vital to the creation of stomach acid.
- Promotility Agents - these medications can help to tighten the lower esophageal sphincter and promote quicker emptying of the stomach. The side effects of these promotility agents can be fairly severe, which means they are rarely used.
3) Surgical Treatment of GERD:
Surgery to treat acid reflux is a treatment of last resort, which means that the surgical management of GERD is only performed on a small amount of people who suffer reflux.
The surgery that's used in very severe cases of acid reflux is called a fundoplication which works by increasing pressure in the lower esophagus to reduce the amount of acid that enters the esophagus. In this procedure, which can be done laparoscopically, the surgeon wraps part of the stomach around the esophagus like a noose.
What Is The Prognosis For Acid Reflux?
GERD is very treatable, however, relapses are common, especially among those who do not alter their lifestyle.
Grades 1-2 (mild to moderate GERD): usually treatable with home-care and H2=blockers.
Grades 3-4 (severe GERD) often requires proton pump inhibitors or surgery as well as long-term treatment to avoid further complications of GERD.
What Are The Complications of GERD?
There are a number of complications associated with acid reflux disease - most rare - and include the following:
- Barrett esophagus - this precancerous complication of GERD leads to changes in the cells lining the esophagus.
- Bleeding - bleeding is caused by ulcers located in the damaged esophageal lining.
- Esophageal Cancer - fortunately, a very rare complication of GERD.
- Esophagitis and Esophageal Ulcers - irritation, inflammation, and sores in the lining of the esophagus.
- Laryngopharengial Reflux - the voice becomes hoarse due to the acid of the stomach in the thrat.
- Respiratory Problems - acid from the stomach can get into the breathing passages and lead to problems with the respiratory system.
- Strictures - chronic reflux can lead to scarring and eventually narrowing of the esophagus.
- Swallowing Issues - the strictures - or narrowing of the esophagus - can lead to difficulties swallowing.
Does Your Baby Have Acid Reflux?
It can be hard to ascertain whether or not a child has reflux as they often lack the words to describe how they are feeling.
Signs to look for to determine if your child has reflux:
- Your child frequently arches her back after feeding
- Frequent spit-up
- Repeated incidents of projectile spit-up (contact your pediatrician immediately, projectile spit-up is often a definite indicator of reflux in infants)
- Your child cries and screams when placed on his back to sleep
- Your child has sour breath
- Agitated crying spells that cannot be soothed
- Lack of wet/dirty diapers
- Low or no weight gain (often with reflux babies are not keeping enough food down to fully digest and/or gain enough weight)
- Your child experiences breathing difficulties during or after eating
- Child refuses to eat
Ways To Soothe Your Baby With Reflux:
- Make sure to burp after feeding (sounds obvious but is a huge help for reflux babies).
- Do not place baby down for sleep immediately after feeding.
- If you must, try to find a secure spot where baby is angled and sleeping "upright" (such as a car seat, swing, crib with a wedge or towel beneath baby's head).
- Medication, talk to your doctor about options, medications vary dependent upon baby's weight, weight gain and discomfort.
- If you do choose to opt for medication be sure that you are given the correct syringe to dispense it to your child. The wrong syringe causes the medication to clog up and leads to your child NOT receiving the correct dose.
- It is possible for your child to have reflux and not show any signs of physical discomfort. Often doctors refer to these children as "happy spitters" because they will spit up frequently, but not suffer any pain while doing so. If you're concerned that this is happening with your child be sure to speak to your pediatrician to ensure that he is gaining weight and keeping some of his intake down.
Additional Gastroesophageal Reflux Disease Resources:
American Gastroenterological Association - library of scholarly articles about diagnosing, treating, and managing GERD.
PAGER - non-profit organization that provides information and support to parents, patients and doctors about Gastroesophageal Reflux (GER).
Esophageal Cancer Awareness Association - outreach for esophageal cancer patients, caregivers, and survivors, to increase public awareness of this disease and to offer education and information in a supportive environment.