An overview of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease, or GERD, is a digestive disorder that occur occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

It affects the ring of muscle between your esophagus and your stomach. This ring is called the lower esophageal sphincter (LES).

GERD may result from a weak or damaged valve between the stomach and the esophagus.

Stomach acid that washes up into the esophagus can cause dangerous tissue damage.

Maintaining a moderate weight, quitting smoking, and reducing stress can help reduce the risk of GERD.

Treating GERD may involve the use of proton pump inhibitors (PPIs), antacids, and other medications, as well as lifestyle changes.

The term “gastroesophageal” refers to the stomach and esophagus. Reflux means to flow back or return. Gastroesophageal reflux is when what’s in your stomach backs up into your esophagus.

In normal digestion, your LES opens to allow food into your stomach. Then it closes to stop food and acidic stomach juices from flowing back into your esophagus. Gastroesophageal reflux happens when the LES is weak or relaxes when it shouldn’t. This lets the stomach's contents flow up into the esophagus.

The main symptom of GERD is acid reflux. Acid reflux can cause an uncomfortable burning feeling in your chest, which can move up into your neck and throat. This feeling is often known as heartburn.

If you have acid reflux, you might develop a sour or bitter taste at the back of your mouth. It might also cause the regurgitation of food or liquid from your stomach into your mouth.

Some other symptoms of GERD include:

1. pain when swallowing

2. chest pain

3. difficulty swallowing

4. nausea

5. chronic cough

6. a hoarse voice

7. bad breath

8. Vomiting.

Anyone experiencing frequent acid reflux symptoms should talk with their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.

There are several possible tests to diagnose GERD, including:

Esophageal pH and impedance monitoring : This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.

Upper GI endoscope : This is a tube with a camera attached that is used to inspect the esophagus. A small sample of tissue may also be taken at the same time for a biopsy.

Upper GI series : This is a type of X-ray that shows certain physical abnormalities that might cause GERD.

Esophageal manometry : This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.

Bravo wireless esophageal pH monitoring : In this test, a small temporary capsule is attached to the esophagus. This measures the acidity continuously for approximately 48 hours.

Here are 10 tips to help prevent GERD symptoms:

1. Achieve and maintain a healthy weight.

2. Eat small, frequent meals rather than huge amounts a few times a day.

3. Reduce fat by decreasing the amount of butter, oils, salad dressings, gravy, fatty meats and full-fat dairy products such as sour cream, cheese and whole milk.

4. Sit upright while eating and stay upright (sitting or standing) for 45 to 60 minutes afterward.

5. Avoid eating before bedtime. Wait at least three hours after eating to go to bed.

6. Try not to wear clothes that are tight in the belly area. They can squeeze your stomach and push acid up into the esophagus.

7. When sleeping, raise the head of the bed 6 to 8 inches, using wooden blocks under the bedposts. Extra pillows don’t work.

8. Your healthcare provider may prescribe acid-reducing medications. Be sure to take them as directed.

9. Cut out possible trigger foods.

10. Stop smoking.

What medications do I take to manage the symptoms of GERD (chronic acid reflux)?

Many over-the-counter (OTC) and prescription medications relieve GERD. Most of OTC drugs come in prescription strength too. Your provider will give you a prescription for these stronger drugs if you’re not getting relief from the OTC formulas.

The most common GERD medications:

Proton pump inhibitors : (stronger acid blockers that also help heal damaged esophagus tissue) include Prevacid®, Prilosec®, Zegerid®, Nexium®, Protonix®, AcipHex® and Dexilant®.

H-2 receptor blockers : (which decrease acid production) include Tagamet®, Pepcid AC®, Axid AR® and Zantac®.

Antacids : (provide quick relief by neutralizing stomach acids) include Tums®, Rolaids®, Mylanta®, Riopan® and Maalox®.

Baclofen : is a prescription drug used to reduce the relaxation of the lower esophageal sphincter which allows acid backwash.

Is there surgery to treat GERD (chronic acid reflux)?

GERD is usually managed with medications and lifestyle changes (like eating habits). If these don’t work, or if you can’t take medications for an extended period, surgery may be a solution.

Laparoscopic antireflux surgery (or Nissen fundoplication) : is the standard surgical treatment. It’s a minimally invasive procedure that fixes your acid reflux by creating a new valve mechanism at the bottom of your esophagus. The surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so food won’t reflux back into the esophagus.

LINX device implantation : is another minimally invasive surgery. A LINX device is a ring of tiny magnets that are strong enough to keep the junction between the stomach and esophagus closed to refluxing acid but weak enough to allow food to pass through.

While again, there’s no one cause of GERD, there are lifestyle choices and certain health factors that can make a diagnosis more likely. These include:

1. living with obesity

2. consistantly lying down or going to sleep shortly after eating

3. eating a lot of certain types of foods, like deep fried or tomato products

4. drinking certain types of beverages, like soda, coffee, or alcohol

5. using an abundance of nonsteroidal anti-inflammatory drugs (NSAIDS), like aspirin or ibuprofen

6. frequently eating large meals

7. smoking

8. living with a connective tissue disorder

9. being pregnant

Esophagitis : This is inflammation of the esophagus. It can also lead to gastrointestinal (GI) bleeding.

Esophageal stricture : Repeated irritation can cause scarring in the esophagus, making it narrow. This can cause difficulty swallowing.

Barrett’s esophagus : The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into esophageal cancer.

Respiratory problems : It is possible to breathe stomach acid into the lungs, which can cause a range of problems, such as chest congestion, hoarseness, asthma, laryngitis, and pneumonia.