Gastroesophageal Reflux Disease

Gastroesophageal reflux disease, commonly known as GERD or GORD, is a condition in which stomach acid leaks backwards up the esophagus, the tube between the mouth and stomach. It is a common condition, especially in people over the age of 40 and pregnant women. People who smoke and/or regularly drink alcohol, and those who are obese are also more likely to develop GERD.

Common symptoms include a burning pain in the chest (heartburn) and an acidic taste in the mouth. The symptoms of GERD can be managed through diet and lifestyle changes, for example, losing weight, quitting smoking and/or reducing alcohol intake, and by taking medications to reduce stomach acidity. Gastroesophageal reflux disease can generally be effectively and well managed and usually causes no long-term problems.

It is important to recognize the difference between gastroesophageal reflux disease (GERD) and gastroesophageal reflux, also known as acid reflux.

Acid reflux is the backward flow of stomach acid up into the throat. This may cause a burning sensation in the chest, and this symptom is commonly referred to as heartburn. Acid reflux, and associated heartburn, is a fairly common, and if it only occurs occasionally it is often non-serious. However when it occurs frequently, or in combination with other symptoms, it may be an indicator that the affected person is experiencing gastroesophageal reflux disease.

Esophagitis is the name given to inflammation of the esophagus. The condition can lead to symptoms including problems swallowing, pain in the chest and, in more severe cases, bleeding may occur. This may involve the presence of blood in the vomit or in the stool. Gastroesophageal reflux disease is a common cause of esophagitis, along with certain eating disorders, such as bulimia, certain medications and some infections. 1

Heartburn is the most common symptom of GERD. It is usually experienced as a burning or sharp sensation in the center of the chest which may spread to the throat. Typically, heartburn follows a meal, though it may also be triggered by lying down or bending over. In some cases, heartburn may occur at night, especially when lying flat without the head raised on a pillow.

Other signs and symptoms of GERD include: 2 3

• Stomach pain
• Pain when swallowing and an acidic taste in the mouth.
• Bloating
• Getting full quickly
• Bad breath
• Non-burning chest pain
• A hoarse voice
• Nausea and/or vomiting
• Regurgitation of food
• Coughing and wheezing
• A persistent sore throat
• A feeling of a lump in the throat that is present despite swallowing
• Enamel erosion

The symptoms experienced and the severity of these symptoms may differ from person to person.

Some of these symptoms may also indicate a more severe condition. For this reason, it is always advisable to seek a professional medical opinion when symptoms occur. In addition, the free Ada app can be used to get an idea of what may be the cause of the symptoms.

The esophageal sphincter, a circular band of muscle at the base of the esophagus, usually prevents acid from leaking. Gastroesophageal reflux disease occurs when the sphincter becomes weakened and does not function as well as it should. There are various reasons why this can happen, but, in some cases, the exact cause cannot be identified. 4

Most people will experience acid reflux at some point in their lives, but some people are more at risk of developing GERD than others. These people include: 3 5

• People over the age of 40
• Pregnant women
• Overweight or obese people
• People who smoke tobacco and drink alcohol and/or caffeinated beverages regularly
• People who are under high levels of stress
• People with hiatus hernia, a condition involving part of the stomach pushing through the diaphragm
• People with certain other gastrointestinal conditions, like some malformations
• People with scleroderma, a rare condition that can cause the skin and internal organs to become thicker and hardened

Tests are often not necessary to confirm a diagnosis of GERD. A doctor will usually be able to identify the condition from a description of the symptoms being experienced. Tests, however, may be necessary if the symptoms are severe and/or other more serious conditions are suspected.

These tests may include: 2 4

• A gastroscopy (endoscopy): Using a flexible telescopic tube, doctors are able to see inside the esophagus and stomach and identify any signs of inflammation or injury. This will typically be the first diagnostic test performed.
• Esophageal manometry: A tube is swallowed that is able to measure the muscle contractions of the esophagus and detect whether the sphincter is functioning as it should. Typically only performed if a gastroscopy is unrevealing.
• Acidity test: A test to check the acid levels in the esophagus may be ordered if a gastroscopy is unrevealing.
• Other tests: Alternative diagnostic tests, such as a chest X-ray or an electrocardiogram may also be ordered if the diagnosis is not certain or other conditions need to be ruled out.

The majority of people who experience GERD do not develop any complications, particularly if the condition is managed well. However, complications are possible.

One of the most common complications of GERD is esophagitis, a condition involving inflammation of the esophagus. If esophagitis occurs, symptoms may include:

• Problems swallowing
• Pain in the chest
• In severe cases, bleeding, which may cause signs of blood in the stool and/or vomit

GERD is one of the most common causes of esophagitis, along with certain eating disorders, e.g. bulimia, as well as certain medications and some infections. 1

Other, less common complications of GERD include: 2 6 7 8

• Ulcers: Stomach acid moving up into the esophagus can cause esophageal ulcers. These ulcers may bleed. If this happens, the blood may not be noticed, unless it is detected in the vomit and/or stool.
• Stricture: If the esophagus becomes damaged, it can scar and narrow, potentially causing a blockage, or stricture. Strictures can vary in severity, but can potentially prevent food and medication from reaching the stomach. If a stricture occurs, professional medical treatment, which may include surgery, is required. If a stricture causes severe difficulty swallowing, this requires urgent medical attention and could progress to become a medical emergency.
• Barrett’s esophagus: A condition that occurs when the normal cells of the esophagus, the squamous cells, are replaced by intestinal cells, usually as a result of damage to the lining of the esophagus. Barrett’s esophagus is a risk factor for esophageal cancer.
• Esophageal cancer: Cancer as a complication of GERD is very rare. Difficulty swallowing and unintended weight loss are two of the most typical early symptoms. For more information, take a look at this comprehensive resource on esophageal cancer.

People worried that they may be experiencing symptoms of GERD or a complication of GERD should talk to a doctor. The free Ada app can also be used to carry out a symptom assessment.

The treatment method used for gastroesophageal reflux disease will depend on the severity of the condition. Mild cases will usually be treated with lifestyle changes and over-the-counter medication.

Lifestyle changes include: 2 9 10

• Losing weight through maintaining a healthy diet and undertaking regular exercise
• Avoiding reflux-inducing foods and drinks, such as caffeinated beverages, chocolate and alcohol
• Quitting smoking
• Avoiding late, very fatty and very large meals
• Reducing stress levels by learning and applying effective stress and health-management techniques

If medication is required, doctors will generally prescribe proton pump inhibitors. This type of medication is generally safe to use and causes few side-effects. If the condition responds well to the medication, the affected person may only need to use them in the short-term, usually for around eight weeks. However, if symptoms return, long-term use may be required. Antacids, such as H2-antagonists, may also be prescribed in some cases.

Losing weight through the maintenance of a healthy and balanced diet, moving around regularly, drinking less coffee, avoiding alcohol, quitting smoking and learning better ways to deal better with daily stress can help to prevent gastroesophageal reflux disease. Treating the symptoms of gastroesophageal reflux can also help to prevent long-term complications of the condition.

• Acid reflux disease
• GERD
• GORD

Q: Are GERD and heartburn the same thing?
A: No, but heartburn is the most typical symptom of GERD. While heartburn can be experienced without GERD, people experiencing heartburn alongside other symptoms of GERD, such as chest pain, stomach pain and an acidic taste in the mouth, should see a doctor for an evaluation.

Q: What is refractory gastroesophageal reflux disease (refractory GERD)?
A: Most people with GERD, who are treated with proton pump inhibitors (PPIs), will find the medication effective in managing symptoms. However, in a smaller number of cases, PPIs will prove ineffective or only partially effective. 11 This is a state known as refractory gastroesophageal reflux disease or refractory GERD. People with refractory GERD will be evaluated for alternative treatment methods by doctors. 12

Q: Can I develop gastroesophageal reflux disease without esophagitis?
A: Yes, although GERD is a common cause of esophagitis, it is possible to develop GERD without also developing esophagitis. There is debate over whether this should be considered a sub-entity of GERD or a condition of its own called non-erosive reflux disease (NERD).

GERD without esophagitis seems to be particularly common in people with refractory GERD. Research suggests that the reflux in refractory GERD is often less acidic than in non-treated GERD, possibly explaining why the inflammation associated with esophagitis does not occur. 13 11

Q: Is there a natural cure for GERD?
A: While it may not be appropriate to speak of a natural “cure” for GERD, there are several natural, or non-medicinal, ways of effectively managing the condition. The most commonly recommended of these include:

• Losing weight by following a healthy, varied and balanced diet, and getting regular exercise
• Avoiding acid reflux-inducing foods and drinks, such as overly fatty food, caffeinated beverages, chocolate and alcohol
• Quitting smoking
• Avoiding late or overly large meals

Q: What is the relationship between GERD and a hiatal hernia?
A: Hiatal hernia is a condition involving the upper section of the stomach pushing through the diaphragm, the muscle that divides the abdomen and the chest. This condition can increase the chance of a person experiencing GERD. 14 15

Q: Can alcohol cause GERD?
A: Although more conclusive evidence is needed, it seems that there is a relationship between alcohol and an increased likelihood of GERD. 16 9 People who regularly consume alcohol and experience GERD should consider cutting down on their alcohol intake to help manage the condition.