GERD (which is an acronym for Gastro-esophageal Reflux Disease) is a condition largely associated with the gastrointestinal tract. Gastroesophageal refers to the stomach and oesophagus. Reflux means to flow back or return. Therefore, GERD is a condition whereby the acidic liquefied contents of the stomach goes back into the oesophagus. GERD occurs when the amount of gastric “juice” that refluxes into the oesophagus exceeds the normal limit, causing symptoms with or without associated injuries to the lining of the stomach and esophagus (also spelt oesophagus). The regurgitated liquid can damage the lining of the oesophagus although visible signs of inflammation occur in a minority of patients. The refluxed liquid usually contains acids and pepsin which are produced in the stomach. The refluxed liquid could also contain bile that has piled up in the stomach from the duodenum. Though pepsin and bile may also injure the oesophagus, their role in the production of oesophageal inflammation and damage is not as clear as the acid.
The Culprit? Lower Esophageal Sphincter (LES)
This ring of muscle is present at the junction of the oesophagus and stomach. In normal digestion, it opens to allow food contents pass from the oesophagus into the stomach and closes to prevent food from flowing back into the oesophagus. GERD occurs when the sphincter becomes weak or relaxes inappropriately allowing the stomach’s content to reflux into the oesophagus. The reflux symptom is known as “heartburn”. While not all GERD patients suffer from this symptom, people who do suffer from this symptom more than twice a week should speak with their doctor immediately. The severity of GERD depends on the level of lower esophageal sphincter dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.
It has not been clearly stated what causes the lower esophageal sphincter to become damaged. However doctors have indicated that pressures on the midsection caused by obesity, frequently eating large meals and hiatal hernia can damage this important muscle. Over time, the reflux of stomach contents damages the oesophageal wall and can cause the cells to become abnormal. This change in cells is known as Barrett’s Oesophagus, a sometimes precancerous condition.
Although GERD can limit daily activities and productivity, it is rarely life-threatening. With an understanding of the causes and proper treatment, most people will find relief.
Causes and Risk Factors
GERD is primarily caused by frequent acid reflux from the stomach into the oesophagus. Factors that contribute to GERD include:
- Hiatal hernias
- Lower Esophageal Sphincter abnormalities
- Abnormal Oesophageal Contractions
- Slow or prolonged emptying of the stomach.
- Connective tissue disorders such as scleroderma
Factors that can aggravate acid reflux include:
- Eating late at night
- Eating certain foods (triggers) such as fatty or fried foods
- Taking certain medications like aspirin
- Taking certain beverages like coffee
The symptoms of GERD are classified under uncomplicated or complicated.
The symptoms of uncomplicated GERD are usually:
- Heartburn or Chest pain
- Difficulty in swallowing
- Regurgitation of food or sour liquid
- Sensation of a lump in your throat
The symptoms of complicated GERD include:
- Barrett’s oesophagus
- Cough and asthma
- Inflammation of the throat and pharynx
- Inflammation and infection of the lungs
- Fluid in the sinuses and middle ear
Your doctor might be able to diagnose GERD based on some physical examinations and a history of your signs and symptoms. However to get a confirmed diagnosis, your doctor might recommend any of the following:
- Upper endoscopy
- pH probe test
- X-ray of the upper digestive system
- Oesophageal manometry
Your doctor is likely to recommend that you first try some lifestyle modifications and over the counter medications. These include:
- Stop smoking
- Maintain a healthy weight
- Avoid tight-fitting clothing
- Don’t lie down after a meal
- Avoid foods and drink that trigger reflux
- Eat food slowly and chew thoroughly
- Antacids that neutralize gastric acid
- Medications to reduce gastric acid production
Baclofen may also ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter.
GERD can usually be controlled by medication. However if medications do not help, your doctor can recommend either of the following surgical procedures:
- LINX Device: To prevent the LES from opening
There are a number of steps you can take to prevent reflux of food contents in the stomach. However what will help one person avoid GERD might not help another. Some of these steps include:
- Lose weight
- Review your medications
- Wear loose-fitting clothes
- Try a gluten-free diet
- Elevate the head during sleep