Gastroesophageal Reflux Disease (GERD)

What is GERD?

Gastroesophageal Reflux Disease (GERD) is a chronic condition in which stomach acid or bile flows back into the esophagus, irritating its lining. This backflow, known as acid reflux, can cause symptoms such as heartburn and regurgitation. If left untreated, GERD can lead to more serious complications.

Common Symptoms of GERD

• Heartburn: A burning sensation in the chest, often after eating or at night.
• Regurgitation: Sour or bitter-tasting acid backing up into the throat or mouth.
• Difficulty swallowing (dysphagia)
• Chest pain
• Chronic cough
• Hoarseness or sore throat
• Lump-in-throat sensation

Causes and Risk Factors

• Weakened lower esophageal sphincter (LES): The LES is a ring of muscle that acts as a valve between the esophagus and stomach. If it weakens or relaxes abnormally, acid can flow back into the esophagus.
• Hiatal hernia: Occurs when part of the stomach pushes up through the diaphragm, making acid reflux more likely.
• Obesity: Increased abdominal pressure can weaken the LES.
• Poor diet: Spicy, fatty, or acidic foods, as well as caffeinated and carbonated drinks, can trigger GERD symptoms.
• Smoking: Reduces LES function and increases acid production.
• Pregnancy: Hormonal changes and increased abdominal pressure can contribute to GERD.

Diagnosis

• Medical history and symptom review: Discussing symptoms and triggers with a healthcare provider.
• Endoscopy: A thin tube with a camera is inserted into the esophagus to check for inflammation or damage.
• Esophageal pH monitoring: Measures the frequency and duration of acid exposure in the esophagus.
• Barium swallow: X-rays taken after drinking a barium solution to highlight the esophagus and stomach on imaging.
• Esophageal manometry: Assesses the function of the esophagus and LES muscles.

Treatment Options

• Lifestyle changes:
  • Maintain a healthy weight: Reduces pressure on the stomach and LES.
  • Avoid trigger foods and drinks: Identify and eliminate foods that worsen symptoms.
  • Eat smaller meals: Helps reduce stomach pressure.
  • Avoid lying down immediately after eating: Wait at least 2-3 hours before reclining.
  • Elevate the head of the bed: Helps prevent nighttime reflux.
• Medications:
  • Antacids: Provide quick relief by neutralizing stomach acid.
  • H2 receptor blockers: Reduce acid production, such as ranitidine or famotidine.
  • Proton pump inhibitors (PPIs): Stronger acid blockers, such as omeprazole or esomeprazole, to promote healing of the esophagus.
  • Prokinetics: Help the stomach empty more quickly, reducing reflux risk.
• Surgical options:
  • Fundoplication: Wrapping the top of the stomach around the LES to tighten it and prevent reflux.
  • Linx device: A ring of magnetic beads is placed around the LES to strengthen it while allowing food to pass through.

Prevention and Management Strategies

• Maintain a healthy lifestyle: Regular exercise and balanced diet.
• Avoid late-night meals: Helps reduce nighttime reflux.
• Limit alcohol and caffeine: Both can relax the LES and increase reflux risk.
• Wear loose-fitting clothing: Tight clothing can put pressure on the stomach.
• Quit smoking: Improves LES function and reduces GERD risk.

Complications of GERD

• Esophagitis: Inflammation of the esophagus that can lead to pain and swallowing difficulties.
• Esophageal stricture: Narrowing of the esophagus due to scar tissue from long-term inflammation.
• Barrett’s esophagus: A condition where the esophageal lining changes, increasing the risk of esophageal cancer.
• Esophageal ulcers: Open sores that can cause pain and bleeding.
• Chronic cough and respiratory issues: Acid reflux can irritate the airway, leading to coughing and potential asthma symptoms.