Gastroesophageal reflux disease (GERD) is a fairly common condition that occurs when stomach acid flows back into the esophagus. This acid reflux can irritate the lining of your esophagus and cause symptoms. It is more commonly seen in older and overweight people and pregnant women.
There is some confusion between the words “acidity”, “heartburn” and “GERD”.
- Acidity is the excessive production of digestive acid in the stomach.
- Heartburn is a symptom of a burning sensation in the chest caused by this excessive acid and its reflux.
- GERD is a disease with a manifestation of some damage to the upper gastrointestinal tract, notably the esophagus and the stomach, which could be in the form of ulceration.
Reflux becomes a disease when it occurs frequently over the long term and causes severe symptoms. It can damage the esophagus, pharynx, or respiratory tract.
GERD is one of the most common gastrointestinal diseases. According to the American College of Gastroenterology, up to 20% of the US population has GERD.
However, GERD is defined as a disease with symptoms occurring two or more times a week and when there is damage to the esophagus in the form of narrowing of the lumen, erosions, or pre-cancerous changes due to chronic acid reflux.
The symptoms can make you uncomfortable and prevent you from eating your favorite foods. Most people are able to manage this condition with lifestyle and dietary changes while some may require medications. Rarely, some may need surgery to ease symptoms.
Common signs and symptoms of GERD include:
- A burning sensation in your chest (heartburn), usually after eating, which may worsen at night or while lying down
- Regurgitation of food or sour liquid
- Epigastric or chest pain
- Dysphagia (Trouble swallowing)
- Cough due to irritation of the throat by the gastric contents
- Laryngitis (Inflammation of the vocal cords)
GERD is caused by the frequent reflux of stomach contents from the stomach into the esophagus. The contents may be acidic or nonacidic.
At the lower end of the esophagus is a sphincter that relaxes to allow the food and liquid you swallow to enter the stomach. This is a one-way sphincter and does not allow the stomach contents to reflux into the esophagus.
If the sphincter weakens, the stomach acid and contents can reflux back into your esophagus. When this happens too often, the stomach acid irritates the lining of your esophagus causing it to get inflamed.
Conditions that can increase your risk of GERD include:
- Hiatus hernia
- Connective tissue disorders, such as scleroderma
- Delayed stomach emptying
- Eating large meals or eating late at night
- Eating certain foods (triggers) such as fatty or fried foods
- Drinking certain beverages, such as alcohol or coffee
- Taking certain medications, such as NSAIDs (aspirin)
- Esophagitis is inflammation of the esophagus. This can lead to inflammation, bleeding, and ulceration of the esophagus leading to pain and difficulty in swallowing.
- Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus can lead to scarring of the esophagus, which can cause stricture and difficulty in swallowing.
- Barrett’s esophagus. Long-term exposure to stomach acid can lead to precancerous changes to the esophagus. The damage from chronic acid exposure can cause precancerous changes in the tissue lining the lower esophagus and an increased risk of esophageal cancer.
Your healthcare provider may diagnose GERD from your history, symptoms, and physical examination. He may advise that you undergo one of the following procedures for diagnosis of the cause.
Endoscopy helps to confirm the diagnosis of GERD and to detect any complications that may develop. Your gastroenterologist inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. With this, he is able to visualize the inside of your esophagus and stomach. He will want to see any signs of inflammation of the esophagus or of other complications. He can collect a sample of tissue (biopsy) to test for complications such as Barrett’s esophagus. In the case of esophageal stricture, he can dilate the narrowed portion of the esophagus to solve any swallowing problems.
Ambulatory acid (pH) probe test
This test helps to identify when, and for how long, stomach acid regurgitates into the esophagus. In this test, your gastroenterologist places a small monitor (a small capsule) with the help of an endoscope, 5 cm above the lower esophageal sphincter for 48 to 72 hours. This is connected to a small computer that is fitted around your waist. The capsule usually falls off within a week and is passed out in the stool. The capsule transmits data wirelessly to the computer while attached.
X-rays are taken as you swallow a chalky barium liquid that coats the inside lining of your digestive tract, which includes the back of your mouth and throat (pharynx) and your esophagus. The radio-opaque coating allows your doctor to see the outline of your esophagus and stomach. This is particularly useful for diagnosing ulcers, and esophageal stricture.
This test measures the rhythmic muscle contractions in your esophagus when you swallow, which can help determine if your esophagus is able to propel food to your stomach normally by measuring the coordination and force exerted by the muscles of your esophagus. This is indicated in people who have difficulty swallowing.
Transnasal esophagoscopy (TNE) is done to look for any damage in your esophagus and stomach. A thin, flexible tube attached to a camera is inserted through your nose and moved down your throat into the esophagus. The camera sends pictures to a video screen.
The first line of treatment your doctor is likely to recommend is lifestyle changes and nonprescription medications.
Lifestyle advice includes:
- Lose weight if you are overweight
- Raise the head end of the bed if your symptoms get worse at night.
- Have your dinner early, about 2 to 3 hours before going to sleep.
- Avoid painkiller drugs such as aspirin, ibuprofen, or naproxen. Take acetaminophen (Tylenol) to relieve pain.
- Drink plenty of water throughout the day.
- Avoid spicy food.
- Limit nonveg food.
- Do not smoke
- Avoid alcohol
- Limit tea and coffee and other drinks with caffeine.
- Avoid aerated beverages
If there is no relief within a few weeks, your doctor might recommend prescription medication and lastly surgery as a final resort.
- Antacids neutralize stomach acid. Antacids containing calcium carbonate may provide quick relief from symptoms. However, they will not heal any inflammation of the esophageal lining. Examples include Mylanta, Rolaids, and Tums,
- Histamine (H-2) blockers, such as cimetidine, famotidine, and nizatidine don’t act as quickly as antacids, but they provide longer relief by decreasing the acid production from the stomach.
- Proton pump inhibitors block acid production, control inflammation and also heal the esophagus. These medications are stronger-acting acid blockers than H-2 blockers. Nonprescription proton pump inhibitors include lansoprazole (Prevacid 24 HR), omeprazole (Prilosec OTC), and esomeprazole (Nexium 24 HR).
- Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Rarely, these medications might cause diarrhea, headaches, and nausea.
- Prescription-strength H-2 blockers include prescription-strength famotidine and nizatidine. Side effects from these medications are generally mild and well tolerated.
Surgery and other procedures
GERD usually responds to medication. But, if the medication doesn’t help, your doctor might recommend some invasive treatment:
- Fundoplication. In this procedure, the fundus (the top part of your stomach) is folded and sutured around the lower esophageal sphincter. This helps to tighten the sphincter and prevent reflux. This is a laparoscopic procedure with minimum invasion. The wrapping of the top part of the stomach can be complete (Nissen fundoplication) or partial (Toupet fundoplication). Your surgeon will decide the type that best suits your condition.
- LINX implant. This is a minimally invasive laparoscopic procedure done under general anesthesia. It uses a tiny bracelet of magnetic titanium beads to surround and squeeze the lower esophageal sphincter. The magnetic attraction between the beads is enough to keep the junction closed and prevent acid reflux but flexible enough to allow food to pass through.
- Transoral incisionless fundoplication (TIF). This is a new procedure and involves tightening the lower esophageal sphincter using polypropylene fasteners to tighten the weak esophageal sphincter. TIF is performed through the endoscope and requires no surgical incision. It allows for quick recovery time and high tolerance.
Severe cases may require a combination of these treatment options along with lifelong lifestyle adjustments.