GERD / Heartburn

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What is GERD?

Gastroesophageal reflux disease, or GERD, is a very common disorder. Gastroesophageal refers to the stomach and the esophagus. Reflux refers to the back-flow of acidic or non-acidic stomach contents into the esophagus.

GERD is characterized by symptoms, with or without tissue damage, that result from repeated or prolonged exposure of the lining of the esophagus to acidic or non-acidic contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD.

GERD is often accompanied by symptoms such as heartburn and regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed only when complications become evident.

Gastroesophageal reflux disease, or GERD, is very common, affecting up to 1 in 5 or more of adult men and women in the U.S. population. It also occurs in children. Although common, the disease often is unrecognized – its symptoms misunderstood. This is unfortunate because GERD is generally a treatable disease, though serious complications can result if it is not treated properly.

Heartburn is the most frequent – but not the only – symptom of GERD. (The disease may be present even without apparent symptoms.) Heartburn is not specific to GERD and can result from other disorders that occur inside and outside the esophagus. All too often, GERD is either self-treated or mistreated.

GERD is a chronic disease. Treatment usually must be maintained on a long-term basis, even after symptoms have been brought under control. Issues of daily living and compliance with long-term use of medication need to be addressed as well. This can be accomplished through follow-up and education.

GERD is often characterized by painful symptoms that can undermine an individual’s quality of life. Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures.

It is essential for individuals who suffer the chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available.

What are the common symptoms of GERD?

Chronic heartburn is the most frequently reported symptom of GERD. Acid regurgitation (refluxed acid into the mouth) is another common symptom, sometimes associated with sour or bitter taste.

Can symptoms other than heartburn be signs of GERD?

Numerous symptoms other than heartburn are associated with GERD. These may include belching, difficulty or pain when swallowing, or waterbrash (sudden excess of saliva).

An alarming symptom needing prompt medical attention is dysphagia (the sensation of food sticking in the esophagus).

Other GERD symptoms may involve chronic sore throat, laryngitis, throat clearing, chronic cough, and other oral complaints such as inflammation of the gums and erosion of the enamel of the teeth. Small amounts of acid can reflux into the back of the throat or into the lungs and cause irritation.

Hoarseness in the morning, a sour taste, or bad breath may be clues of GERD. Chronic asthma, cough, wheezing, and noncardiac chest pain, (it may feel like angina) may be due to GERD. People with these symptoms often have less frequent or even absent typical symptoms of GERD such as heartburn.

Chest pain or chest pressure may indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation. Possible heart conditions must always be excluded first.

When seeing a doctor, relief or improvement of symptoms after a two-week trial therapy with a proton pump inhibitor (a prescription medication that inhibits gastric acid secretion) is an indication that GERD is the likely cause. This can also be confirmed with pH monitoring, which measures the level of acid refluxing into the esophagus and as high as the larynx.

What causes GERD?

There is no known single cause of gastroesophageal reflux disease (GERD). It occurs when the esophageal defenses are overwhelmed by gastric contents that reflux into the esophagus. This can cause injury to tissue. GERD can also be present without esophageal damage (approximately 50 – 70% of patients have this form of the disease).

Gastroesophageal reflux occurs when the LES barrier is somehow compromised. Occasional reflux occurs normally, and without consequence other than infrequent heartburn, in people who do not have GERD. In people with GERD, reflux causes frequent symptoms or damages the esophageal tissue.

Some, but not all, people with hiatal hernia have GERD and vice versa. Hiatal hernia occurs when a part of the stomach moves above the diaphragm, from the abdominal to the chest area. The diaphragm is a muscle that separates the chest (containing the esophagus) from the abdomen (containing the stomach). If the diaphragm is not intact, it can compromise the ability of the LES to prevent acid reflux. A hiatal hernia may decrease the sphincter pressure necessary to maintain the anti-reflux barrier.

Even when the LES and the diaphragm are intact and functioning normally, reflux can still occur. The LES may relax after having large meals leading to distension of the upper part of the stomach. When that happens there is not enough pressure at the LES to prevent reflux. In some patients the LES is too weak or cannot mount enough pressure to prevent reflux during periods of increased pressure within the abdomen.

The extent of injury to the esophagus – and the degree of severity of GERD – depends on the frequency of reflux, the amount of time the refluxed material stays in the esophagus, and the quantity of acid in the esophagus.

 

Source:  International Foundation for Gastrointestinal Disorders, Inc. (IFFGD). 1998-2018. Adapted from IFFGD Publication: GERD Questions and Answers. Revised 2010 by Ronnie Fass, MD, Chair, Division of GI and Hepatology, Metro Health Medical Center, Cleveland, OH. Original Contributors: Joel E. Richter, MD, Philip O. Katz, MD, and J. Patrick Waring, M.D. Editor: William F. Norton, International Foundation for Functional Gastrointestinal Disorders, Milwaukee, WI. What is GERD? https://www.aboutgerd.org/what-is-gerd.html