Understanding Gastroesophageal Reflux Disease(GERD)

GERD/Acid Reflux: Causes, Symptoms, Diagnosis, Treatment, Complications, & Prevention

Understanding Gastroesophageal Reflux Disease(GERD)

When stomach acid repeatedly flows back into the esophagus, the tube that connects the mouth and stomach, it is known as gastroesophageal reflux disease or GERD. Acid reflux, the term for this backflow, can irritate the lining of the esophagus. Acid reflux may occur when you lie down too soon after dinner or after a heavy, fatty meal. While occasional acid reflux is normal, recurrent occurrences can progress to GERD.

Most people can reduce their GERD symptoms with medication and lifestyle changes. In rare instances, the problem may need to be managed surgically.

What is Acid Reflux?

Under normal circumstances, the contents of your stomach should only flow downward. When stomach acid refluxes backward into the throat and esophagus, it causes acid reflux. This backflow can cause a sensation of acid reaching areas where it doesn’t belong, leading to discomfort. The acid irritates and inflames the tissues lining the esophagus, stretching from the stomach through the chest and neck.

Almost everyone experiences acid reflux occasionally. It often manifests as heartburn, a burning sensation in the chest near the sternum, or indigestion, which is a burning feeling in the stomach after eating. While occasional acid reflux can be bothersome, it is not considered a disease. However, some individuals suffer from chronic reflux, which can significantly affect their quality of life and potentially lead to tissue damage.

What is Gastroesophageal Reflux Disease(GERD)?

The term "GERD," or gastroesophageal reflux disease, describes an ongoing condition in which acid reflux occurs in the esophagus. Acid reflux is classified as chronic when it occurs at least twice a week over several weeks. While temporary conditions can lead to occasional acid reflux, GERD represents a persistent mechanical issue, indicating that the mechanisms designed to prevent acid from entering the esophagus are not functioning properly.

Causes of GERD

GERD is caused by acid reflux or nonacidic reflux from the stomach. The lower esophageal sphincter, a circular band of muscle that surrounds the bottom of the esophagus, relaxes during swallowing to let food and liquids pass into the stomach. The sphincter then shuts once again.

Stomach acid might return to the esophagus if the sphincter weakens or does not relax as it should. The lining of the esophagus becomes irritated by this continuous backwash of acid, frequently leading to inflammation.

Risk Factors for GERD

The following conditions may raise your risk of GERD:

• Being overweight.
• A hiatal hernia is the name for the protrusion of the upper abdomen over the diaphragm.
• Pregnancy.
• Diseases of the connective tissue, like scleroderma.
• Delayed stomach emptying.
• Acid reflux can be made worse by the following factors:
• Smoking.
• Eating late at night or in huge quantities.
• Consuming particular foods, such as fried or fatty meals.
• Consuming certain liquids, like coffee or alcohol.
• Using certain medications, such as aspirin.

Hiatal Hernia and GERD

A hiatal hernia may impair the lower esophageal sphincter's (LES) function, raising the risk of reflux esophagitis, according to certain medical experts. The diaphragmatic hiatus, a little opening in the diaphragm that allows the top portion of the stomach to protrude into the chest cavity, is the cause of this disorder. The muscle that divides the chest from the abdominal cavity is called the diaphragm. According to recent research, the diaphragm's opening is crucial for supporting the bottom part of the esophagus.

A hiatal hernia seldom results in reflux or heartburn issues in patients. However, it could make it easier for stomach contents to reflux into the esophagus.

A hiatal hernia may result from abrupt physical exertion, vomiting, coughing, or straining that raises abdominal pressure. Although a minor hiatal hernia can arise at any age, it is more common in otherwise healthy people over 50.

Hiatal hernias usually don't need to be treated. If the hernia presents a risk of strangulation—that is, if it gets twisted and shuts off the blood supply—intervention can be required. Additionally, if the hernia is linked to severe GERD or esophagitis—an esophageal inflammation—treatment may be necessary. In some situations, your physician can advise surgery to prevent strangling or to minimize the extent of the hernia.

GERD and Weight

Obesity and overweight individuals have an increased chance of having gastroesophageal reflux disease (GERD). Excess weight can considerably increase the risk of developing this illness. Although lifestyle factors and food preferences may play a role, being overweight puts more strain on the stomach, raising the risk of acid reflux.

GERD and Pregnancy

Pregnant women are more likely to experience gastroesophageal reflux disease (GERD), with many reporting symptoms by the third trimester. Pregnancy hormones play a major role in this since they can affect the esophageal and stomach muscles and raise the risk of acid reflux. Furthermore, the increasing baby's strain on the stomach may make the problem worse.

Diet, GERD, and Other Behaviors

If you currently have acid reflux, some dietary and lifestyle decisions may exacerbate it:

• Smoking Some foods and beverages, such as chocolate, fried or fatty meals, coffee, and alcohol
• Large meals
• Eating too close to bedtime
• GERD and medicine
• Heartburn may be brought on by or made worse by certain drugs. Among the things that might cause GERD are:
• Antibiotic Supplements, such as potassium and iron
• Painkillers for irregular heartbeats, such as aspirin or ibuprofen Quinidine
• To slow down bone loss, take bisphosphonates.

GERD and Food

Although they definitely couldn't cause acid reflux on their own, foods and beverages may certainly aggravate it. In higher dosages, chocolate, coffee, wine, mint, garlic, and onions may relax your LES.

Foods high in fat produce more gas in the stomach and take longer to digest, which increases the chance of acid escaping. Dinner may not have time to fully digest if it's a heavy meal before you go to bed.

GERD in Children

Unbelievably, more babies and kids than previously believed had GERD, according to recent studies. Recurrent episodes of vomiting may result from it. In addition, it may result in coughing and other respiratory issues. Teens and older children can also get GERD. But it's more usual for young individuals to experience an occasional attack of reflux without it being a more significant or chronic condition.

Signs and Symptoms of GERD

Common symptoms of GERD include:

• Heartburn is a common term for the burning feeling in the chest. Heartburn often occurs after eating, and it may be more severe at night or when you're resting.
• Leftover food or sour liquid in the throat.
• Chest or upper abdomen ache.
• Disorders related to swallowing, or dysphagia.
• A feeling of a lump in the throat.

In addition, if you suffer acid reflux at night, you may have:

• A constant cough.
• Laryngitis, or inflammation of the voice chords.
• A new or worsening asthma attack.

GERD symptoms may become worse:

• Either in bed or at night.
• Following a hearty or fatty meal.
• Following a squat.
• Following alcohol or tobacco consumption.

Diagnosis of GERD

A physician will usually review your medical history and do a physical examination to evaluate your symptoms. If you present warning signs such as difficulty swallowing (dysphagia) or chest pain, they may refer you to a gastroenterologist or suggest specific tests, including:

Ambulatory 24-hour pH probe

A little tube is put into your esophagus through your nose. The amount of acid exposed to your esophagus is measured by a pH sensor at the tube's tip, which transmits the information to a portable computer. This tube is worn for around a whole day.

X-ray of the Upper Digestive System 

X-rays are taken after consuming a chalky substance that covers and fills the interior lining of the digestive system. A medical practitioner may see the stomach and esophagus as silhouettes thanks to the covering. This is especially helpful for those who have difficulty swallowing.

Occasionally, an X-ray is taken following a barium tablet intake. This may aid in the diagnosis of esophageal narrowing causing difficulty swallowing.

Upper Endoscopy

An upper endoscopy visually examines the upper digestive tract using a small camera attached to a flexible tube. The camera facilitates giving a picture of the stomach and esophageal interiors. Test results may not confirm reflux, but an endoscopy could reveal other issues including esophageal inflammation.

To detect potential issues like Barrett's esophagus, an endoscopy can also be performed to obtain a biopsy or sample of tissue. Sometimes during this process, the esophagus might be stretched or dilated if a narrowing is observed in it. This helps those who have difficulty swallowing.

Esophageal Manometry

Esophageal manometry, also known as esophageal motility studies, is not used to diagnose GERD but helps rule out other conditions that may present similar symptoms. This is particularly important if your doctor is considering anti-reflux surgery.

During the procedure:

A pressure-sensitive catheter is inserted into the esophagus by your doctor. This may be done just before esophageal pH impedance studies to guide catheter placement. The catheter evaluates the strength and synchronization of muscle contractions in the esophagus, as well as the lower esophageal sphincter's capacity to relax and contract. Before anti-reflux surgery, esophageal manometry is an essential part of the assessment procedure.

Transnasal Esophagoscopy

The purpose of this test is to assess the esophagus for any damage. A tiny camera is placed within a thin, flexible tube that is sent down the mouth and into the esophagus. Images are taken by the camera and shown for analysis on a video screen.

After reaching a diagnosis, your doctor will consult with you to determine the most effective treatment plan tailored to your needs.

Treatment of GERD

Since GERD is a chronic condition, long-term care is needed. Physicians frequently prescribe medication and advise lifestyle modifications to manage GERD. Physicians may recommend surgery if symptoms do not get better.

Lifestyle Modifications

The mainstay of GERD treatment is changing one's lifestyle since it can alleviate symptoms. These changes may consist of:

• Reducing weight for those who have recently gained weight or are overweight
• Sleeping on an inclined surface, eating less, and avoiding trigger foods
• Trying to avoid eating anything three hours or less before bed.
• Breathing exercises
• Eating foods and drinking liquids that may alleviate your acid reflux
• Quit smoking and alcohol
• Avoiding large, heavy meals in the evening
• Raising your head while sleeping

Medicine for GERD

Over-the-counter (OTC) medications for acid reflux.

Antacids neutralize stomach acid, preventing reflux from being as damaging to the esophagus. They are not a viable long-term remedy since they can cause negative effects if used too frequently, even though they perform effectively for periodic acid reflux.

Alginates. Seaweed naturally produces sugars called alginates. They assist stop acid reflux by floating on top of the acid, forming a physical barrier between the acid and your esophagus. Alginates are available both on their own and in combination with antacids.

Prescription medications for GERD include:

H2 blockers, or Histamine receptor antagonists. H2 blockers lessen stomach acid by blocking histamine, a molecule that tells your body to produce acid in your stomach. Among these drugs are cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid). H-2 blockers can prevent the stomach from creating acid for up to 12 hours, although they don't work as quickly as antacids. Your body can adapt to their effects.

Proton pump inhibitors (PPIs). PPIs are more potent acid blockers that aid in the healing process. If you have symptoms of tissue damage in your esophagus or your GERD is relatively severe, your provider may prescribe them as a first-line therapy. They reduce acid reflux by 90% of the time.

Baclofen. Muscular relaxants like Baclofen are frequently administered to treat muscular spasms. Additionally, by lowering the frequency of LES relaxation events, acid reflux episodes can also be decreased. Although it's not the first line of treatment for acid reflux, your treatment strategy may include baclofen.

Diet 

In certain cases, certain meals might exacerbate GERD symptoms. These consist of:

• Oily meals
• Spicy foods
• Cocoa or chocolate
• Peppermint
• Foods high in caffeine
• Tomato products
• Alcoholic beverages

It's crucial to see a doctor if someone avoids certain meals but still has heartburn regularly since there can be other underlying conditions causing the symptoms.

Surgery

Surgery for GERD includes:

Fundoplication Nissen. The most frequent procedure for GERD is a fundoplication. When feasible, a laparoscopic procedure is used, which results in fewer incisions and a shorter recuperation period. To tighten the connection between your lower esophagus and stomach, a surgeon will sew the top of your stomach around it. This is also how a hiatal hernia is repaired.

LINX Apparatus. During surgery, a more recent technique inserts a gadget known as LINX. A ring of small magnets called the LINX device helps keep the opening between the stomach and esophagus closed.

Transoral Incisionless Fundoplication (TIF). Transoral Incisionless Fundoplication (TIF) is a cutting-edge procedure that employs polypropylene fasteners to partially wrap the lower esophagus, effectively tightening the lower esophageal sphincter. This innovative treatment is performed through the mouth using an endoscope, eliminating the need for surgical incisions. Key benefits of TIF include high patient tolerance and a quick recovery time.

However, TIF is not recommended as a standalone option for individuals with a large hiatal hernia. Alternatively, it may be considered in combination with laparoscopic hiatal hernia repair.

Complications of Untreated GERD

Prolonged inflammation of the esophagus over time can lead to:

• Esophagitis. Inflammation of the esophageal lining is known as esophagitis. Chronic esophagitis can lead to long-term discomfort and complications such as esophageal ulcers. Long-term tissue alterations such as scarring or intestinal metaplasia, a precursor to cancer, may result from it.
• Esophageal Stricture. Additionally, scar tissue may form on your esophagus to shield it from ongoing damage and inflammation. Your esophagus may constrict as a result of scar tissue. We refer to this as a stricture. It may be difficult to swallow due to esophageal strictures, which can make eating and drinking difficult.
• Barrett's Esophagus. The term for intestinal metaplasia of the esophagus is Barrett's esophagus. It denotes a shift in the esophageal lining's appearance to that of the intestinal lining. This change occurs with extended exposure to acid and inflammation. It increases the chance of esophageal cancer.
• Laryngopharyngeal Reflux. Some persons with GERD develop LPR, which is reflux that enters the throat. While you sleep, acid may find its way up into your throat. In addition to causing vocal chord growths, swelling, and hoarseness, it also raises the risk of aspirating acid particles into your airways.
• Gum disease, loss of the tooth enamel, or other dental issues

To reduce your risk of complications, you should take action to avoid, manage, and treat GERD symptoms.

How to Prevent GERD?

You may manage the symptoms of your GERD by altering your behaviors and way of living. A few ideas are as follows:

• Avoid Food and Beverage Triggers. Meals that can relax the LES should be avoided, such as chocolate, peppermint, fatty meals, coffee, and alcohol. Additionally, you should stay away from foods and drinks including citrus fruits and juices, tomato products, and pepper that may aggravate a damaged esophageal lining if they trigger symptoms.
• Eat Smaller Servings. Reducing the size of meals may also aid in symptom management. Additionally, eating meals two to three hours before going to bed helps your stomach to partially empty and reduce acid production.
• Eat Slowly. Each meal should be enjoyed slowly.
• Give Your Food a Good Chew. If you put down your fork after a mouthful, it could help you remember to do this. Only until you've fully eaten and swallowed that mouthful may you pick it up again.
• Quit Smoking. Smoking cigarettes weakens the LES. It's critical to give up smoking to lessen GERD symptoms.
• Raise Your Head. Gravity can reduce the amount that refluxes into your esophagus when you sleep on a properly made wedge or raise the head of your bed on 6-inch blocks. Avoid using pillows as self-support. That simply makes the stomach feel more compressed.
• Maintain a Healthy Weight. Symptoms are frequently made worse by obesity. Losing weight is a relief for many overweight people.
• Dress Comfortably. Wearing clothing that clings to your waist puts strain on your lower esophagus and tummy.

FAQs about GERD

Can I live a normal life with GERD?

If you follow specific lifestyle guidelines and take proper care of your gastroesophageal reflux disease, you may have a normal life with the illness. You may greatly lessen symptoms by changing your diet to exclude trigger foods like citrus, coffee, and spicy and fatty meals. Reflux can be avoided by eating smaller meals and delaying resting after meals. Remaining at a healthy weight, giving up smoking, and consuming less alcohol are important strategies for managing GERD. Proton pump inhibitors, a drug recommended by a doctor, or over-the-counter antacids can relieve symptoms and aid in managing the illness. The symptoms of insomnia can be relieved by raising the head of your bed, and stress reduction methods like exercise or meditation are also helpful.

What does GERD stand for?

Gastroesophageal reflux disease, commonly referred to as GERD, is a common disease where the stomach's contents ascend to the esophagus. Reflux becomes a disease when it produces repeated or severe symptoms or injury. The pharynx, respiratory tract, or esophagus may sustain damage from reflux.

Is GERD a serious disease?

The esophagus may suffer irreversible damage from untreated GERD. Avoiding things that bring on your symptoms is one of the easiest strategies to manage your GERD. Some people will have to limit particular foods; others may have to give them up completely.

How to cure Gerd permanently?

GERD cannot be completely cured, although it may frequently be greatly controlled and improved with a combination of medication, lifestyle modifications, and, in certain situations, surgery. Keeping a healthy weight, avoiding foods that trigger symptoms, such as hot or greasy meals, and eating more often and in smaller portions can all help manage symptoms. To lessen reflux at night, it's also critical to avoid lying down after eating and to raise the head of your bed. Over time, medications such as proton pump inhibitors, H2 blockers, and antacids can help control symptoms and reduce stomach acid. In severe situations, the lower esophageal sphincter may need to be strengthened through surgery, such as a fundoplication, to provide longer-lasting relief. These techniques help many GERD sufferers lead comfortable lives and keep their symptoms under control.

What is the root cause of GERD?

You may experience acid reflux after a large, rich meal or if you go to bed too soon after dinner. Your esophagus becomes coated in stomach acid, which causes heartburn and other symptoms. While acid reflux that occurs sometimes can be managed at home, persistent acid reflux, or GERD, may need to be treated by a doctor.