Gastroesophageal Reflux Disease (GERD) - Causes, Symptoms, Diagnosis & Treatment

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Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.

Both acid reflux and heartburn are common digestive conditions that many people experience from time to time. When these signs and symptoms occur at least twice each week or interfere with your daily life, or when your doctor can see damage to your esophagus, you may be diagnosed with GERD.

Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications, or even surgery, to reduce symptoms.


Gastroesophageal Reflux Disease (GERD) 

SYMPTOMS

GERD signs and symptoms include:

  • A burning sensation in your chest (heartburn), sometimes spreading to your throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in your throat

CAUSES

GERD is caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus.

When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.

However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn. Sometimes this can disrupt your daily life.

This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can wear away the esophageal lining, causing complications such as bleeding, esophageal narrowing or Barrett's esophagus (a precancerous condition).

RISK FACTORS

Conditions that can increase your risk of GERD include:

  • Obesity
  • Bulging of top of stomach up into the diaphragm (hiatal hernia)
  • Pregnancy
  • Smoking
  • Dry mouth
  • Asthma
  • Diabetes
  • Delayed stomach emptying
  • Connective tissue disorders, such as scleroderma

COMPLICATIONS

Over time, chronic inflammation in your esophagus can lead to complications, including:

  • Narrowing of the esophagus (esophageal stricture). Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.
  • An open sore in the esophagus (esophageal ulcer). Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
  • Precancerous changes to the esophagus (Barrett's esophagus). In Barrett's esophagus, the tissue lining the lower esophagus changes. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but your doctor will likely recommend regular endoscopy exams to look for early warning signs of esophageal cancer.

TESTS AND DIAGNOSIS

Diagnosis of GERD is based on:

  • Your symptoms
  • A test to monitor the amount of acid in your esophagus

  • An X-ray of your upper digestive system
  • A flexible tube to look inside your esophagus

  • A test to measure the movement of the esophagus

TREATMENTS AND DRUGS

Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. If you don't experience relief within a few weeks, your doctor may recommend other treatments, including medications and surgery.

Initial treatments to control heartburn

Over-the-counter treatments that may help control heartburn include:

  • Antacids that neutralize stomach acid
  • Medications to reduce acid production
  • Medications that block acid production and heal the esophagus
  • Prescription-strength proton pump inhibitors. 

  • Medications to strengthen the lower esophageal sphincter

Surgery and other procedures used if medications don't help

Most GERD can be controlled through medications. In situations where medications aren't helpful or you wish to avoid long-term medication use, your doctor may recommend more-invasive procedures, such as:

  • Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication)
  • Surgery to strengthen the lower esophageal sphincter (Linx)

LIFESTYLE AND HOME REMEDIES

  • Maintain a healthy weight. 
  • Avoid tight-fitting clothing
  • Avoid foods and drinks that trigger heartburn
  • Eat smaller meals
  • Don't lie down after a meal
  • Elevate the head of your bed
  • Don't smoke

ALTERNATIVE MEDICINE

  • Herbal remedies. Herbal remedies sometimes used for GERD symptoms include licorice, slippery elm, chamomile, marshmallow and others. Herbal remedies can have serious side effects, and they may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
  • Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.
  • Acupuncture. Acupuncture involves inserting thin needles into specific points on your body. Limited evidence suggests it may help people with heartburn, but major studies have not proved a benefit. Ask your doctor whether acupuncture is safe for you.

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