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Gastroesophageal Reflux Disease (GERD)


What is GERD (Acid reflux)?

Gastroesophageal reflux disease, also known as GERD, is a digestive disease that involves the flow of stomach acid or bile into the esophagus. This stomach acid irritates the lining of the throat and causes a variety of symptoms.

Alternative names

Acid reflux; Acid regurgitation; Acid indigestion; Heartburn


Symptoms of GERD

More common symptoms are:

  • Feeling that food may be left trapped behind the breastbone
  • Heartburn or a burning pain in the chest (under the breastbone)
    • Increased by bending, stooping, lying down, or eating
    • More likely or worse at night
    • Relieved by antacids
  • Nausea after eating

Less common symptoms are:

  • Cough or wheezing
  • Difficulty swallowing
  • Hiccups
  • Hoarseness or change in voice
  • Regurgitation of food
  • Sore throat

Causes, and risk factors

The exact cause of GERD is not known and it is believed to be caused by complex multiple factors in different individuals which may include:

  • Lower Esophageal Sphincter (LES): Abnormal functioning of the LES is expected to cause refluxing of food, acid, pepsin and bile into the esophagus. Two of the various abnormalities of LES leading to regurgitation are weak contraction and abnormal relaxation (also called transient LES relaxations). Laxity of LES is another cause leading to refluxing of contents of stomach in patients suffering from GERD.
    Gastroesophageal Reflux Disease (GERD)
  • Hiatal Hernia: Most patients suffering from GERD have a hiatal hernia, though the contributing factors are not known exactly. With a hiatal hernia, a small part of the upper stomach attached to the esophagus pushes up through the diaphragm causing the stomach and Lower Esophageal Sphincter (LES) to lie in the chest and the LES is not level with diaphragm. It needs to be understood that the effect of LES and diaphragm occurs at the same location (forming an effective barrier) in those not suffering from hiatal hernia, avoiding reflux of contents of the stomach. Whereas in people suffering from GERD, the pressure due to contraction of LES and diaphragm occurs at two different spots (not forming an effective pressure barrier) leading to reflux of contents of the stomach.
  • Esophageal contractions: The process of swallowing helps in pushing food, saliva, bile and pepsin through the esophagus into the stomach. “Swallowing causes a ring-like wave of contraction of the esophageal muscles, which narrows the lumen (inner cavity) of the esophagus.” This contraction wave of the esophagus traveling from upper esophagus to lower esophagus is called peristaltic movement. Various forms of abnormal peristaltic movements are observed causing GERD.
  • Emptying of Stomach: About 20% of patients suffer from reflux due to abnormally slow emptying of stomach after a meal; this may be due to transient LES causing GERD.
  • Foods:Foods such as fatty foods, spicy foods, chocolate, caffeine, onions, tomato, sauce, carbonated beverages, mint, large meals and alcohol are causal factors for GERD.
  • Treatment for GERD

    • To bring the symptoms under control so that the individual feels better;
    • heal the esophagus of inflammation or injury;
    • manage or prevent complications such as Barrett's esophagus or stricture;
    • and maintain the symptoms of GERD in remission so that daily life is unaffected or minimally affected by reflux.

    A diagnosis of GERD should be made by a physician. The disease can usually be diagnosed based on the presentation of symptoms alone. GERD can occur, however, with no apparent symptoms. Diagnostic tests may be used to confirm or exclude a diagnosis or to look for complications such as inflammation, stricture, or Barrett's esophagus.

    GERD is a recurrent and chronic disease for which long-term medical therapy is usually effective. It is important to recognize that chronic reflux does not resolve itself. There is not yet a cure for GERD. Long-term and appropriate treatment is necessary.

    Treatment options include lifestyle modifications, medications, surgery, or a combination of methods. Over-the-counter preparations provide only temporary symptom relief. They do not prevent recurrence of symptoms or allow an injured esophagus to heal. They should not be taken regularly as a substitute for prescription medicines – they may be hiding a more serious condition. If needed regularly, for more than two weeks, consult a physician for a diagnosis and appropriate treatment.

    Complications of GERD

    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 color and composition of the tissue lining the lower esophagus change. 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.

    Prevention of GERD

    Lifestyle changes sometimes prevent symptoms of GERD. Because fatty foods, mints, chocolates, alcohol, nicotine, and caffeinated beverages such as coffee or colas relax the LES, you may be able to reduce the amount of acid reflux you experience by avoiding these foods. Carbonated drinks, citrus fruits and juices, spicy foods, and tomato sauce may irritate the lining of your esophagus and make the effects of GERD more severe. Cutting these foods from your diet could reduce the severity of the symptoms.

    You may help reduce reflux by quitting smoking, wearing loose clothing, eating smaller meals, not lying down for at least three hours after you eat, and losing weight if you are overweight. Some people are able to prevent symptoms at night by raising the head of their bed with 6-inch blocks or by sleeping on a special wedge-shaped pillow that elevates the upper part of the body.

    Some medications, such as birth control pills and drugs for osteoporosis, may cause reflux and heartburn as a side effect. If medications you are taking seem to be the cause of your heartburn, talk with your doctor about other medications you might be able to use instead. Do not stop taking a prescription medication until you talk with your doctor.


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