Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that occurs when stomach acid flows back into the esophagus, causing symptoms and potentially leading to complications.

Causes and Risk Factors

• Weakening of the lower esophageal sphincter (LES), which allows stomach acid to flow back into the esophagus
• Hiatal hernia, where part of the stomach bulges up into the chest through an opening in the diaphragm
• Obesity, which increases pressure on the stomach and can cause stomach acid to flow back into the esophagus
• Pregnancy, which can cause increased pressure on the stomach and lead to GERD symptoms
• Certain foods and drinks, such as citrus fruits, tomatoes, chocolate, spicy foods, and caffeine, which can trigger GERD symptoms
• Smoking, which can weaken the LES and increase the risk of GERD

Symptoms

• Heartburn, a burning sensation in the chest and throat
• Regurgitation, where stomach acid flows back up into the mouth
• Trouble swallowing (dysphagia)
• Chest pain or tightness
• Bloating and discomfort in the upper abdomen
• Nausea and vomiting
• Hoarseness or a sore throat
• Coughing or wheezing, especially at night

Diagnosis

GERD is typically diagnosed based on symptoms and medical history. Diagnostic tests may include:

• Upper endoscopy, where a flexible tube with a camera is inserted through the mouth to visualize the esophagus and stomach
• Ambulatory acid probe test, which measures the amount of acid in the esophagus over a 24-hour period
• Esophageal manometry, which measures the muscle contractions of the esophagus
• Barium swallow, where a patient swallows a barium solution and X-rays are taken to visualize the esophagus

Treatment

Treatment for GERD typically involves lifestyle changes and medication. Lifestyle changes may include:

• Eating smaller, more frequent meals
• Avoiding trigger foods and drinks
• Quitting smoking
• Losing weight if overweight or obese
• Raising the head of the bed by 6-8 inches to reduce symptoms at night

Medications may include:

• Antacids, which neutralize stomach acid
• Histamine-2 (H2) blockers, which reduce acid production in the stomach
• Proton pump inhibitors (PPIs), which block the production of stomach acid

Complications

If left untreated, GERD can lead to complications such as:

• Esophagitis, inflammation of the esophagus
• Stricture, narrowing of the esophagus due to scarring
• Barrett's esophagus, a precancerous condition where the lining of the esophagus changes
• Esophageal cancer, although this is rare

Prevention

To prevent GERD symptoms, it is recommended to:

• Maintain a healthy weight
• Avoid trigger foods and drinks
• Quit smoking
• Eat smaller, more frequent meals
• Raise the head of the bed by 6-8 inches to reduce symptoms at night