In the United States, about 20% of people suffer from gastroesophageal reflux disease (GERD), a common digestive disorder. The esophagus is the tube connecting the mouth and the stomach, which can become irritated, inflamed, and damaged over time when stomach contents, including acid, flow back into it.
GERD is primarily caused by a problem with the lower esophageal sphincter (LES), a muscle ring that serves as a valve between the esophagus and stomach. In normal circumstances, the LES closes tightly after the stomach contents have been swallowed, preventing them from recirculating back into the esophagus. Some people, however, have a weak or overly relaxed LES, which allows stomach contents to escape into the esophagus.
Some factors that can contribute to GERD include:
Obesity
Hiatal hernia, a condition where the upper part of the stomach bulges through the diaphragm
Pregnancy
Smoking
Eating large or spicy meals, especially before bedtime
Drinking alcohol, coffee, or carbonated beverages
Taking certain medications, such as aspirin, ibuprofen, or some blood pressure drugs
The most common symptom of GERD is heartburn, a burning sensation in the chest that may rise to the throat. Some people may also experience a sour or bitter taste in the mouth, or regurgitation of food or liquid. Other symptoms of GERD may include:
Difficulty swallowing or feeling of a lump in the throat
Chronic cough or hoarseness
Bad breath or dental erosion
Chest pain or discomfort
Nausea or vomiting
Asthma or wheezing
Some people may have GERD without any noticeable symptoms. However, this does not mean that they are not at risk of complications. GERD can cause serious damage to the esophagus over time, such as:
Esophagitis, an inflammation of the esophagus that can lead to bleeding, ulcers, or narrowing
Barrett’s esophagus, a condition where the normal lining of the esophagus is replaced by abnormal cells that can increase the risk of esophageal cancer
Esophageal cancer, a rare but life-threatening type of cancer that can affect the esophagus
To diagnose GERD, a doctor will usually ask about the symptoms, medical history, and lifestyle habits of the patient. The doctor may also perform a physical examination and order some tests, such as:
Endoscopy, a procedure where a thin, flexible tube with a camera and light is inserted through the mouth to examine the esophagus and the stomach
pH monitoring, a test where a small device is attached to the esophagus to measure the acidity level over 24 hours
Esophageal manometry, a test where a thin, flexible tube with sensors is inserted through the nose to measure the pressure and movement of the esophagus
Barium swallow, an X-ray test where the patient swallows a liquid containing barium, a contrast agent that makes the esophagus and the stomach visible on the X-ray images
The treatment of GERD depends on the severity of the symptoms and the extent of the damage to the esophagus. The main goals of treatment are to relieve the symptoms, heal the esophagus, and prevent complications. The treatment options may include:
Lifestyle changes, such as losing weight, quitting smoking, avoiding trigger foods and drinks, eating smaller and more frequent meals, raising the head of the bed, and not lying down within three hours after eating
Medications, such as antacids, H2 blockers, proton pump inhibitors, or prokinetics, that can reduce the amount or the effect of stomach acid on the esophagus
Surgery, such as fundoplication, where the upper part of the stomach is wrapped around the lower end of the esophagus to strengthen the LES and prevent reflux
Endoscopic procedures, such as radiofrequency ablation, where heat is applied to the abnormal cells in the esophagus to destroy them and prevent cancer
The best way to prevent GERD is to avoid the factors that can cause or worsen it. Some preventive measures are:
Maintaining a healthy weight and body mass index (BMI)
Eating a balanced and nutritious diet that is low in fat, spice, and acid
Drinking plenty of water and limiting the intake of alcohol, caffeine, and carbonated beverages
Avoiding smoking and exposure to secondhand smoke
Managing stress and practicing relaxation techniques
Seeking medical attention if the symptoms of GERD persist or worsen
With proper diagnosis, treatment, and prevention, GERD can be controlled and its complications avoided. However, GERD is a chronic and potentially serious condition that can affect the quality of life and the health of the esophagus. In case you have any questions or concerns about GERD, speak with your doctor or gastroenterologist.
