Gastroesophageal Reflux Disease (GERD)

What is Gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD or acid reflux) is a digestive disorder in which the liquid content of the stomach flows backward (regurgitates, or refluxes) into the esophagus. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. The lining of the esophagus can't handle these caustic substances, so the esophagus becomes inflamed. This causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

If GERD is not treated, it can cause permanent damage to the esophagus.

Gastroesophageal reflux disease is a very common disorder. It is estimated that more than one third of the US population experiences heartburn at least once per month, 20% at least weekly and around 7% daily. GERD can occur in infants, in the elderly, and at any age in between. GERD is not related to the types of food people eat, does not occur more often among members of a family, and is not related to occupation, income, race, or social status.

Most common symptom of GERD

Heartburn is a burning pain in the center of the chest, behind the breastbone. It often starts in the upper abdomen and spreads up into the neck. It usually starts about 30-60 minutes after eating and can last as long as 2 hours. Lying down or bending over can bring on heartburn or make it worse.

Persistent heartburn is the most common (but not the only) symptom of GERD. The disease may be present even without apparent symptoms.

Occasional heartburn is common but does not necessarily mean one has GERD. If it occurs occasionally just after a meal and less than once per week, it is likely a "benign" condition. However, heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

What is the difference between GERD and heartburn?

Gastroesophageal reflux disease is referred to as "heartburn" because the most common symptom is a burning discomfort in the chest under the breast bone.

Gastroesophageal reflux disease is a disease, and heartburn is its most common symptom. Not everyone with GERD has heartburn. Everyone who gets occasional heartburn certainly does not necessarily have GERD. It is only when heartburn becomes so frequent that it is disruptive that one can assume that GERD has developed. Patients that have heartburn symptoms more than once a week are at risk of developing GERD.

GERD symptoms

The symptoms of GERD are a result of the damage caused by stomach acid that has entered the esophagus or higher into the throat and may include:

  • Heartburn. Heartburn is the primary symptom of GERD. It is a burning sensation that radiates up from the stomach to the chest and throat. Heartburn is most likely to occur in connection with the following activities: after a heavy meal, bending over, lifting, lying down.
  • Dyspepsia. Up to half of GERD sufferers have dyspepsia: pain and discomfort in the upper abdomen; fullness in the stomach; nausea after eating.
  • Regurgitation. Regurgitation is the feeling of acid backing up in the throat. Sometimes acid regurgitates as far as the mouth and be experienced as a "wet burp."
  • Chest sensations or pain. Some people may have the sensation that food is trapped behind the breastbone. Chest pain is a common symptom of GERD. It is very important to differentiate it from chest pain caused by heart conditions, such as angina and heart attack.
  • Coughing and respiratory symptoms. Asthmatic symptoms like coughing and wheezing may occur. In fact, in one study, GERD alone accounted for 41.1% of cases of chronic cough in nonsmoking patients. The incidence was even higher when GERD and asthma were combined.
  • Recurring nausea and vomiting. Nausea that persists for weeks or even months and is not attributable to a common cause of stomach upset may be a symptom of acid reflux. In rare cases, vomiting can occur as often as once a day.
  • Difficulty swallowing (dysphagia). Difficulty swallowing may be due to abnormal esophageal motility or to an esophageal stricture (blockage due to scarring).
  • Chronic sore throat

GERD causes

No one knows for certain why people get GERD. Studies show that most healthy people experience brief, spontaneous episodes of reflux daily. These occur almost exclusively after meals, are caused by a sudden relaxation of the lower esophageal sphincter, and do not produce symptoms.

GERD occurs as a result of the failure of the various mechanisms designed to keep stomach contents (acid and digestive juices) out of the esophagus. The lower esophageal sphincter (LES), is a muscle or valve located at the bottom of the esophagus where the esophagus joins the stomach. The LES normally maintains a higher pressure than the pressure of the stomach to keep stomach contents out of the esophagus. Transient or brief LES relaxations may lead to backwashing of stomach contents into the esophagus. These LES relaxations account for most of the gastroesophageal reflux episodes in people, including the occasional symptoms in normal people and in most people who have GERD. In some people who have severe GERD, the LES has an abnormally low pressure, allowing stomach contents to more readily bathe the esophagus.

  • Malfunction of the lower esophageal sphincter muscles. LES is responsible for closing and opening the lower end of the esophagus and is essential for maintaining a pressure barrier against contents from the stomach. It is a complex area of smooth muscles and various hormones. If it weakens and loses tone, the LES cannot close up completely after food empties into the stomach. In such cases, acid from the stomach backs up into the esophagus.

    A functional (frequent transient LES relaxation) or mechanical (hypotensive LES) problem of the LES is the most common cause of GERD.
  • Hiatal Hernia. A hiatal hernia is a hernia that occurs at the opening of the diaphragm where the esophagus meets the stomach. If the muscles that ring the diaphragm opening become weak or damaged, the upper portion of the stomach protrudes through the diaphragm opening. A hiatal hernia prevents the diaphragm muscles from supporting the lower esophageal sphincter. The sphincter becomes incompetent, and GERD occurs. The risk of GERD increases with the size of the hiatal hernia.
    The gastroesophageal junction must be located in the abdomen so that the diaphragmatic crura can assist the action of the LES, thus functioning as an extrinsic sphincter. The presence of a hiatal hernia disrupts this synergistic action and can promote reflux.
  • Esophageal motility disorders and delayed gastric emptying. Impaired muscle function or nerve damage can prevent the stomach from emptying properly. Delayed gastric emptying is one of the GERD causes. The stomach's inability to empty puts pressure on the lower esophageal sphincter.
  • Medications. Certain medications or hormones (eg, progesterone) can decrease the pressure of the LES and cause GERD:
    • Tranquilizers - most notably benzodiazepines and theophylline
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcers, and may also cause GERD and increase severity in people who already have GERD.
    • Calcium channel blockers (used to treat high blood pressure and angina) can weaken the lower esophageal sphincter and allow it to open when it should be closed.
    • Birth control pills - hormones in birth control pills can weaken the lower esophageal sphincter.
    • Tricyclic antidepressants, anticholinergics (used in drugs that treat urinary tract disorders, allergies, and glaucoma) can reduce saliva production and slow down digestion, making the stomach take longer to empty.
    • Beta adrenergic agonists (used for asthma and obstructive lung diseases)
  • Dopamine (used in Parkinson's disease)
  • Bisphosphonates

Other possible causal factors in GERD include delayed clearance of physiologic reflux by saliva, decreased secretion of bicarbonate by esophageal submucosal glands and attenuated ability of the cells lining the esophagus to resist acid injury.

Contributing and risk factors

Each time you eat, stomach acids are released. Normally the LES acts as a guard to prevent stomach acids from backing up into the esophagus. An increase of the pressure in the stomach or relaxation of the muscle tone of the valve may cause reflux to occur. The following factors may contribute to aggravating reflux:

  • Certain foods. Eating fatty meals increases tendency to heartburn, because fat delays the emptying of the stomach. Foods and drinks that are associated with reflux events include chocolate, peppermint, citrus fruits, garlic, tomato-based foods, coffee, fruit juices.
  • Large meals. Large meals increase pressure on the stomach causing the stomach contents to be forced out and up into the esophagus. You will need to give your body at least two hours to digest your food properly. In addition, never ever lie down immediately after eating a large meal. The more the stomach is stretched by food, the higher the tendency to reflux.
  • Alcohol use. Alcohol is a depressant. It relaxes the body in many ways, and it also relaxes the lower esophageal sphincter, allowing acid to enter the esophagus.
  • Excess weight. When you are overweight, the fat in the abdominal cavity increases the pressure inside it. This can cause the contents of the stomach to move up into the gullet.
  • Pregnancy. Hormonal changes during pregnancy cause the esophageal sphincter to relax. And because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it. Both of these factors increase the tendency to reflux.
  • Tobacco smoking. The use of tobacco products, such as cigarettes, cigars, snuff, chewing tobacco, and pipe tobacco, can increase the likelihood of developing GERD, or make your symptoms of GERD even worse. Tobacco prevents the esophageal sphincter from working properly. It increases stomach acid production and reduces the rate at which the stomach empties. Tobacco can also decrease the amount of saliva you make.
  • Respiratory diseases. People with asthma are at very high risk for GERD. One study indicated that patients with chronic obstructive pulmonary diseases (e.g., emphysema or chronic bronchitis) were more likely to have GERD.
  • Hiatal hernia. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest, preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus. The oesophagus remains open, allowing stomach acid to enter it.
  • Diabetes. One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.
  • Zollinger-Ellison syndrome. One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.
  • Scleroderma (connective tissue disorders). Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.
  • Genetic factors. An inherited risk exists in many cases of GERD, possibly because of inherited muscular or structural problems in stomach or esophagus.
  • Medications. Medications that are smooth muscle relaxants, such as theophylline, other oral bronchodilators, calcium channel blockers and diazepam.
  • Position of the body. The tendency to reflux increases when you are lying down. A simple way to relieve this is to use a pillow under the mattress or to raise the head of your bed by 10 cm. Bending over or bending and lifting can also cause reflux.

Diseases and conditions with similar symptoms

Conditions that might be confused with GERD include:

  • Esophageal spasms
  • Gall bladder attacks
  • Peptic ulcer disease
  • Gastritis
  • Asthma
  • Coronary artery disease

More information about GERD:

References






Copyright © 2006 HealthAssist.net. All rights reserved.
Products mentioned are trademarks of their respective companies.
All information on health-assist.net is for educational purposes only.
For medical advice, diagnoses, and treatment, consult your doctor.