Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that 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. While many people experience acid reflux from time to time, GERD is diagnosed when acid reflux happens more than twice a week or causes inflammation in the esophagus.

GERD affects approximately 20% of the adult population in the United States, making it one of the most common digestive disorders. The condition occurs when the lower esophageal sphincter (LES)—a ring of muscle at the bottom of the esophagus that acts as a valve between the esophagus and stomach—becomes weakened or relaxes inappropriately, allowing stomach contents to flow back up.

While GERD can significantly impact quality of life, most people can manage their symptoms through lifestyle changes and medications. However, some people may need stronger medications or surgery to ease symptoms. Left untreated, GERD can lead to serious complications including esophageal damage, bleeding, and an increased risk of esophageal cancer. Understanding and properly managing GERD is crucial for preventing these long-term complications and maintaining a good quality of life.

Symptoms

GERD symptoms can vary from mild to severe and may occur daily or intermittently:

Common Symptoms

Primary Symptoms

• Heartburn: Burning sensation in chest, usually after eating, worse at night
• Regurgitation: Sour or bitter taste from stomach acid backing up
• Dysphagia: Difficulty swallowing or feeling of food stuck
• Chest pain: Can mimic heart-related pain

Respiratory Symptoms

• Chronic cough: Especially at night
• Asthma-like symptoms: Wheezing, shortness of breath
• Laryngitis: Hoarseness, sore throat
• Pneumonia: From aspiration of stomach contents

Other Symptoms

• Dental erosion: From acid exposure
• Bad breath: Halitosis from regurgitation
• Excessive saliva: Water brash
• Feeling of lump in throat: Globus sensation
• Disrupted sleep: From nighttime reflux

Alarm Symptoms

Causes and Risk Factors

GERD occurs when the lower esophageal sphincter doesn't function properly:

Primary Causes

Lower Esophageal Sphincter (LES) Dysfunction

• Weak LES muscle tone
• Inappropriate LES relaxation
• Increased pressure on LES
• Delayed stomach emptying

Hiatal Hernia

• Upper part of stomach bulges through diaphragm
• Weakens LES function
• Common in people over 50
• Can be congenital or acquired

Risk Factors

Lifestyle Factors

• Obesity: Increased abdominal pressure
• Smoking: Weakens LES, reduces saliva
• Alcohol: Relaxes LES, increases acid production
• Large meals: Distends stomach
• Late-night eating: Lying down with full stomach
• Tight clothing: Increases abdominal pressure

Dietary Triggers

• Fatty foods: Delay stomach emptying
• Spicy foods: Irritate esophagus
• Citrus fruits: High acid content
• Tomato products: Acidic
• Chocolate: Contains methylxanthine
• Caffeine: Relaxes LES
• Carbonated beverages: Increase stomach pressure
• Mint: Relaxes LES

Medical Conditions

• Pregnancy: Hormonal changes and pressure
• Diabetes: Delayed stomach emptying
• Connective tissue disorders: Scleroderma
• Zollinger-Ellison syndrome: Excess acid production
• Gastroparesis: Slow stomach emptying

Medications

• Aspirin and NSAIDs
• Calcium channel blockers
• Certain asthma medications
• Antihistamines
• Sedatives
• Antidepressants
• Bisphosphonates

Diagnosis

GERD diagnosis typically begins with symptom evaluation and may include various tests:

Initial Assessment

Diagnostic Tests

Other Tests

• Barium swallow: X-ray with contrast
• Impedance testing: Detects non-acid reflux
• PPI trial: Diagnostic and therapeutic
• Bernstein test: Rarely used acid perfusion

Treatment

GERD treatment aims to reduce symptoms, heal esophageal damage, and prevent complications:

Medications

Surgical Options

Endoscopic Procedures

• Stretta: Radiofrequency energy to LES
• TIF: Transoral incisionless fundoplication
• MUSE: Endoscopic stapling
• Less invasive but variable results

Lifestyle Management

Lifestyle modifications are essential for managing GERD effectively:

Dietary Changes

• Avoid trigger foods: Keep a food diary
• Smaller meals: Reduce stomach pressure
• Eat slowly: Chew thoroughly
• Stay upright: 3 hours after eating
• Limit liquids with meals: Reduces distention

Sleep Modifications

• Elevate head of bed: 6-8 inches
• Use wedge pillow: Not just extra pillows
• Sleep on left side: Reduces reflux
• Avoid late meals: 3 hours before bed
• Loose pajamas: Reduce pressure

Weight Management

• Lose excess weight: Even 10% helps
• Gradual weight loss: 1-2 pounds weekly
• Exercise regularly: Avoid high-impact
• Avoid tight clothing: Especially around waist

Habit Changes

• Quit smoking: Improves LES function
• Limit alcohol: Especially red wine
• Stress management: Can worsen symptoms
• Avoid lying down after meals: Wait 3 hours
• Chew gum: Increases saliva, neutralizes acid

Complications

Untreated GERD can lead to serious complications:

Prevention

While not all cases of GERD can be prevented, risk can be reduced:

Primary Prevention

• Maintain healthy weight: Reduces abdominal pressure
• Avoid trigger foods: Know your sensitivities
• Don't smoke: Protects LES function
• Moderate alcohol: Limit intake
• Eat smaller meals: Prevents overfilling
• Good posture: During and after meals

Secondary Prevention

For those with occasional reflux:

• Early treatment of symptoms
• Identify and avoid triggers
• Regular medical follow-up
• Adherence to medications
• Lifestyle modifications

Preventing Complications

• Take medications as prescribed: Don't stop suddenly
• Regular monitoring: If Barrett's esophagus
• Report new symptoms: Early intervention
• Follow-up endoscopy: As recommended

Living With GERD

Managing GERD requires ongoing attention but allows for normal life:

Daily Management

• Medication routine: Same time daily
• Meal planning: Avoid triggers
• Symptom diary: Track patterns
• Stress management: Regular relaxation
• Exercise wisely: Low-impact activities

Social Considerations

• Dining out: Research menus, eat early
• Travel: Pack medications, plan meals
• Work: Keep antacids handy
• Relationships: Communicate needs
• Sleep partners: Explain bed elevation

Long-term Outlook

• Most people achieve good symptom control
• May need lifelong management
• Regular monitoring prevents complications
• Quality of life usually excellent with treatment
• Surgery successful for appropriate candidates

Diet and Nutrition

Diet plays a crucial role in managing GERD symptoms:

Foods to Avoid

GERD-Friendly Foods

• Lean proteins: Chicken, fish, turkey
• Complex carbs: Oatmeal, brown rice
• Non-citrus fruits: Bananas, melons, apples
• Vegetables: Green beans, broccoli, carrots
• Healthy fats: Avocado, olive oil (moderate)
• Ginger: Natural anti-inflammatory
• Alkaline foods: Almonds, fennel

Eating Strategies

• Small portions: 5-6 small meals
• Slow eating: 20-30 minutes per meal
• Stop before full: 80% capacity
• Upright position: During and after
• No bedtime snacks: 3-hour rule

When to See a Doctor

Schedule an Appointment If:

• Heartburn occurs more than twice weekly
• Symptoms persist despite OTC medications
• Difficulty or pain when swallowing
• Persistent nausea or vomiting
• Unexplained weight loss
• Chronic cough or hoarseness

Seek Emergency Care For:

• Severe chest pain (rule out heart attack)
• Choking or severe difficulty swallowing
• Vomiting blood or coffee-ground material
• Black, tarry stools
• Severe abdominal pain

Related Conditions

Several conditions are associated with or similar to GERD: