Understanding Gastroesophageal Reflux Disease

What is GERD?

Gastroesophageal reflux disease, or GERD, occurs when the muscle between the stomach and the esophagus weakens and allows the stomach contents to flow back into the esophagus. The weakening or relaxing of the lower esophageal sphincter happens for a number of reasons and causes symptoms such as heartburn and bloating.

The Symptoms of GERD

The most common symptoms of GERD include heartburn and regurgitation. Not everyone experiences heartburn with GERD, but if so, it usually occurs after a meal. The heartburn pain ranges from mild to very sharp and occurs in the upper abdomen, the neck and the back. Other symptoms of GERD include:

  • Increase in saliva
  • Chest pain
  • Chronic dry coughing
  • Nausea
  • Bad breath
  • Hoarseness
  • Laryngitis

When acid reflux enters the throat beyond the upper esophageal sphincter, it can cause a sore throat and lead to hoarseness. GERD strikes both adults and children and produces a wide range of symptoms from discomfort to vomiting.

What Causes GERD?

A weakened or relaxed lower esophageal muscle typically causes GERD, but it can also result from a hiatal hernia. While not everyone with a hiatal hernia develops GERD, it does happen in some cases. A hiatal hernia occurs when the stomach protrudes up into the chest through the opening between the abdomen and the chest cavity. Stress and dietary habits also contribute to GERD as well as obesity and pregnancy. Some foods and beverages that trigger GERD symptoms include:

  • Alcohol
  • Chocolate
  • Peppermint
  • Carbonated drinks
  • Fatty and spicy foods
  • Tomatoes
  • Coffee

Diagnosing GERD

Doctors diagnose GERD in several ways, from administering tests to taking biopsies. With common symptoms such as heartburn and acid reflux, doctors usually start treating the problems using certain medications and eliminating things that cause GERD. However, in the presence of weight loss, internal bleeding and other severe symptoms, doctors administer tests such as an upper endoscopy and pH testing.

An upper endoscopy test involves a small tube with a light at the tip. The tube inserts directly into the esophagus and lets the doctor see the esophageal lining and detect any damage from GERD. This test also examines the stomach and the first part of the small intestine. The doctor may also take a small biopsy of tissue and test for GERD-related damage.

The pH test measures the acid in the esophagus. It involves a small sensor that the doctor places in the esophagus during the upper endoscopy. Alternatively, the doctor may place a thin probe into the esophagus where it remains for 24 hours while measuring the acid content.

How to Treat GERD

Eliminating foods and beverages that trigger the symptoms reduces discomfort. If acid reflux and other GERD symptoms occur after eating or when lying down, make sure not to overeat or consume foods that cause the symptoms. Propping up the head at night may also minimize the flow of acid into the esophagus. If the symptoms persist, taking antacids can help relieve the discomfort and eliminate the symptoms.

When antacids and dietary changes do not help, doctors may prescribe stronger medications, such as cimetidine and omeprazole. These histamine H2 receptor antagonists and proton pump inhibitors treat mild acid reflux symptoms. If a patient cannot tolerate these medications, doctors may consider a surgical procedure known as fundoplication.

Common Issues Related to GERD

  • Obesity
  • Pregnancy
  • Smoking
  • Alcohol abuse
  • Hiatal hernia
  • Esophagitis
  • Indigestion
  • Ulcers

When to See a Doctor About GERD

Persistent or new onset  symptoms warrant a doctor’s evaluation, and the doctor can determine another course of action.  Alarming symptoms including difficulty swallowing, blood in the stool, abnormal weight loss and others should be promptly evaluated to exclude any serious underlying issues.  If there are any questions regarding symptoms you are having, you should speak with your gastroenterologist.