GERD

Causes 

• Certain foods and beverages, such as spicy foods, citrus fruits, chocolate, caffeine, alcohol, and fatty foods, can trigger GERD symptoms. Eating large meals, lying down after eating, or eating late at night can also exacerbate symptoms.

• Excess body weight can increase abdominal pressure, which can push stomach contents up into the esophagus, leading to acid reflux.

• A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity. This can affect the LES and contribute to GERD.

• Hormonal changes during pregnancy can relax the LES, while the growing uterus can increase abdominal pressure, leading to GERD.

• Smoking can weaken the LES and increase acid production in the stomach, both of which can contribute to GERD.

• Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and some asthma medications, can relax the LES or irritate the esophagus, leading to GERD symptoms.

Symptoms 

• Regurgitation: This is the sensation of acid backing up into the throat or mouth, often leaving a sour or bitter taste.

• Dysphagia: Difficulty swallowing or the sensation of food being stuck in the throat or chest.

• Chest Pain: GERD-related chest pain can mimic that of a heart attack, leading to confusion. 

• Chronic Cough: Especially at night or after meals.

• Hoarseness or Sore Throat: Acid reflux can irritate the vocal cords and throat.

• Nausea: Especially in the morning.

• Asthma-like Symptoms: Acid reflux can exacerbate asthma symptoms, such as wheezing and shortness of breath.

Complications

• Chronic inflammation of the esophagus can lead to esophagitis, which can cause pain and difficulty swallowing.

• Over time, repeated exposure to stomach acid can cause the esophagus to narrow (esophageal stricture), making it difficult to swallow.

• In some cases, long-term GERD can lead to changes in the cells lining the esophagus, a condition known as Barrett’s esophagus. This condition increases the risk of developing esophageal cancer.

• Stomach acid can cause sores (ulcers) to form in the esophagus, leading to bleeding and pain.

Diagnosis 

• Upper Endoscopy: A flexible tube with a camera is inserted through the mouth to examine the esophagus and stomach. This can detect inflammation, ulcers, and other abnormalities.

• Esophageal pH Monitoring: This test measures the amount of acid in the esophagus over 24 hours, helping to confirm the diagnosis of GERD.

• Barium Swallow: You’ll swallow a barium solution, which coats the lining of the esophagus and stomach, allowing them to be seen on X-rays. This can detect abnormalities in the esophagus.

• Esophageal Manometry: This test measures the strength and coordination of the esophageal muscles and LES.

Treatment 

• Avoiding trigger foods, eating smaller meals, losing weight, quitting smoking, and elevating the head of your bed can help reduce GERD symptoms.

• Over-the-counter antacids, H2 blockers, and proton pump inhibitors (PPIs) can reduce stomach acid and relieve symptoms. In more severe cases, prescription medications may be needed.

• For those who don’t respond to medications or have complications from GERD, surgery may be an option. The most common procedure is fundoplication, which involves wrapping the top of the stomach around the LES to strengthen it and prevent reflux.

When to See a Doctor