GERD Causes Symptoms and Treatment

Gastroesophageal reflux disease or GERD is a condition where the contents of the stomach and acids return backward from the stomach to the esophagus and also the subsequent mucosal damage by that. It is also called as gastric acid disease, gastric reflux disease, acid reflux disease, etc. It can cause irritation of the esophagus, damage, heartburn, and other symptoms. When eating foods, it passes from the throat to the stomach through the esophagus, called the food pipe. When the food reaches the stomach it is prevented from returning back into the esophagus or regurgitate by the help of a ring of muscle fibers. These ring of muscle fibers are called the lower esophageal sphincter or LES. When the sphincter is not closed properly, food, liquids, and acids in the stomach can regurgitate back into the esophagus, and this reflux of food and acid is called as the acid reflux or gastroesophageal reflux disease.

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Causes

GERD is caused by the changes in barrier between the stomach and the esophagus due to abnormal relaxation of the lower esophageal sphincter, impaired expulsion of the gastric contents, impaired gastric reflux from the esophagus, or hiatal hernia. It can be a temporary phenomenon or a permanent one.

The trigger factors which initiate GERD are alcohol, obesity, hiatal hernia, pregnancy, scleroderma, smoking, etc. The drugs that induce the GERD symptoms are anticholenergics, beta-blockers, bronchodialators, calcium channel blockers, dopamine, progestin, sedatives, and tricyclic antidepressants.

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Other factors that contribute to GERD are Zollinger-Ellison syndrome, which is increased gastric acidity due to gastrin production, hypercalcemia, that increases the gastrin production and increased acidity, scleroderma and systemic sclerosis that can cause esophageal dysmotility, use of medicines such as prednisolone, visceroptosis in which the stomach has been reduced in the abdomen thereby upsetting the gastric motility and acid secretion etc.

​​Signs and Symptoms

The common symptoms of GERD are:

Heartburn or a burning sensation in the chest

Regurgitation or expulsion of material from the esophagus

Dysphagia or difficulty on swallowing

The less common symptoms of GERD are:

Odynophagia or pain with swallowing

Sialorrhea, or increased salivation

Nausea, or feeling of vomiting

Chest pain

Coughing and wheezing

Hiccups

Hoarceness

​Sore throat

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Some associated symptoms of GERD are:

Chronic cough

Laryngitis, inflammation of the larynx and hoarceness.

Asthma

Erosion of dental enamel due to acid leach of the enamel of the tooth

Dentine hypersensitivity due to decalcification of the dentine due to acids

Sinusitis

Pharyngitis

Globus pharyngeus or a choking sensation felt in the throat

Globus hystericus or sensation that a foreign body is present in the throat

Symptoms of GERD in children are:

Repeated vomiting

Effortless spitting up

Coughing

Wheezing.

Inconsolable crying, refusal of food, cry for food and then rejecting food or milk bottle and again crying for it, failure to gain weight, bad breath, belching and burping etc.

Complications ​

Asthma is caused due to difficulty in passage of air through the pharynx due to GERD.

Bronchospasm due to irritation and spasm of the airways due to gastric acid.​

Reflux esophagitis, which is the necrosis of the esophageal epithelium causing ulcers at the junction between the esophagus and the stomach.

Esophageal strictures, which is the persistent narrowing of the esophagus by the inflammation.

Dental erosion caused by the frequent exposure to reflux acid contents.

Barrett's esophagus or the change in lining of epithelium from squamous cells to intestinal columnar epithelial cells.

Esophageal adenocarcinoma, which is the cancer of the esophagus.

Diagnosis of GERD

​Detailed history is necessary for diagnosis. Other investigations for GERD include esophageal pH monitoring, barium swallow X-ray, esophageal manometry, and esophagogastroduodenoscopy.

Esophagogastroduodenoscopy is a type of endoscopy of the esophagus which involves insertion of a thin scope through the mouth and the throat into the esophagus and stomach to determine and assess the internal surface structures of the stomach and duodenum.

Biopsies of the esophageal, duodenum, and the walls of the stomach can be taken to identify, edema and basal hyperplasia, inflammation, Barretts esophagus, elongation of papillae, thinning of the lining squamous layer, dysplasia or precancer, or carcinoma.

​Treatment

The 3 modalities of treatment for GERD are lifestyle modification, medication, and surgery.

Certain foods seems to exacerbate the the symptoms of GERD and these needs to be curbed from the diet. Antacids such as calcium bicarbonate actually increase the acidity of the stomach and needs to be avoided. Drugs such as aspirin, ibuprofen, or naproxen are usually avoided because of reflex acid production and acetaminiphen is used instead. Habits such as smoking reduces the esophageal sphincter competence and thus allowing the acid to get into the esophagus and so smoking is stopped.

Lifestyle Modification

Certain positions of sleep seem to reduce night time reflux episodes in some people. Elevating the head seems to improve in reducing the GERD symptoms. The head of the bed can be elevated by bed risers that support bed post or legs, a therapeutic bed pillow, inflatable mattress lifter, or a bed elevator facility.

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Medications used to treat GERD

Proton pump inhibitors such as  omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole etc. are used in effectively reducing the acid production. They stop acid production via proton pump inhibition.

Gastric H2 receptor blockers such as ranitidine, famotidine, cimetidine etc. reduces gastric acid secretion. Good relief is achieved by these drugs.

Antacids taken before meals or just after symptoms begin, can reduce gastric acidity.

Alginic acid may coat the mucosa of the GI tract and also increase pH thus decreasing GERD symptoms.

Surgery​

Surgical methods are used to treat GERD. The common surgical treatment for GERD is the  Nissen fundoplication. Here the upper part of the stomach around the lower esophageal sphincter LES is wrapped around. It is done to strengthen the sphincter and therefore preventing the acid reflux. Laparoscopic repair of a hernia is also done for reducing acid reflux. 

A treatment called transoral incisionless fundoplication (TIF) is used where the valve between the stomach and esophagus is rebuild by a device called Esophyx done intraorally.

Prevention

​GERD is prevented through lifestyle modification methods such as:

Sleeping on the left side or raising the upper side of the body significantly reduces GERD symptoms as mentioned in the treatment part. Raising the upper part of the body by raising the bed, using pillows, or elevating the head and body part of the bed. The entire upper part including the body and head should be raised to prevent acid reflux.

Sleeping on the left side also helps to reduce these reflux symptoms by the use of the gravity when the esophagus is at a higher level than the stomach.

Eating smaller meals causes lesser acid production and so reduced GERD symptoms. Avoiding eating just before sleeping also helps to prevent any reflux symptoms.

Losing weight helps to reduce the risk of acid reflux. More body fat will put more pressure on the stomach and its contents to reflux into the esophagus. Thus reducing the excessive body fat will help get relief from GERD symptoms.

Avoiding tight clothing around the body helps to prevent GERD symptoms as the tight clothing puts pressure on the stomach causing reflux symptoms.

Avoiding acidic foods and foods that trigger GERD symptoms help to prevent reflux. The acidic foods include fruit or juices, fatty foods, coffee, tea, onions, peppermint, chocolate, etc.

Avoiding taking foods shortly before going to bed, because it produces excess gastric acid that takes time to subside.

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