“Gastroesophageal reflux disease (GERD): Understanding the Causes, Symptoms, and Effective Management Strategies”

Introduction

It is also known as “reflux esophagitis”. It refers to reflux of gastric contents into the lower esophagus, resulting in esophageal irritation and inflammation. GERD is a common condition, that affects approximately 20% of the U.S. population on a regular basis. It is one of the most common gastrointestinal disorders that produces symptoms and for which people visit physicians on regular basis so understanding this can helps you from becoming this disease a serious problem. As if left untreated it can lead to serious complications like esophagitis (inflammation of the esophagus), esophageal strictures (narrowing of the esophagus), Barrett’s esophagus (a precancerous condition), and even esophageal cancer. According to the American College of Gastroenterology, effective treatment of GERD not only alleviates symptoms but also reduces the risk of long-term damage to the esophagus.

What is GERD?

A chronic condition where stomach acid flows back into the esophagus. It is often confused with the Occasional acid reflux which is a common condition where stomach acid flows back into the esophagus, causing temporary discomfort like heartburn or regurgitation it is often triggered by certain foods, overeating, or lying down after a meal. In comparison to that GERD is a chronic condition where acid reflux occurs two or more times per week, leading to persistent symptoms and complications like esophagitis or Barrett’s esophagus.

Lower esophageal sphincter (LES) plays a very crucial role in preventing acid reflux back into the esophagus. It normally relaxes when food from esophagus comes and close as soon as food is in stomach. But in Gerd either there is Pathological transient relaxation of lower esophageal sphincter (LES) or the lower esophageal sphincter becomes incompetent that it is unable to tighten enough to stop the food going back into esophagus.

Symptoms of GERD

Common symptoms:

• Heartburn and regurgitation are the major symptoms.
• Heartburn (burning sensation in the chest) is provoked by bending, straining, or lying down.
• “Water brash” – salivation due to reflex salivary gland stimulation as acid enters the gullet.
• Regurgitation (sour or bitter taste in the mouth).
• Difficulty swallowing (dysphagia).

Extra-esophageal:

• Hoarseness or sore throat.
• Chest pain (can mimic heart-related pain).
• Laryngitis
• dental erosions
• Recurrent chest infection
• Chronic cough

Laryngopharyngeal Reflux (LPR) is a type of acid reflux in which stomach acid flows in backward direction into the throat, voice box (larynx), or even the nasal passages in which it doesn’t show any classic symptoms, but it usually affects the upper airways making it difficult to diagnose.

Causes and Risk Factors of GERD

• Weakness or dysfunction of the LES.
• Lifestyle factors:
• Obesity.
• Smoking.
• Alcohol consumption.
• Poor diet (spicy, fatty, or acidic foods).

Medical conditions causing GERD:

• Hiatal hernia.
• Pregnancy.
• Delayed stomach emptying (gastroparesis).

Complications of Untreated GERD

• Esophagitis (inflammation of the esophagus).
• Esophageal strictures (narrowing of the esophagus).
• Barrett’s esophagus (precancerous changes in the esophageal lining).
• Increased risk of esophageal cancer.
• Iron deficiency anemia – (blood loss from long-standing esophagitis)

Diagnosis of GERD

Medical history and symptom evaluation are the corner stones in diagnosis the GERD and most of the cases are diagnosed just with effective history taking and examination of a patient.

Diagnostic tests:

if we say these tests are not for the diagnosis of the GERD but for the confirmation the GERD then it is not wrong because most of the patients are diagnosed with the good history taking and evaluation. Following tests are used in diagnosis and confirmation of GERD

• Endoscopy.
• Esophageal pH monitoring.
• Barium swallow.
• Esophageal manometry

Reflux Testing:

Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing.

The two methods are:

• Wireless pH Testing
• 24-Hour pH Impedance

Treatment Options

Lifestyle Modifications:

By changing your lifestyle one can prevent and manage its GERD very effectively here are few lifestyle changes for management of GERD

• Dietary changes i.e avoid trigger foods, eat small portion of foods instead of large portions
• Weight loss is important if you are Obese as larger fat on your stomach puts extra pressure on it
• Elevate the head of the bed.
• Avoid lying down after eating.
• Avoid eating few hours before going to bed

Medications:

• Antacids (for quick relief).
• H2 blockers (e.g., ranitidine, famotidine). These block the action of histamine on parietal cells & decrease acid secretion. These drugs relive only the symptoms, without healing esophagitis.
• Proton pump inhibitors (PPIs) (e.g., omeprazole, esomeprazole). PPIs are the treatment of choice. PPIs reduced gastric acid production by inhibiting H+/K+ ATPase. PPIs relieve both the symptoms and esophagitis. Side effects = headache, diarrhea, increased risk of Clostridium difficile infection

Surgical Treatment:

Indications of surgery:

• Failure of medical therapy
• Unwilling to take long-term PPIs
• Severe regurgitation
• Barrett’s esophagus

Surgical Options:

• Fundoplication (wrapping the top of the stomach around the LES).
• LINX device (magnetic ring to strengthen the LES).

When to See a doctor

• Persistent or worsening symptoms.
• Difficulty swallowing or pain while swallowing.
• Unexplained weight loss.
• Chest pain that could indicate a heart condition.

FAQs

Can Gerd cause back pain?

Yes, GERD can cause back pain in some cases. The pain is often described as a burning or discomfort that radiates from the chest to the upper back, typically between the shoulder blades.

Can Gerd be cured?

GERD cannot be completely cured in most cases, but it can be effectively managed with lifestyle changes, medications, and, in some cases, surgery. While symptoms can often be controlled, long-term management is typically required to prevent complications and maintain quality of life.

Can Gerd cause SOB, Nausea or CHEST PAIN?

Yes, GERD can cause shortness of breath (SOB), nausea, and chest pain. 

How GERD AFFECTS QUALITY OF LIFE?

GERD significantly impacts quality of life by causing chronic discomfort, sleep disturbances, dietary restrictions, and emotional stress, often affecting daily activities and productivity. Effective management through lifestyle changes, medications, or surgery can help alleviate symptoms and improve overall well-being.

GERD VS IBS?

GERD primarily affects the esophagus, causing heartburn and regurgitation due to acid reflux, while IBS impacts the colon, leading to abdominal pain, bloating, and altered bowel habits. Both conditions can be triggered by stress or diet but require different diagnostic approaches and treatments.

GERD VS PEPTIC ULCER?

GERD involves acid reflux affecting the esophagus, causing heartburn and regurgitation, while peptic ulcers are sores in the stomach or duodenum, leading to localized stomach pain and nausea. GERD is often due to a weak LES, whereas peptic ulcers are commonly caused by H. pylori infection or NSAID use.