Gastrointestinal disorders are numerous and GERD is among the most prevalent.
The prevalence of GERD in western culture is around 20%.
While GERD is a commonly mentioned term, this condition is quite misunderstood.
In this post, we will focus on GERD, its symptoms, causes, and treatment options.
What is GERD?
Gastroesophageal reflux disease (GERD) is a digestive disorder that happens due to the retrograde flow of stomach content back into the esophagus.
More precisely, GERD is a condition where stomach acid frequently goes back into the esophagus and irritates the esophageal lining.
You have acid reflux because the lower esophageal sphincter, a valve located at the end of the esophagus, fails to close adequately when food reaches your stomach.
As a result, acid backwash flows back up the esophagus into a person’s mouth and throat.
That’s why you have a sour taste in your mouth.
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What is the difference between acid reflux and GERD?
Acid reflux and GERD are often used as interchangeable terms, but they’re not the same.
Acid reflux is a medical condition characterized by the backward flow of stomach acid into the esophagus.
People often have heartburn during an episode with acid reflux.
Sometimes acid reflux may develop into GERD, a chronic and more severe form of the condition.
In other words, GERD is more serious acid reflux.
Acid reflux may lead to GERD, but it doesn’t have to in all cases.
While most people will experience acid reflux at some point in their lives, not all of them will have GERD.
That’s the main difference between these two forms.
GERD symptoms
The most common signs and typical symptoms of GERD include:
- Frequent heartburn, mainly after eating and tends to aggravate at night
- Difficulty swallowing or hoarseness
- Chest pain
- The sensation of a lump of food stuck in the throat
- Regurgitation of food or sour liquid
- Bad breath and sore throat
- Vomiting
In addition to the abovementioned symptom, a person with GERD may also have a chronic cough and laryngitis if they also experience nighttime acid reflux.
Other nighttime acid reflux symptoms include disrupted sleep and new or worsening asthma symptoms.
It’s easy to think these symptoms are associated with other digestive problem and ignore until they go away.
With GERD, going away is not always the option.
That’s why you should see your doctor and describe all symptoms you’re experiencing.
Causes and risk factors
Frequent acid reflux is the main cause of GERD.
Upon swallowing, the lower esophageal sphincter relaxes to allow liquid and food to move to the stomach.
After swallowing, the sphincter closes again.
Weakened sphincter and other problems allow stomach acid to flow back into the esophagus.
When this happens for a while, you may experience irritations and inflammation on your esophagus.
While anyone can develop GERD, some people have a higher risk than others.
Common risk factors include age, sex, lack of physical exercise, medication use, stress, low or high BMI, alcohol consumption, cigarette smoking, and unhealthy diet.
When it comes to age and sex, GERD is more common in women and with increasing age.
Other risk factors also include:
- Hiatal hernia
- Pregnancy
- Delayed stomach emptying
- Scleroderma and other connective tissue disorders
- Eating late at night
- Eating large meals
- Some medications e.g. aspirin
- Drinking coffee and alcohol
- Eating foods that trigger GERD symptoms
Complications
Untreated GERD, or a condition that is unmanaged properly, can lead to serious complications such as:
Barrett’s esophagus (precancerous changes to the esophagus)
Damage from acid can induce changes in the tissue lining of the lower esophagus. This may lead to esophageal cancer.
Esophageal stricture (narrowing of the esophagus)
This is due to scar tissue formation in response to damage to the lower esophagus brought on by stomach acid.
The formation of scar tissue narrows the food pathway making it difficult to swallow.
Esophageal ulcer (open sore in the esophagus)
An esophagus tissue that can be worn away by gastric acid.
As a result, open sore forms.
In some cases, the ulcer is painful, bleeds, and may cause difficulty swallowing.
Besides the abovementioned complications, GERD may also cause asthma, chronic cough, and other breathing problems if you breathe stomach acid into the lungs.
Moreover, this condition can cause tooth enamel erosion and contribute to gum disease and other dental problems.
It is also important to mention erosive esophagitis, an inflammation of the esophagus with evident esophageal damage.
You can reduce the risk of complications by managing your symptoms or adhering to the treatment.
When to see a doctor
The smartest thing to do is see the doctor if you experience the symptoms mentioned above, especially if they are persistent or severe such as chronic heartburn.
You should also consider scheduling an appointment to see the doctor if you take over-the-counter heartburn medications twice a week or more.
Immediate medical assistance is necessary for persons with chest pain accompanied by shortness of breath and pain in the jaw or arm.
These could be the symptoms of a heart attack. You should never ignore them.
Diagnosis
Symptoms of GERD should not be ignored.
Follow instructions from the section above to see your doctor and describe symptoms in detail.
Based on the symptoms you report, the doctor will presume GERD could be the culprit, but they need more information to make an accurate diagnosis.
The healthcare professional will perform a physical exam and may order some diagnostic tests such as:
X-ray of the upper digestive system
You need to drink a chalky liquid that fills and coats the digestive tract lining.
Thanks to this coating, the doctor can see a silhouette of your stomach, esophagus, and upper intestine.
Upper endoscopy
This is to examine the inside of the stomach and esophagus.
The test may detect esophageal inflammation or esophagitis and other complications.
Sometimes this test is done to perform a biopsy.
Esophageal manometry
This measures the rhythmic muscle contractions in a patient’s esophagus as they swallow.
Additionally, doctors may use this test to measure force and coordination that esophageal muscles exert
Ambulatory acid (pH) probe test
This is to detect when regurgitation occurs and how long it lasts
Once the doctor gets all information necessary to rule out other conditions with similar symptoms, they will diagnose GERD and recommend adequate treatment.
Treatment
Healthcare professionals may recommend a patient with GERD start with over-the-counter medications and lifestyle modification first.
However, if this approach is ineffective, you could need stronger prescription medications or surgery even.
Regardless of the severity of symptoms, whether they’re mild or not, you need to modify your lifestyle.
Unfortunately, the importance of healthy lifestyle choices is often underestimated.
But let’s start with the actual treatment for GERD.
Over the counter medications
Over-the-counter medications may include antacids to neutralize stomach acid and medication to reduce the production of acid.
Additionally, you may need to take medications that inhibit acid production and promote healing of the esophagus.
Prescription medications
H-2 receptor blockers
E.g. famotidine (Pepcid) and nizatidine.
Although these drugs are generally well-tolerated, long-term use may increase the risk of bone fractures and vitamin B12 deficiency.
Proton pump inhibitor
E.g. esomeprazole (Nexium), omeprazole (Zegerid, Prilosec), lansoprazole (Prevacid) etc.
These medications are usually safe but may cause headaches, nausea, diarrhea, and vitamin B12 deficiency.
Medications for strengthening lower esophageal sphincter
E.g. baclofen. Fatigue and nausea are common side effects.
In cases when lifestyle modifications and medications (both OTC and prescription) don’t work, the doctor may recommend surgery or other procedures.
These include:
Transoral incisionless fundoplication (TIF)
The procedure where a surgeon uses polypropylene fasteners to create a partial wrap around the lower esophagus to tighten the lower esophageal sphincter.
The procedure is performed through a patient’s mouth with an endoscope only.
No incision is necessary.
High tolerance and quick recovery are the main advantages of TIF.
Nissen fundoplication
This involves wrapping the top of the stomach around the lower esophageal sphincter.
Wrapping can be partial or complete. The procedure is minimally invasive.
LINX device
A doctor wraps a ring of small magnetic beads around the esophagus and junction of the stomach.
Beads have a magnetic attraction that is strong enough to prevent acid reflux but still allows for the passing of the food.
The cornerstone of GERD treatment is a healthy lifestyle.
These include weight loss and maintenance, avoiding meals at least three hours before bedtime, and maintaining good sleep hygiene.
Make sure your diet doesn’t include chocolate, spicy foods, caffeine, carbonated beverages, and citrus fruits.
8 home remedies for relief
GERD can harm a patient’s quality of life, particularly when symptoms are severe.
The more you adhere to the doctor’s instructions, the easier it will be to manage symptoms and improve your quality of life.
In addition to medications recommended by your healthcare provider, you may also want to check out some home remedies.
As you can see below, a great deal of these home remedies revolves around a healthy lifestyle.
They include:
1) Identify your trigger
Some foods can worsen symptoms of GERD.
These include tomato and tomato-based products, mint, onions, garlic, chocolate, caffeine, soda, citrus fruit juices, fried foods, high-fat foods, and alcohol.
If you’re not sure what your trigger is, you may want to start a food journal.
2) Eat small meals
This way, you will put less pressure on the stomach and prevent the backflow of stomach acid.
3) Eat a healthier diet
Make sure your diet contains high-protein, low-fat meals, and foods abundant in fiber.
4) Quit smoking
This unhealthy habit can cause or contribute to heartburn.
Smoking can damage the lower esophageal sphincter.
5) Try herbal remedies
Chamomile, slippery elm, marshmallow, and licorice to help manage GERD symptoms.
They are also available in the form of dietary supplements.
6) Don’t wear tight clothes
This has nothing to do with fashion or appearance.
Tight clothes can increase acid reflux, particularly when you’re wearing tight bottoms and belts.
7) Avoid lying down after a meal
Wait at least three hours before you do so.
8) Elevate the head of the bed
This may be necessary if you have heartburn at night.
You may want to place cement or wood blocks under the feet of the bed so that your head is slightly raised.
If elevating your bed is impossible, you may want to insert a wedge between the box spring and mattress.
Putting additional pillows may not be that effective.
How long does GERD last?
Heartburn itself lasts anywhere from a few minutes up to several hours, depending on the main cause.
Keep in mind GERD is a chronic condition, and its symptoms don’t go away quickly, especially not on their own.
With proper treatment that includes acid suppression, it may take two to eight weeks for the esophagus to start to heal.
However, not every person is different, and the severity of symptoms may vary.
Always remember GERD is a complex condition that requires a proactive approach.
Can GERD go away without medication?
Mild GERD cases may go away with lifestyle adjustments only, without medication.
Moderate and severe symptoms of GERD require a more structured approach that includes a combination of medications and a healthy lifestyle.
It is important to adhere to the doctor’s recommendations to manage symptoms and improve your quality of life.
Conclusion
GERD is frequent and chronic acid reflux with potentially serious complications when left untreated.
The condition has uncomfortable symptoms, but it is manageable.
GERD patients have a lot of options to improve their quality of life and manage their symptoms.
If you have persistent symptoms, you shouldn’t ignore them.
Instead, schedule an appointment to see your doctor and take it from there.
If you’re not sure which foods trigger GERD in your case, you may want to keep a food journal.
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