What is Gastro-oesophageal Reflux Disease (GERD)?
Gastro-oesophageal Reflux Disease (GERD), also known as acid reflux, affects more than 60 million Americans at least once a month and more than 15 million adults every day. It is a long-term gastrointestinal (GI) condition where stomach contents flow back into the oesophagus, causing heartburn or a burning sensation in the chest. Symptoms typically occur after eating and may worsen at night or when lying down. Other symptoms include regurgitation of food or sour liquid, trouble swallowing, chronic cough, or asthma.
GERD is mainly caused by a lower oesophageal sphincter (LES) that does not close properly, allowing acid and other stomach contents to reflux into the oesophagus. Untreated GERD can lead to complications such as oesophagitis (inflammation), Barrett’s oesophagus (pre-cancerous changes), oesophageal stricture (narrowing), and oesophageal cancer.
Management often includes lifestyle changes—such as weight loss, dietary adjustments, and avoiding triggers like spicy foods, alcohol, and caffeine—and medications like proton pump inhibitors (PPIs) or H2 blockers to reduce acid and promote healing. Consultation with a healthcare provider is recommended for recurring symptoms.
What causes Gastro-oesophageal Reflux Disease (GERD)?
GERD results from frequent or severe reflux of stomach contents into the oesophagus, usually due to LES dysfunction. Risk factors include:
- Lower oesophageal sphincter (LES) dysfunction, sometimes triggered by certain foods, medications, or hormones
- Hiatal hernia (part of stomach bulges through the diaphragm)
- Obesity, increasing abdominal pressure
- Dietary triggers: spicy foods, onions, citrus, peppermint, tomato products, chocolate, garlic, alcohol, caffeinated drinks
- Smoking, which weakens the LES
- Pregnancy, due to hormonal changes and increased abdominal pressure
- Medications such as asthma drugs, antihistamines, painkillers, sedatives, and antidepressants
- Delayed stomach emptying (gastroparesis)
Addressing these factors through lifestyle changes and medications can help control GERD symptoms. Consult a healthcare provider for diagnosis and treatment if reflux symptoms occur frequently.
What are the symptoms of Gastro-oesophageal Reflux Disease (GERD)?
- Heartburn: burning chest sensation after eating, worse at night or when lying down
- Regurgitation: sour or bitter acid backing up into the throat or mouth
- Dysphagia: difficulty swallowing or feeling food stuck in the throat
- Chest pain: may mimic angina when acid irritates the oesophagus
- Laryngitis: voice box inflammation from acid irritation
- Asthma-like symptoms: coughing, wheezing, shortness of breath from aspirated acid
- Sore throat and hoarseness: often noticed in the morning
- Increased saliva (water brash) in response to acid in the oesophagus
- Tooth erosion: acid wears away enamel, increasing sensitivity
How is Gastro-oesophageal Reflux Disease (GERD) diagnosed?
Initial diagnosis is often based on symptoms and response to treatment. Further tests include:
- Medical history and physical exam
- Trial of proton pump inhibitors (PPIs) to gauge symptom improvement
- Esophagram: X-ray series after swallowing barium
- Endoscopy: camera inspection of oesophagus, stomach, and duodenum with possible biopsy
- Esophageal manometry: measures oesophageal muscle contractions and LES function
- 24-hour pH monitoring: measures acid exposure in the oesophagus over a day
- Esophageal pH impedance: detects both acid and non-acid reflux episodes
How is Gastro-oesophageal Reflux Disease (GERD) treated?
Lifestyle Changes
- Avoid trigger foods and beverages (fatty foods, coffee, peppermint, alcohol, chocolate, spicy foods)
- Eat smaller, more frequent meals and avoid eating close to bedtime
- Lose weight if overweight to reduce abdominal pressure
- Elevate the head of the bed 6–8 inches to prevent nocturnal reflux
- Quit smoking to improve LES tone
- Wear loose-fitting clothing to reduce stomach pressure
Medications
- Antacids for rapid relief by neutralizing stomach acid
- H2-receptor antagonists (e.g., ranitidine, famotidine) to decrease acid production
- Proton pump inhibitors (e.g., omeprazole, esomeprazole, pantoprazole) for more potent acid suppression
- Prokinetics (e.g., metoclopramide) to strengthen LES and speed gastric emptying
Surgical and Other Procedures
- Fundoplication: wraps upper stomach around the LES, often via laparoscopy
- LINX device: ring of magnetic beads around the LES to reinforce its barrier function
- Bariatric surgery (gastric bypass) for obese patients with refractory GERD
Sources
- Acid reflux (GER and GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Apr. 25, 2024.
- Acid Reflux. American College of Gastroenterology. Accessed Apr. 25, 2024.
- Katz PO, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology. 2022; doi:10.14309/ajg.0000000000001538.
- Gastroesophageal reflux disease. Antunes C, et al. (2023). Accessed Apr. 25, 2024.