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What Is GERD What Are Its Causes Symptoms And Treatment

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What is GERD? 

Gastroesophageal reflux disease is commonly known as GERD. It happens when the sphincter muscle located at the end of the esophagus does not close properly. It leads the stomach acid to leak back into the esophagus and irritate the lining of the esophagus. It happens because the leaked back content include stomach acids, pepsin, and bile which can injure the esophagus and cause inflammation.
Gastroesophageal reflux disease
Gastroesophageal Reflux Disease

Why should we not confuse GERD with trivial heartburns?


Dr. Susan Ng, a Gastroenterologist in East Bay, is of the opinion that, though healthy individuals also experience reflux which may lead to burning sensations in the chest and throat, their condition should not be confused with GERD. As patients with GERD, reflux more acidic content, and the acids remain in the esophagus for a longer time. If these acids cause an injury to the esophagus, it may result in esophagitis. This injury may heal with medications, but when the treatment is stopped, the injury may return in a matter of months. GERD is a chronic condition which can last a lifetime and needs special care. 

What are the causes of GERD?


The leading causes of GERD are:



  • Abnormalities in Lower esophageal sphincter or LES: The LES is a muscular ring surrounding the lower part of the esophagus. When we eat food, the LES opens and relaxes and allows the food to pass to the stomach. When there is an abnormality in the LES, then the LEX relaxes for a long time leading to reflux. 
  • A Hiatal Hernia: people with a hiatal hernia develop GERD. The diaphragm is a muscle that separates the abdomen from the chest. When people have a hiatal hernia, the upper part of their stomach moves up to the chest, through the diaphragmatic hiatus. The diaphragm supports the esophagus. When a patient has a hiatal hernia, the stomach acids reflux easily to the esophagus resulting in GERD. 
  • Esophageal Contractions: Swallowing food is very important for making rings of contractions in the esophageal muscles. Due to this contraction food, saliva, and other materials are pushed to the stomach through the esophagus. Abnormalities in these contractions may lead to GERD.
  • Pregnant women also develop GERD due to hormonal imbalance.
  • The intake of certain foods and drinks like fatty and fried food, alcohol, etc. may lead to GERD.

What are the symptoms of GERD?

  • The primary symptoms of GERD in adults include:
  • Heartburn.
  • Having an acidic taste, at the back of the mouth.
  • Chest pain. 
  • Bad breath
  • Teeth erosion.
  • A problem in swallowing food. 
  • More amount of saliva produced in the mouth. 
  • Sore throats and coughing. 

Children and infants with GERD cannot explain their uneasiness, but they experience the following symptoms:
  • Frequent vomiting.
  • Spitting milk.
  • Coughing.
  • Inability to gain weight.
  • Respiratory problems.
  • Infants with GERD cry for milk, and when they are given milk, they remove the breast or bottle and start crying again.
  • Burping too frequently.

How is GERD diagnosed?


Diagnosis of GERD is done when people complain about the different symptoms. The most common symptom being heartburn. The doctor gives medicines to suppress formation of acids in the stomach, if the patient finds relief in the drug then the doctor confirms GERD. This way of diagnosis is called a therapeutic trial. But sometimes GERD can also be present in people who do not experience its symptoms. 

The doctor may also suggest one of the following tests like Endoscopy, Esophageal Acid Testing, Esophageal Motility testing, Gastric emptying studies, and Acid Perfusion test. 

What are the treatments offered for GERD?

The doctor suggests the following changes in food choices and eating habits, to treat GERD:
  • Eating small portions of early dinner so that the stomach is empty before we sleep.
  • Avoiding foods like chocolate, fried fatty foods, alcohol, coffee and peppermint reduce the risk of GERD.
  • The doctor may suggest chewing gums to avoid GERD as chewing gums stimulates bicarbonate-containing saliva and also increases the rate of swallowing. The saliva neutralizes the acids in the esophagus. So chewing gums after meals can be a good idea.
  • The doctor may also suggest elevating the upper body while we sleep, as stomach acids reflux easily when we lie down.
  • Along with suggesting lifestyle and food choices, the doctor may also recommend medicines like:
  • Antacids: Antacids neutralizes the stomach acids so that there is no reflux. But the relief that antacids bring is short lived.
  • Histamine antagonist: To provide relief from Acid reflux for a longer time histamine antagonist are prescribed.
  • Proton Pump Inhibitors or PPI: PPI restricts the secretion of acids in the stomach for a longer time. 
  • Promotility drugs: These drugs stimulate the muscles and increase the pressure in an esophageal sphincter and facilitates the contractions of the esophagus. 
  • If the patient does not find relief from GERD with medicines, then a surgical procedure called fundoplication or anti-reflux surgery is suggested. 

    With a proper understanding of their problem, care and treatments, patients of GERD usually find relief from their problems.

References:


  1. https://en.m.wikipedia.org/wiki/Gastroesophageal_reflux_disease
  2. https://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/
  3. http://www.eastbaygi.com/patient-education/
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