Gastroesophageal Reflux Disease (GERD)

What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal Reflux Disease (GERD) is one of the most common digestive problems worldwide. It results from excessive back flow of stomach content to the esophagus. Consequently, acid exposure can lead to damage in the lining. As a result, multiple symptoms occur, but mainly heartburn. Furthermore, GERD can result in the back flow of stomach contents to reach all the way to the mouth, a symptom referred to as regurgitation. In addition, it can result in many other symptoms including: 

 
Symptoms of gastroesophageal reflux disease (GERD):
  • Heartburn 
  • Regurgitation
  • Difficulty with swallowing 
  • Painful swallowing 
  • Long standing cough. 
  • Chest pain
  • Sore throat
  • Chronic cough
  • Hoarseness 

 

What Causes Gastroesophageal Reflux Disease (GERD)?

While the answer is not a single cause, we know multiple factors predispose to it. First of all, relaxation of a muscle separating the stomach and the esophagus can play an important role in the disease. As the main function of the muscle is to separate the stomach from the esophagus and prevent the back flow of the stomach contents, factors that can affect its function, result in increased reflux. Those factors include having a hiatal hernia, obesity, as well as certain triggers including caffeine, fatty foods, and smoking cigarettes as well as alcohol consumption.

 

What Are The Complications of Gastroesophageal Reflux Disease (GERD)?

Gastroesophgeal reflux, if untreated, can lead to many complications. For the most part, those complications increase with the duration of reflux. Once they develop, patients will need prompt attention and management. For the most part, the treatment is effective in prevention of some of the complications.

 

Complications of GERD 
  • Erosive esophagitis: Inflammation of the esophagus related to reflux. 
  • Esophgeal strictures: Narrowing in the esophagus caused by scarring from long standing inflammation. 
  • Barrett’s Esophagus: Changes in the cell type in the lining of the esophagus associated with long standing reflux. This condition predisposes to esophageal cancer and will require follow up for early diagnosis and prevention of cancer. 
 
Some complications are outside the digestive tract and they include: 
  • Chronic cough
  • Hoarseness
  • Dental problems including erosion of the enamel. 
 

When to Seek Attention?

With new onset symptoms always see your doctor. As the symptoms can be vague and the source of your symptoms can be other vital organs, it is very important to discuss them with your doctor. While evaluation and management for GERD is usually simple, excluding other possible causes might be needed. This is especially important if you have history of heart disease, or conditions predisposing to it. If you have associated symptoms including shortness of breath work up for other causes becomes crucial. Furthermore, having symptoms for a long period of time suggests the need for endoscopic evaluation,  to look for any changes related to long term reflux in the esophagus. Also, regardless of the duration, there are certain clues that would suggest further work-up and possibly endoscopy is needed. 

Symptoms that suggest the need for further evaluation and possible endoscopic evaluation:
  • Weight loss. 
  • Difficulty or pain with swallowing 
  • Black stool, bleeding or anemia (low blood count)
  • Failure to respond to usual treatments
  • Older age and long duration of GERD.
  • Family history of cancers, mainly esophageal and gastric cancer
  • During pregnancy mainly to discuss safety of medication use

As this list is not exhaustive, it is necessary to discuss your symptoms with your doctor or with us before deciding on the need to have more testing and evaluation, and choose the best management plan. 

 

How to Treat Gastroesophageal Reflux Disease (GERD)?

When we treat GERD we focus on two aspects. First is decreasing the reflux of gastric contents into the esophagus, and the second is decreasing acidity of stomach contents. To achieve this, lifestyle modifications improve symptoms by minimizing the reflux of stomach contents. On the other hand, medications help through decreasing acid secretion, or by neutralizing the acid in the stomach.

 

Lifestyle Modifications:

Those changes can be very helpful in controlling symptoms and improving your overall health. They include: 

  • Weight loss: Weight reduction improves symptoms of GERD if you are overweight, while at the same time improving your overall health. To achieve good results, it is helpful to set a goal over a certain period of time, possibly 10% of the weight over a 6 month period is a realistic goal. 
  • Dietary modifications: Avoidance of triggers, including:
    • Excessive caffeine
    • Chocolate
    • Alcohol
    • Peppermint
    • Fatty foods
    • Other triggers if any other foods trigger symptoms
  • Elevation of the head of the bed by 30 degrees or 6 to 8 inches. This is not equivalent to using more pillows, you can use either a wedge pillow or adjustable mattress. This allows you to let gravity help you, limiting reflux while you are asleep. 
 
Medications: 

There are many over the counter medications for GERD. They belong to 3 separate groups. 

  • Antacids: This group includes Tums and Maalox. It works by neutralizing gastric content acidity, which in turn decreases the damage caused by the reflux. While those medications might provide symptom relief, we mainly use those medications if symptoms are temporary, mild and infrequent. 
  • Histamine receptor antagonists: This group of medications is slightly more effective. Famotidine is the main medication in this group. FDA requested the removal of Ranitidine from the market due to safety concerns and is no longer recommended. You can use Famotidine for mild or infrequent symptoms. For frequent or severe symptoms Famotidine is usually not sufficient to control symptoms. 
  • Proton pump inhibitors: this is the most effective medication for the treatment of GERD. This efficacy is because of its ability to block the stomach cells from secreting acid. There are many medications in this group including: omeprazole, pantoprazole and lansoprazole among others. Those are helpful for moderate to severe or persistent symptoms. Unfortunately, researchers linked long term use of the medication with an increase in the risk of kidney disease and dementia. This is why you need to discuss with your physician or with us the ongoing use of these medications, and consider stopping it if it is not needed anymore.  However, if you need those medications, overall they are considered to have an acceptable safety profile. 
 
Surgery: 

With the advancements in the medical field, surgery currently has a very limited role in the treatment of of reflux disease. However, in highly selected patients with symptoms related to reflux despite medical treatment and lifestyle changes, surgery can still be a good option for you after undergoing special testing. 

 

For more information please visit: 

  1. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults
  2. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940?p=1