Gastroesophageal Reflux Disease (GERD)

GERD (gastroesophageal reflux disease) is caused by reflux of acidic gastric secretions or non-acidic content back into the esophagus. Occasional reflux is normal especially after eating. But those with GERD have more acid or more frequent episodes.  The esophagus’ sensitivity to acid may also be enhanced although the acid reflux amount is normal.

Symptoms of GERD

Major symptoms of GERD include:

  • A burning sensation in the epigastric region, in the mid-chest, usually occurring just after a meal
  • Sour or bitter taste in the mouth and throat
  • Food rising back up into the throat and mouth
  • Abdominal distension in the epigastric region.

Other possible symptoms of GERD include the following:

  • Non-cardiac chest pain
  • Chronic hoarseness; change in voice
  • Persistent cough with no apparent cause
  • Difficulty swallowing; feeling a lump in the throat
  • Oral symptoms such as tooth decay and bad breath
  • Asthma unresponsive to usual medication
  • Abnormality of the lower esophageal sphincter, which normally prevents acid reflux from the stomach; it has lower pressure or opens more often probably due to alcohol drinking, smoking, coffee, tea, caffeinated drinks, and certain medications such as some asthma drugs
  • Abnormality of the esophagus, causing food to move down slowly or food rising back up from the stomach to remain in the esophagus longer than usual
  • Abnormality of the stomach, causing food to remain in the stomach longer than usual and increasing the chance of acid reflux from the stomach into the esophagus; high-fat foods and chocolate likely to make the stomach  contract less
  • Lifestyle behaviors such as going to bed immediately after eating,  having a large meal, smoking, drinking soda or alcohol, stress
  • Obesity, increasing pressure on the stomach and causing acid reflux
  • Pregnancy; the increased hormones during pregnancy causing the esophageal sphincter to become weak and the enlarged uterus putting more pressure on the stomach
  • Avoid items that increase gastric acid secretion such as spicy and sour food, alcohol, caffeinated drinks, sodas, garlic, onions, etc. Also avoid large meals and have more frequent smaller meals instead.  
  • Relieve stress possibly by getting enough sleep, exercising, meditating, and praying
  • Control weight, especially for obese or overweight people. With weight loss, the pressure in the stomach is reduced, decreasing the severity and intensity of reflux of food and acid into the esophagus. Losing weight also has other health benefits, making one strong and healthy.
  • Avoid lying down immediately after eating. It’s better to wait for at least 3-4 hours. However, if necessary to lie down, use high pillows. In addition, do not exercise immediately after eating.
  • History taking and general physical examination -  Generally, doctors diagnose GERD based on the patient's symptoms mainly. If the esophageal symptoms match GERD conditions, no further testing is needed for a diagnosis of GERD.
  • Additional tests: These may be required if the patient does not get better after following medical advice or getting initial treatment or if the patient experiences other warning symptoms such as difficulty swallowing, painful swallowing, frequent vomiting, history of vomiting blood, severe stomach pain, black stool, pale skin, loss of appetite, and weight loss. Examples of additional tests include the following:
    • Gastrointestinal endoscopy
    • Barium swallow testing
    • Nuclear medicine imaging
    • Esophageal manometry
    • Esophageal pH test
  • Adjusting lifestyle and eating habits
  • Taking medicine as prescribed
  • Getting the Transoral Incisionless Fundoplication (TIF) procedure
  • Getting the fundoplication surgery
GERD can affect daily life. This is because the acid can cause irritation and inflammation of the esophagus. Serious ulcer complications then can lead to the narrowing of the esophagus, making it difficult or painful swallowing. There is also a risk of esophageal cancer although currently still rare. 

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