Acid Reflux and gastroesophageal reflux disease (GERD): Causes, Symptoms, Risks, Complications, Diagnosis, Treatment and Prevention

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Illustration of gastroesophageal reflux disease

1Overview

Acid reflux or gastroesophageal reflux disease (GERD) is a common condition encountered by gastroenterologists. It is a chronic, relapsing condition that comes with a risk of increased morbidity and even potential mortality due to its complications. Many patients are prone to self-diagnosing themselves with GERD. Many also treat themselves for symptoms of the disease they do not seek the advice of a doctor. However, a great number of people suffer from the more severe disease, which can become erosive or ulcerative esophagitis.

More than 50 million Americans suffer from GERD, and it is known commonly as heartburn. They experience symptoms at least once a month, however, as many as 25 million experience the effects of GERD on a daily basis.

In addition, almost 38.5 million outpatient visits are due to GERD on a yearly basis. Those who have GERD do not always have reflux esophagitis, but as many as 60% of patients do.

GERD is also more common in pregnant women and in the elderly. Patients with GERD also report that their quality of life, productivity, and well-being decrease because of the disease. In fact, many patients with GERD report that their quality of life is lower compared to patients with angina pectoris. In addition, GERD is a risk factor for the development of esophageal adenocarcinoma, which is a throat cancer that is potentially fatal. 

2Causes

Although some amounts of reflux are normal, GERD is associated with an abnormal physiology. Reflux is composed of saliva that has been diluted. The esophagus moves (peristalsis). This movement moves the reflux along the esophagus. Between the stomach and the esophagus is a lower esophageal sphincter (LES), which functions abnormally in GERD. Thus, the contents of the stomach regurgitate back into the esophagus. The problem with this is that the contents of the stomach already have a low pH level, while the esophagus has a high pH level.

The contact between the acidic contents of the stomach and the basic pH of the esophagus causes the burning sensation. Other factors lead to the harmful effects of GERD on patients. These include lower pH, higher exposure to acid, and longer clearance time. Aside from the acid found in the stomach, other contents of the bolus are bile acids and pancreatic acids.

3Symptoms

The most common symptoms associated with GERD are regurgitation, heartburn, and difficulty swallowing. However, the disease can manifest in other ways. There has been increasing attention on the symptomatology of GERD, including asthma, cough, and dental erosions.

Aspiration of gastric fluids, or regurgitation, can cause dental erosions due to the acidic contents of the stomach. This can also cause a chronic cough and recurrent pneumonitis. Aside from this, GERD is also associated with chronic sinusitis. It is also a common cause of unexplained disturbances in sleeping patterns. It can manifest in angina-like pain, which radiates to the back, jaw, and neck.

4Risk Factors

There are many risk factors associated with the development of GERD. One of them is a hiatal hernia, which is when part of the stomach and the LES move up the diaphragm, which causes the stomach to weaken.

Another risk factor is having a weak esophageal sphincter, which allows the acid reflux to occur. The circular muscle between the esophagus and the stomach is supposed to keep the contents of the stomach from going back up the esophagus.

Pregnancy is another risk factor for GERD. The pressure of having a growing fetus combined with the hormones produced during pregnancy can cause acid reflux. The growing fetus presses down on the stomach, which increases the chances that the contents will move back up.

Smoking can also damage the throat’s reflex muscles. It also increases how much acid is made and stored in the stomach. The more acidic the food is, the more painful the acid reflux becomes. Smoking also relaxes the LES.

Obesity, particularly abdominal obesity, can cause reflux because the extra fat pushes down on the stomach and allows the contents to move back up the esophagus.

5Complications 

There are many complications that occur from having GERD. One of the most serious is having Barrett’s esophagus, which causes the throat to become diseased. The problem with this condition is that it frequently leads to throat cancer and if often times deadly for those who have it.

When the cells in the esophagus are exposed to acid, they may cause scarring. Strictures may occur, making it difficult to swallow. This can potentially lead to weight loss because the person is not getting enough nutrition, leading to malnutrition of different types.

GERD can also be a cause for ulceration of the esophagus. An ulcer is an open sore that can bleed. This can make swallowing painful. As with strictures, it can also lead to unintentional weight loss in patients, leading to malnutrition.

6Diagnosis

The presence of typical symptoms of heartburn are clues for the physician that the person has GERD. When the patient complains of heartburn, or even tasting sour, bitter acid in the mouth, then this can form as a definitive diagnosis of GERD. However, in instances where the symptoms are unusual, objective testing may be required.

One type of test is a barium study, which is an x-ray study that evaluates the structure and function of the esophagus. It is excellent for identifying strictures in the esophagus caused by GERD.

Esophageal manometry is another diagnostic procedure that can be used by a doctor. It is also known as an esophageal motility study. Here, a pressure-sensitive catheter is placed into the esophagus. It permits the physician to assess the strength and coordination of the muscles of the esophagus.

pH monitoring is another means of diagnosis. Using this test, a physician places an acid-sensitive catheter into the patient’s throat, attached to a small monitoring device. It records the changes in pH level over a period of 24 hours. In provides information about the pattern and severity of the reflux.

7Treatment

The usual first-line treatment for GERD is a lifestyle and dietary modifications. The patient is asked to refrain from smoking. The patient is also asked to avoid caffeinated beverages, decaffeinated coffee, and other substances that increase the acidity of the stomach. Aside from this, fatty foods should be avoided because they slow the time that the stomach takes to empty its contents. This makes it more likely for GERD to occur. Smaller, more frequent meals are also recommended. GERD is usually worsened by large meals, which increases the pressure on the stomach.

Drug therapy may be indicated in patients who suffer from GERD and whose symptoms are not relieved by lifestyle interventions alone. These drugs include antacids, which decrease the pH of the stomach, and proton-pump inhibitors, which function in the same manner.

H2 blockers may also be used because they block histamine’s effect on the secretions in the stomach. The lower acid secretion by 70%. They also achieve good control of symptoms in about 80% of patients.

8Prevention

The prevention of GERD depends on the risk factors associated with it. Refraining from smoking is one way to prevent GERD. Another is to eat small, frequent meals. Wearing loose clothing may also help prevent GERD by decreasing the pressure on the stomach. Tight clothes increase pressure.

GERD can also be prevented by eating green leafy vegetables and avoiding fatty foods. The latter increases gastric emptying time, which increases the chances that a person will develop acid reflux. Another preventive measure is to avoid alcohol, which also decreases the pH of the stomach, making it more acidic. Milk is a little-known cause of acid reflux because it is an acidic substance. Aside from these, having a healthy lifestyle and exercising regularly can help prevent GERD.

Another way to prevent GERD and its complications is to ensure that doctors are regularly visited when symptoms of GERD do appear. The doctor can prescribe drugs to treat GERD and prevent the problems associated with it. Aside from these, ensuring that the person’s lifestyle is free from stress can also prevent GERD. Stress causes the reflux of the stomach contents back into the esophagus. Managing stress is one of the most effective means to prevent GERD and it is also one of the best treatments for it.

9Risks from Long-Term GERD 

Risks from long-term GERD are serious. They include cancers such as adenocarcinoma. Barrett’s esophagus causes the cells in the esophagus to mutate, increasing the likelihood that the person will acquire cancer. When ulcers are large enough in the esophagus, they can cause bleeding, which is uncomfortable and increases morbidity. Another complication is the formation of strictures, which are thick bands of skin in the esophagus that prevent the person from swallowing well. This leads to weight loss and malnutrition, which may eventually cause death. Dental erosion is another problem. The pH of the mouth is also neutral and the hydrochloric acid from the stomach causes the enamel of teeth to become eroded, causing extensive damages.