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.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), GERD affects about 20 percent of people in the United States. If left untreated, it can sometimes cause serious complications.
More than 50 million Americans suffer from Acid Reflux, 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 Acid Reflux on a yearly basis. Those who have GERD do not always have reflux esophagitis, but as many as 60% of patients do.
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 Acid Reflux. 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.
The most common symptoms associated with GERD are regurgitation, heartburn, and difficulty swallowing. However, the disease can manifest in other ways.
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 pneumonia. 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.
GERD Risk 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. Certain conditions can increase your chances of developing GERD, including:
Some lifestyle behaviors can also raise your risk of GERD, including:
- eating large meals
- lying down or going to sleep shortly after eating
- eating certain types of foods, such as deep fried or spicy foods
- drinking certain types of beverages, such as soda, coffee, or alcohol
- using nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin or ibuprofen
If you have any of these risk factors, taking steps to modify them may help you prevent or manage it.
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. Potential complications include:
- esophagitis, an inflammation of your esophagus
- esophageal stricture, which happens when your esophagus narrows or tightens
- Barrett’s esophagus, involving permanent changes to the lining of your esophagus
- esophageal cancer, which affects a small portion of people with Barrett’s esophagus
- asthma, chronic cough, or other breathing problems, which may develop if you breath stomach acid into your lungs
- tooth enamel erosion, gum disease, or other dental problems
The presence of typical symptoms of heartburn are clues for the physician that the person has it. 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.
They might use one or more of the following procedures to confirm a diagnosis or check for complications of it:
- barium swallow: after drinking a barium solution, X-ray imaging is used to examine your upper digestive tract
- upper endoscopy: a flexible tube with a tiny camera is threaded into your esophagus to examine it and collect a sample of tissue (biopsy) if needed
- esophageal manometry: a flexible tube is threaded into your esophagus to measure the strength of your esophageal muscles
- esophageal pH monitoring: a monitor is inserted into your esophagus to learn if and when stomach acid enters it
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.
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.
Risks from Long-Term
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.
GERD in infants
About two-thirds of 4-month-old babies have symptoms of GERD. Up to 10 percent of 1-year-old babies are affected by it.
It’s normal for babies to spit up food and vomit sometimes. But if your baby is spitting up food or vomiting frequently, they might have GERD.
Other potential signs and symptoms of GERD in infants includes:
- refusal to eat
- trouble swallowing
- gagging or choking
- wet burps or hiccups
- irritability during or after feeding
- arching of their back during or after feeding
- weight loss or poor growth
- recurring cough or pneumonia
- difficulty sleeping
Diet and GERD
In some people, certain types of foods and beverages trigger symptoms of GERD. Common dietary triggers include:
- high-fat foods
- spicy foods
- citrus fruit
Dietary triggers can vary from one person to another.
Home remedies for GERD
There are several lifestyle changes and home remedies that may help relieve such symptoms.
For example, it might help to:
- quit smoking
- lose excess weight
- eat smaller meals
- chew gum after eating
- avoid lying down after eating
- avoid foods and drinks that trigger your symptoms
- avoid wearing tight clothing
- practice relaxation techniques
Some herbal remedies might also provide relief.
Herbs commonly used include:
- licorice root
- marshmallow root
- slippery elm
Although more research is needed, some people report experiencing relief from acid reflux after taking supplements, tinctures, or teas that contain these herbs.
But in some cases, herbal remedies can cause side effects or interfere with certain medications.
Anxiety and GERD
According to 2015 research, anxiety might make some of the symptoms of GERD worse.
If you suspect that anxiety is making your symptoms worse, consider talking to your doctor about strategies to relieve it.
Some things you can do to reduce anxiety include:
- limit your exposure to experiences, people, and places that make you feel anxious
- practice relaxation techniques, like meditation or deep breathing exercises
- adjust your sleep habits, exercise routine, or other lifestyle behaviors
If your doctor suspects you have an anxiety disorder, they might refer you to a mental health specialist for diagnosis and treatment. Treatment for an anxiety disorder might include medication, talk therapy, or a combination of both.
Pregnancy and GERD
Pregnancy can increase your chances of experiencing acid reflux. If you had such disease before getting pregnant, your symptoms might get worse.
Hormonal changes during pregnancy can cause the muscles in your esophagus to relax more frequently. A growing fetus can also place pressure on your stomach. This can increase the risk of stomach acid entering your esophagus.
Many medications that are used to treat acid reflux are safe to take during pregnancy. But in some cases, your doctor might advise you to avoid certain antacids or other treatments.
Asthma and GERD
It’s been reported that more than 75 percent of people with asthma also experience GERD.
More research is needed to understand the exact relationship between asthma and GERD. It’s possible that GERD might make symptoms of asthma worse. But asthma and some asthma medications might raise your risk of experiencing GERD.
If you have asthma and GERD, it’s important to manage both conditions.
IBS and GERD
Irritable bowel syndrome (IBS) is a condition that can affect your large intestine. Common symptoms include:
According to a recent review, GERD-related symptoms are more common in people with IBS than the general population.
If you have symptoms of both IBS and GERD, make an appointment with your doctor. They might recommend changes to your diet, medications, or other treatments.
Drinking alcohol and GERD
In some people with GERD, certain foods and drinks can make the symptoms worse. Those dietary triggers might include alcoholic beverages.
Depending on your specific triggers, you might be able to drink alcohol in moderation. But for some people, even small amounts of alcohol trigger symptoms of it.
If you combine alcohol with fruit juices or other mixers, those mixers might also trigger symptoms.
The difference between GERD and heartburn
Heartburn is a common symptom of acid reflux. Most people experience it from time to time, and in general, occasional heartburn isn’t a cause for concern.
But if you get heartburn more than twice a week, you might have GERD.
GERD is a chronic type of acid reflux that can cause complications if left untreated.