Gastroesophageal Reflux Disease – GERD
Gastroesophageal reflux disease (GERD) is a condition causing the stomach’s contents to leak in reverse to the esophagus, the tube transferring food from the mouth to the stomach.
The reflux can cause burning (heartburn) and other symptoms, leading to damage to the esophagus.
Once the meal is chewed and swallowed, it is pushed down to the stomach through the esophagus, a muscular tube about 8 inches long and made of soft tissue.
A small muscle encircling the bottom of the tube connects the stomach and esophagus. If the muscle is weak or relaxes when it should not, stomach contents can backwash through this small connection and into the esophagus, which causes acid reflux.
Acid reflux can occur naturally at times, and the person might not notice. But when it happens more often than a few times a week for several weeks, a person likely has GERD.
GERD affects at least 20% of U.S. adults at some point in their lives.
GERD is not as common in children and teens but can occur, especially if a child or adolescent has a condition or lifestyle behavior that contributes to reflux risk.
The symptoms from reflux can harm the quality of life, sometimes preventing people from doing everyday activities.
The acid in the backwashed stomach contents from consistent reflux also can damage the delicate tissue of the lining of the esophagus and lead to more severe complications.
CAUSES AND SYMPTOMS
Several factors can cause the muscle of the lower esophagus to weaken or relax. Older age is one cause of this, as is a history of smoking or alcohol use.
Some medications cause reflux as a side effect—pressure on the stomach from being overweight, obese, or pregnant increases GERD’s chance.
Confident children and adults have a hiatal hernia condition, although it is more common in older adults who are obese.
With a hiatal hernia, the upper part of the stomach pushes upward toward the chest and through an orifice in the diaphragm, the lower chest’s muscle that assists with breathing. Some neurological (brain and nerve) conditions, such as cerebral palsy, also can cause GERD.
Some behaviors can trigger reflux and add to GERD problems. In addition to certain medications, eating large meals or eating late at night can cause reflux.
Fatty and fried foods can trigger or aggravate reflux, as can some beverages such as coffee or alcohol.
Heartburn is a prevalent and common symptom of GERD for most people. It feels like a painful burning in the middle of the chest.
In addition to heartburn, other symptoms of GERD include:
- Difficulty swallowing
- General chest pain
- Regurgitating (having food or liquid come back into the throat) food or a sour liquid
- A sensation of a bulge in the throat
- Possible nausea and vomiting, especially in children
Bad breath and even problems with swelling gums or a hoarse voice can occur in some people, especially those with long-term GERD.
GERD also can lead to some breathing problems in people who tend to get GERD at night.
Diagnosis of GERD begins with a physical examination and discussion of symptoms. The doctor also might consider a patient’s risk factors for GERD, such as being overweight.
Not all patients with GERD need testing, but if the doctor suspects damage to the esophagus, a patient might have an x-ray examination of the upper digestive system called an upper GI.
Moving x-ray images can show reflux when the patient drinks a special liquid called barium that shows up on x-rays.
A gastric discharge scan is an imaging test that looks to see if the patient’s stomach is emptying too slowly.
The patient drinks milk filled with a tracer, but the test does not use radiation.
A doctor also might confirm a GERD diagnosis or look for complications with an upper endoscopy procedure.
The practitioner inserts a thin, flexible tube called an endoscope down the patient’s throat. The end of the tube has a light and camera that can produce images on a screen so the doctor can see the tissue lining.
The tool also can help the doctor collect a sample of the tissue for a biopsy. A biopsy involves studying a small piece of cells in a laboratory.
In some cases, a patient has a 24-hour impedance probe study. The practitioner inserts a tiny tube through the nose to the esophagus that stays in place for 24 hours.
The test can help detect triggers of reflux.
Most people with GERD receive no medications, but first, make lifestyle and diet changes to ease reflux instances.
The doctor will recommend avoiding alcohol, quitting smoking, and losing weight if the patient is overweight or obese.
One of the best ways to prevent reflux from GERD is to limit meal size, especially in the evening, and avoid lying down until two to three hours after eating.
Some medications ease GERD symptoms. Over-the-counter antacids (such as Rolaids and Tums) and drugs called H2 receptor blockers such as famotidine (Pepcid) or ranitidine (Zantac) can ease symptoms.
If these fail to work, doctors can recommend stronger medications sold in over-the-counter brands or by prescription called proton pump inhibitors (like Prilosec or Prevacid). People with severe and chronic GERD might have surgery.
Over time, GERD can cause complications because of damage from the stomach acid that escapes into the esophagus.
The damage can cause scar tissue to form, narrowing the path for food and causing swallowing problems.
Stomach acid also can lead to an open sore (ulcer) in the esophagus that can bleed and cause pain.
In some people, the acid damage can make changes to the tissue that lines the esophagus, increasing esophageal cancer risk. This precancerous condition is called Barrett’s esophagus.
GERD can often be prevented by making lifestyle changes, such as avoiding caffeine, alcohol, smoking, fatty food, and overeating.
Sometimes losing only 10 or 15 pounds can nearly eliminate GERD instances. Over time, a person learns which foods and activities are most likely to trigger GERD and avoid them.
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