Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is the chronic form of acid reflux. Due to a number of reasons, the acidic stomach contents flow backward from the stomach into the esophagus (gullet). Since the esophagus is not structured to adequately handle the acid, GERD results in a number of symptoms or complications if left untreated.
Every person will experience acute bouts of acid reflux which often resolve spontaneously. These episodes are infrequent and usually triggered by certain conditions as discussed under Acid Reflux Causes. With GERD however, the reflux is chronic – it occurs almost on a daily basis and sometimes even several times in a day.
How does GERD occur?
The lower esophageal sphincter (LES) prevents the acidic stomach contents from flowing out of the stomach and into the esophagus.
Most cases of GERD are associated with a dysfunction of the LES. This may occur for a number of reasons – in the acute setting, it is usually a result of certain foods and drinks like alcohol affect the tonicity of the sphincter but this is a temporary effect. With GERD however, the dysfunction is constant and just exacerbated by the same causes as acute acid reflux.
In some cases, the LES is functioning normally but due to various factors affecting the stomach, the LES cannot prevent the regurgitation. Sometimes bile from the duodenum also flows through the stomach and up into the esophagus.
What causes GERD?
The main cause of GERD is a lower esophageal sphincter dysfunction. This muscular valves is unable to remain contracted to the extent that it should and this allows the stomach contents to flow backward during stomach contractions and when lying flat.
Other causes include :
- Hiatal hernia where a portion of the stomach protrudes through the opening in the diaphragm.
- Intra-abdominal pressure may also cause GERD and this commonly occurs due to abdominal obesity and pregnancy.
- Delayed gastric emptying is where the stomach contents do not exit the stomach at a normal rate and may back up into the esophagus.
- Impaired esophageal motility is a result of defective peristalsis that does not allow the regurgitated contents to be pushed back down and retained within the stomach.
What are the symptoms of GERD?
Some cases of GERD remain asymptomatic for long periods of time and may only be detected by the complications, like those that arise in the upper respiratory tract, as explained under Silent Acid Reflux. The more common symptoms of GERD includes :
- Chronic heartburn (burning chest pain) especially after eating and at night when sleeping.
- Water brash which is a sudden collection of saliva in the mouth.
- Nausea and sometimes vomiting.
- Stomach ache or gastric pain, especially after eating.
- Stomach bloating which is a sensation of fullness or pressure in the stomach area.
Other symptoms that may be due to severe GERD :
- Chronic sore throat that tends to arise upon waking (morning sore throat) and eases during the course of the day.
- Difficulty swallowing (dysphagia)
- Lump in throat feeling
- Persistent cough
- Hoarse voice
What are the complications of GERD?
Over time, the irritation of the esophagus lining by the stomach acid may lead to a range of complications including :
- Esophageal ulcer
- Esophageal stricture
- Barrett’s esophagus
- Esophageal cancer
Prompt treatment may prevent complications.
What is the treatment for GERD?
Treatment involves the use of medication like :
- Antacids to neutralize stomach acid.
- Proton pump inhibitors or H2-blockers to reduce gastric acid secretion.
- Sucralfates to line the esophagus and protect it from the acid.
- Prokinetic drugs will speed up the movement of the stomach contents.
This is discussed further under stomach acid medication.
Laparoscopic anti-reflux surgery is rarely conducted but may be necessary in cases of persistent GERD that is unresponsive to medication.