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Gastroesophageal Reflux Disease: Signs and Symptoms,Treatment,Complications

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Gastroesophageal Reflux Disease: Signs and Symptoms,Treatment,Complications

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Gastroesophageal reflux disease (GERD) results in heartburn as the stomach acids regurgitate into the esophagus. Read the article to learn more.

Medically reviewed by

iCliniq medical review team

Published At August 15, 2017
Reviewed AtApril 13, 2024

Introduction

Gastroesophageal reflux disease (GERD) occurs due to gastric acid refluxing back up the esophagus (food pipe). It is commonly observed in individuals with irregular food habits. It causes acid reflux, which may result in tooth erosion and a burning sensation in the esophageal tract.

What Are the Symptoms?

Heartburn, chest pain, or upper abdomen pain is more pronounced when lying with a full stomach.

  • Nausea.

  • Coughing and choking.

  • Hoarseness of voice.

  • A shortness of breath or asthma-like symptoms.

  • Back pain.

  • Persistent vomiting, difficulty and pain during swallowing, weight loss, and dark stools.

What Are the Risk Factors?

Several factors can heighten the risk of gastroesophageal reflux disease (GERD). These include:

  • Obesity: Carrying excess weight can increase the likelihood of experiencing GERD.

  • Hiatal Hernia: A condition where the top of the stomach protrudes above the diaphragm, which can contribute to GERD.

  • Pregnancy: The changes in the body during pregnancy, particularly the pressure on the abdomen, can lead to an increased risk of GERD.

  • Connective Tissue Disorders: Conditions like scleroderma, which affect the connective tissues, may contribute to GERD.

  • Delayed Stomach Emptying: When the stomach takes longer to empty, acid reflux can increase.

Several factors can exacerbate acid reflux symptoms:

  • Smoking: Tobacco smoke can irritate the digestive system and worsen GERD symptoms.

  • Large or Late Meals: Eating substantial meals, especially late at night, can trigger or worsen acid reflux.

  • Certain Foods (Triggers): Foods high in fat or fried can trigger GERD symptoms.

  • Certain Beverages: Alcohol and coffee can potentially relax the lower esophageal sphincter, which may lead to the backward flow of stomach acid into the esophagus.

  • Certain Medications: Some medications, such as Aspirin, can contribute to GERD symptoms by irritating the esophagus.

How to Diagnose GERD?

Diagnosing GERD involves a comprehensive physical examination and a discussion of symptoms and medical history. The diagnostic procedure includes:

  • Upper Endoscopy: This is a procedure where a flexible tube is inserted through the mouth to check the esophagus, stomach, and the start of the small intestine. It helps diagnose issues like esophagitis, Barrett's esophagus, and esophageal stricture while ruling out other serious conditions that may mimic GERD.

  • Reflux Testing: It measures reflux activity over 48 hours. Wireless pH testing involves a small chip in the lower esophagus recording acid levels transmitted to a device worn around the belt. 24-Hour pH Impedance, using a catheter through the nose, monitors pH levels for 24 hours to assess reflux severity.

  • Esophageal Manometry: The test evaluates the lower esophageal sphincter's contractions, strength, and relaxation function.

  • It helps rule out conditions mimicking GERD and is necessary before anti-reflux surgery.

  • Barium Esophagogram: This X-ray study involves swallowing barium to coat the esophagus. It helps detect abnormalities, checks for esophageal narrowing (stricture) and evaluates motor function, though it doesn't directly test for reflux.

What Is the Treatment?

The management of GERD includes a combination of medications as well as diet and lifestyle modifications. It includes:

  • Avoid spicy, fatty, fried foods, chocolates, and carbonated drinks.

  • Avoid citrus-containing foods like tomatoes, oranges, and fruit juices.

  • Eat multiple small portions of food rather than three large meals.

  • Limit caffeine intake.

  • Have dinner at least two hours before bedtime so the stomach is light before bed.

  • Elevate the head end of the bed by placing wooden blocks under the bedpost. Using extra pillows will not provide relief.

  • Avoid cigarette smoking and alcohol consumption.

  • Maintain a healthy weight. Medications that will help are antacids. They neutralize the stomach acid. H2 blockers block the action of histamine in the stomach cells, and proton pump inhibitors decrease stomach acid production.

  • Endoscopic, laparoscopic, or open surgical procedures are indicated for GERD if it does not respond to treatment or in the case of severe erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma or associated hiatal hernia.

Can GERD Be Cured?

Gastroesophageal reflux disease can be cured. The primary treatment involves medications that reduce stomach acid levels. Additionally, lifestyle changes play a key role in managing the disease. If lifestyle adjustments are insufficient, healthcare professionals may consider surgery a treatment option.

Why Is Endoscopy Needed?

GERD is diagnosed with the patient's symptoms and the positive response to treatment. An endoscopic evaluation is not necessary unless in the following situations:

  • Symptoms that are persistent or progressive despite appropriate medical therapy.

  • Dysphagia (difficulty in swallowing), odynophagia (pain during swallowing), persistent vomiting.

  • Unintentional weight loss.

  • The evidence of gastrointestinal bleeding is like black discoloration of stool or hematemesis (vomiting of blood).

  • Symptoms of anemia include dizziness, fatigue, palpitations, etc.

  • Screening for Barrett’s esophagus in high-risk patients. White men above 50 years of age, a positive family history of Barrett’s esophagus or esophageal adenocarcinoma, prolonged reflux symptoms (persisting for five years or more), persons with a smoking habit, and obesity.

  • PH monitoring and manometric studies confirm the diagnosis when an adequate response is not obtained from the treatment.

  • Before doing an anti-reflux surgery.

What Are the Complications of GERD?

  • Erosive Esophagitis: Inflammation and erosion of the esophageal epithelium due to acid damage. Appropriate management of GERD can prevent the development and progression of erosive esophagitis.

  • Esophageal Stricture: Strictures are caused by scar formation during the healing process of erosive esophagitis. Such strictures cause a block in the esophagus, resulting in difficulty swallowing, pain during eating, and persistent vomiting. It is treated with endoscopic dilation of the stricture.

  • Barrett's Esophagus: Barrett's esophagus is the change of esophageal epithelium from a stratified squamous type to the columnar epithelium type with epithelial cells. This change in epithelium occurs due to acid damage. When dysplastic or precancerous changes occur in Barrett's esophagus, it acts as a precursor for esophageal cancer (adenocarcinoma). GERD patients with risk factors for Barrett's esophagus will require an endoscopy and biopsy to assess the degree of damage and change in the epithelium and the presence of dysplastic cells, which are precursors for adenocarcinoma. Depending on the endoscopy and biopsy findings, further management is by either serial endoscopic surveillance, endoscopic ablation with laser, radio frequency, or cryotherapy. An endoscopic mucosal resection or surgical resection is done if found to be positive for cancer cells.

  • Esophageal Adenocarcinoma - Dysplastic changes occurring in Barrett's esophagus are a precursor for adenocarcinoma development. So, it is essential to appropriately manage GERD, prevent the development of Barrett's esophagus, and carry out an endoscopic evaluation and surveillance in high-risk patients.

Conclusion

GERD is the reflexing back of gastric content, commonly seen in individuals with irregular eating habits. Maintaining a good diet and eating pattern will help manage the condition. Early diagnosis can aid with better treatment. Avoiding certain foods that trigger acid reflux and maintaining a proper schedule to eat on time can help prevent the recurrence of this condition.

Frequently Asked Questions

1.

What Are the Various Causes of Gastroesophageal Reflux Disease?

The following are the various causes that could result in gastroesophageal reflux disease.
- Obesity.
- Intake of a heavy meal followed by lying on your back or bending below.
- Eating before bedtime or lying down immediately after a meal.
- Intake of certain drugs such as Aspirin or Ibuprofen, some muscle relaxants, and certain antihypertensive medications.

2.

Is It Possible to Cure GERD Permanently?

Yes, early diagnosis and treatment can permanently cure gastroesophageal reflux disease. A permanent cure is possible for young adults. If it is left untreated, the condition can cause permanent damage to the esophagus. One of the most common complications of gastroesophageal reflux disease is something called Barrett's esophagus. This condition can even progress to cancer of the esophagus.

3.

What Foods Should I Avoid When I Have GERD?

The following are foods that you should avoid if you are diagnosed with gastroesophageal reflux disease.
- Foods that are rich in fat content. This is because fried foods can cause the lower esophageal sphincter to dilate more than the required amount.
- This leads to the accumulation of excess stomach acid (HCL). This accumulated acid will enter into the esophagus.
- Tomatoes.
- Citrus fruit like oranges.
- Garlic.
- Onions.
- Spicy foods.
- Caffeine and carbonated beverages.
- Mint.

4.

Is GERD Curable?

The factors determining the treatment outcome in a gastroesophageal reflux disease are
the patient's age, severity, and comorbidities. The condition is easily curable when the patient is an adult, and proper medical attention is given. However, it can become a problem if it is not treated. This is because hydrochloric acid reflux damages the tissue lining the esophagus, leading to severe inflammation and pain. In adults, chronic, untreated gastroesophageal reflux disease can cause permanent damage to the esophagus, and sometimes even tumors can arise.

5.

Is It Possible to Cure GERD Naturally?

Gastroesophageal reflux disease (GERD) cannot be treated naturally. However, specific lifestyle changes can help in reducing the severity and symptoms of the condition. They are as follows.
- Avoiding the triggers of reflux.
- Avoiding spicy food.
- Sleeping in an elevated bed.
- Taking proper treatment and regular follow up.
- Eating fiber-rich food.

6.

What Is the Best Treatment for GERD?

The following are the best medications available to treat gastroesophageal reflux disease.
- Antacids.
- Histamine blockers.
- Proton pump inhibitors like Omeprazole.
- Prokinetic agents.
However, it is essential to note that these drugs are unsafe without proper medical advice and can lead to potential side effects.

7.

How Long Should I Take GERD Treatment?

To reduce gastroesophageal reflux disease symptoms, potential acid suppression therapy must be given to the patient at least for two or eight weeks. It would help if you continued until healing improves. You should discuss with the doctor regarding the duration of GERD treatment.

8.

How Long Will I Need to Take Omeprazole for GERD?

The first line of treatment for adults who are diagnosed with gastroesophageal reflux disease is 20 milligrams (mg) of Omeprazole once a day before the intake of food. It has to be taken at least eight weeks. For children, the dose and duration of treatment are primarily based on body weight.

9.

What Are the Most Common Symptoms of GERD?

The following are the frequently seen symptoms in patients who are diagnosed with gastroesophageal reflux disease.
A burning sensation in the upper part of the abdomen and chest, especially after eating. It might be especially worse at night.
- Chest pain.
- Difficulty in swallowing
- Reflux of food.
- The frequent feeling of sour liquid in the mouth.
- Lump in the throat.

10.

How to Identify GERD in Babies?

Identifying gastroesophageal reflux disease in babies can be quite complex. However, a doctor will diagnose your baby with gastroesophageal reflux disease if he or she has the following symptoms.
- Spitting up milk or foods and vomiting.
- Reluctant to eat and taking excessive time to eat and swallow.
- Irritability during feeding.
- Wet burps.
- Hiccups.
- Frequent episodes of cough or recurrent pneumonia.
- Choking.

11.

Is It Possible to Cure GERD With Diet?

Unfortunately, there is no diet until today to prevent or treat gastroesophageal reflux disease. However, avoiding certain spicy foods and meat may reduce the symptoms of gastroesophageal reflux disease in some people. Also, increased fiber intake, like fruits and vegetables, may prevent gastroesophageal reflux disease.

12.

Can I Diagnose GERD at Home?

No, you can not definitively diagnose gastroesophageal reflux disease at home. You can only note its symptoms. To diagnose it, proper medical consultation is required. It will involve the following.
Thorough and focused medical history taking and physical examination.
- Upper endoscopy.
- Ambulatory acid (pH) probe test.
- Esophageal manometry.
- X-ray of your upper gastrointestinal tract.

13.

How Can I Relieve GERD Pain?

The following are specific lifestyle changes and remedies that can help to cope up with the pain caused by gastroesophageal reflux disease.
- Maintain a healthy body weight.
- Quit smoking and alcohol.
- Elevate the head of your bed, which can prevent acid easily refluxing through your esophagus.
- Do not lie down after the intake of food.
- Eat your food slowly and chew it thoroughly well.
- Avoid foods and drinks such as chocolate and coffee that trigger reflux.
- Avoid heavy meals.

14.

What Are the Symptoms That Differentiate Gerd From Chest Pain?

If the patient is suffering from an acute episode of chest pain, he or she might experience the following symptoms and the common symptoms of gastroesophageal reflux disease.
Tightness in the center of the chest.
- A feeling of heaviness in one or both arms.
- Pain that radiates to the arms, neck, jaw, lips.
- Shortness of breath.
- Nausea and vomiting.
- Dizziness.
- Loss of appetite.
- Profuse sweating.

15.

What Type of Health Issues Can Lead to the Development of GERD?

The most common conditions seen in patients that can increase their chances of developing gastroesophageal reflux disease include the following.
- Obesity.
- Pregnancy.
- Hiatal hernia.

16.

Does GERD Affect the Teeth?

Yes, gastroesophageal reflux disease can affect your teeth. Sometimes, the first clinical indication that a person may have gastroesophageal reflux disease is the enamel's erosion. This symptom is seen prominently on the molar teeth.

17.

Can Milk Relieve GERD Symptoms?

Yes, it is a fact that milk can temporarily control the activity of stomach acid. However, the nutrients in milk, especially the fats present in it, stimulates the stomach to secrete more acid. These patients might consume fat-free milk to a limited extent.

18.

What Are the Probiotics That Can Prevent GERD?

Probiotic supplements that contain Lactobacillus acidophilus are frequently used for symptoms such as stomach burn and other gastric problems such as diarrhea and constipation. The bacteria in probiotics are "gut-friendly" and help maintain a balance in the digestive system between good and harmful bacteria.

19.

Is GERD a Cause of Esophageal Cancer?

Yes, chronic untreated gastroesophageal reflux disease can be a cause of esophageal cancer. This risk is significantly higher in people who have more frequent episodes. However, GERD is very common, and not all people who have it develop esophageal cancer. The most common complication of GERD that leads to cancer development in the esophagus is Barrett's esophagus.

20.

Why Does Gerd Cause Difficulty in Breathing?

Gastroesophageal reflux disease causes difficulty breathing because stomach acid that refluxes into the lower esophagus can sometimes enter the lungs. This occurs mainly when a person is sleeping. This can cause inflammation of the airways. This can be a potential cause of aspiration pneumonia.

21.

Does Constipation Aggravate the Symptoms of GERD?

Yes, constipation can cause symptoms of gastroesophageal reflux disease. On the other hand, the drugs used in the treatment of gastroesophageal reflux disease can also cause constipation. In these cases, prokinetic agents such as lactulose are given to relieve constipation.

22.

Can Chocolate GERD Symptoms?

Yes, chocolate causes gastroesophageal reflux disease symptoms. Cocoa makes the intestinal cells relax the lower esophageal sphincter. This leads to the release of a surge of serotonin. When this muscle relaxes, gastric contents can reflux through the sphincter. This causes a burning sensation in the upper abdomen. Chocolate also contains caffeine and theobromine, which can aggravate the symptoms.

23.

What Foods Can a GERD Patient Eat?

The following are the list of foods that a person affected with gastroesophageal reflux disease can eat.
- Fresh green vegetables.
- Ginger.
- Oatmeal.
- Non-citrus fruits like mangoes and bananas.
- Egg white.
Source Article IclonSourcesSource Article Arrow
Dr. Lekshmi R. Venugopal
Dr. Lekshmi R. Venugopal

General Practitioner

Tags:

erosive gastritisgastroesophageal reflux diseasebarrett's esophagusacid refluxheartburn
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