Gastroesophageal Reflux Disease (GERD) is a chronic condition characterized by the frequent
backflow of stomach acid into the esophagus. This is a very common GI ailment, that is seen
commonly in the general population. Reflux can lead to a variety of symptoms, with heartburn
being the most common.
What is Heartburn?
Heartburn is a burning sensation that occurs in the chest or throat, often after eating or when
lying down. It is caused by the irritation of the esophagus due to acid reflux. While occasional
heartburn is common, frequent episodes can indicate GERD.
Symptoms of GERD
In addition to heartburn, GERD can cause:
Regurgitation of food or sour liquid
Chest pain
Difficulty swallowing (dysphagia)
Chronic cough or throat clearing
Hoarseness or sore throat
Feeling of a lump in the throat
Causes and Risk Factors
Several factors can contribute to GERD, including:
Weak Lower Esophageal Sphincter (LES): This muscle normally prevents stomach
contents from backing up into the esophagus. When it relaxes inappropriately, reflux
occurs.
Obesity: Extra weight can increase pressure on the abdomen, pushing stomach contents
upward.
Pregnancy: Hormonal changes and pressure from the growing fetus can lead to increased
reflux.
Dietary Choices: Spicy foods, citrus, chocolate, caffeine, and alcohol can trigger
symptoms.
Treatment Options
1. Lifestyle Modifications:
Maintain a healthy weight
Avoid trigger foods
Eat smaller, more frequent meals
Elevate the head of the bed
2. Medications:
Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g.,
omeprazole, Prilosec, pantoprazole, Aciphex, Nexium, dexilent and Zegerid).
H2-Receptor Antagonists: Lower acid production (e.g., famotidine, cimetidine,
Pepcid).
Antacids: Provide quick relief by neutralizing stomach acid. Like Mylanta,
Gaviscon, Maalox.
3. Surgery: In severe cases where lifestyle changes and medications are ineffective,
surgical options like fundoplication may be considered to strengthen the LES.
Gastroesophageal reflux disease (GERD) can lead to several serious complications if left
untreated. Here are some of the key complications associated with chronic reflux:
1. Esophagitis
Esophagitis is the inflammation of the esophagus caused by the repeated exposure to
stomach acid. Symptoms can include pain when swallowing, chest pain, and difficulty
swallowing (dysphagia). Chronic esophagitis can lead to further complications, such as
ulcers and bleeding.
2. Stricture
Repeated inflammation and damage to the esophagus can result in the formation of scar
tissue, leading to strictures or narrowing of the esophagus. This can cause significant
swallowing difficulties, as food may have trouble passing through. Treatment may involve
endoscopic dilation to widen the esophagus.
3. Barrett’s Esophagus
Barrett’s esophagus is a condition where the normal squamous cells of the esophagus are
replaced by columnar cells, often as a result of chronic acid exposure. While Barrett's itself is
not cancer, it increases the risk of developing esophageal adenocarcinoma, a serious type of
cancer.
4. Esophageal Cancer
Individuals with long-standing GERD, particularly those with Barrett's esophagus, are at an
increased risk of developing esophageal cancer. Symptoms of esophageal cancer can include
persistent heartburn, difficulty swallowing, unintentional weight loss, and persistent cough.
Early detection is crucial for improving treatment outcomes.
5. Respiratory Issues
Chronic reflux can also lead to respiratory problems, such as asthma or chronic cough, due to
aspiration of stomach contents into the lungs. This can cause inflammation and other
pulmonary complications.
When to See a Doctor
If heartburn occurs more than twice a week, worsens, or is accompanied by other symptoms like
difficulty swallowing or weight loss, it's essential to consult a healthcare professional. Proper diagnosis and management can help prevent complications and improve quality of life. EGD (UPPER ENDOSCOPY) OR UGIS (XRAYS) are the best tests to assess any damage or
complications, and done as an outpatient.
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