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Gastroesophageal Reflux Disease (GERD): Causes, and Symptoms,

The esophagus is a muscular organ that transports food from the throat to the stomach. Gastroesophageal reflux disease (GERD) refers to a condition in which the stomach acid flows back into the esophagus (food pipe). This occurs when the muscles at the end of the esophagus become weak or do not work properly.

GERD causes severe heartburn and irritates the lining of the esophagus.  Esophageal reflux causes burning sensation in the chest, which can even radiate up to the throat. Chronic refluxes can cause a sour taste in the mouth, which may even lead to difficulty in swallowing.

Gastroesophageal Reflux

What are the Causes of GERD?

Gastroesophageal reflux disease is caused by the improper functioning of the muscles that control lower esophageal sphincter (LES). One of the common causes of esophageal reflux disease is a hiatal hernia, which occurs when the LES and upper part of the stomach move above the diaphragm.

Overeating and lying down immediately after having a heavy meal are the most common causes that can result in acid reflux.

GERD is caused due to the weakening of the lower esophageal sphincter that allows the stomach contents and digestive juices to move-up into the esophagus. A constant rise of these substances towards the esophagus can irritate the esophageal lining, which often leads to inflammation.

Symptoms of GERD:

The symptoms of GERD range from mild acid reflux that rarely occurs to severe acid reflux that can occur at least once in a week. The most common signs and symptoms of gastroesophageal reflux disease include:

  • Heartburn
  • Difficulty swallowing
  • Nausea
  • Chest pain
  • Sour or bitter taste in the mouth
  • Hoarseness
  • Bad breath
  • Regurgitation (vomiting of the food or sour liquid)
  • Excess of saliva production
  • Chronic sore throat
  • Inflammation of the gums
  • Persistent cough, especially during the night

Risk factors for GERD:

The common factors that increase the risk of gastroesophageal reflux disease include:

Obesity: Being overweight imposes pressure on the stomach, which can result in acid reflux and heartburn.

Smoking: Smoking can weaken the muscles that control the lower esophageal sphincter and increase the likelihood of developing GERD.

Hiatal hernia: Hiatal hernia is a condition that caused bulging of the stomach up into the diaphragm. It can weaken the lower esophageal sphincter and increase the risk of GERD.

Pregnancy: Pregnant women experience GERD due to an increase in the progesterone levels and pressure imposed on the stomach due to the growth of the baby. The symptoms of GERD can worsen during the third trimester of pregnancy.

Connective tissue disorders: Scleroderma is a connective tissue disorder that can affect the strength of esophageal muscles, which in turn results in GERD.

Asthma: Asthma can increase the risk of reflux due to increased pressure in the lungs and continuous cough. Also, certain medications that are used in the treatment of asthma may loosen the lower esophageal sphincter muscles.

Diabetes: Diabetic patients who suffer from a condition known as gastroparesis (delayed emptying of the stomach) are at a higher risk for GERD.

Medications: Drugs that are used in the treatment of high blood pressure, asthma, and depression can contribute to the risk of acid reflux disease. Also, certain medicines, such as ibuprofen, aspirin, and muscle relaxants can boost the symptoms of GERD.

Dietary triggers: Certain foods, such as caffeinated products, spicy or fried foods, citrus fruits and juices can trigger the symptoms of acid reflux disease.

Complications of GERD:

If GERD is left untreated it can lead to complications, such as:

Breathing Problems: Stomach acid reflux can worsen the symptoms of asthma by irritating the airways and lungs

Esophagitis: Repeated backflow of the stomach acids can irritate the lining of the esophagus, which can increase the risk of erosion and ulcers.

Esophageal Strictures: Acid reflux can result in scarring of the tissue that lines the esophagus. This results in narrowing of the esophagus and prevents the food from reaching the stomach.

Esophageal Ulcers: Excess production of the stomach acid can wear away the tissue that lines the esophagus, thereby forming open sores (esophageal ulcers). Esophageal ulcers can bleed, which can also cause pain and difficulty swallowing.

Esophageal Cancer or Barrett’s Esophagus: Damage (scarring) caused to the tissue lining the lower esophagus can increase the risk of esophageal cancer.

Diagnosis of GERD:

To diagnose gastroesophageal reflux disease, the doctor will review the symptoms and medical history of the patient. Also, the doctor will know about the foods consumed to identify the primary reason behind the symptoms, such as heartburn. To confirm the diagnosis of GERD, the doctor would recommend the following tests:

Ambulatory Acid Probe Test: During this procedure, the doctor will insert a thin, flexible tube (catheter) through the nose into the esophagus. A small device is clipped to the esophagus during an endoscopy, which passes out through the stool two days later. A strap is worn around the waist and is connected to the monitor. The procedure helps to measure the amount of stomach acid produced in 24 hours.

X-ray: Before performing the X-ray examination, the doctor will ask the patient to swallow a chalky liquid called as barium. The liquid will coat the lining of the throat, stomach, and upper digestive tract. This makes it easier to look for the abnormalities of the internal organs.

Endoscopy: In this procedure, the doctor will insert a thin, flexible tube attached with a camera (endoscope) down through the throat. This helps to examine the lining of the esophagus and stomach.

Esophageal Manometry: It is also known as esophageal mobility testing, which enables to measure rhythmic muscle contractions by force exerted on the walls of the esophagus.

Treatment of GERD:

Depending on the underlying cause and the severity of the symptoms the doctor will prescribe the following medications, which include:

  • The doctor prescribes H-2- receptor blockers, such as famotidine, cimetidine, and nizatidine to reduce the stomach acid production.
  • Also, the doctor may prescribe proton pump inhibitors, such as lansoprazole and omeprazole to block the acid production.

Prevention of GERD:

The symptoms of gastroesophageal reflux disease can be prevented by following certain measures, such as:

  • Avoid eating spicy, acidic, or fatty foods that can trigger acid reflux
  • Avoid eating larger meals, especially close to the bedtime
  • Limit alcohol consumption as it may trigger heartburn
  • Eat smaller meals as a large meal can exert pressure on lower esophageal sphincter muscles
  • Avoid wearing tight-fitted clothes that constrict the stomach

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