What is Gastroesophageal reflux disease (GERD)?

    Gastroesophageal reflux disease (GERD) is characterized by the repeated flow of stomach acid back into the oesophagus, the tube connecting the mouth and stomach.

    This phenomenon, known as acid reflux, can irritate the oesophageal lining.

    While occasional acid reflux is common, persistent and recurrent occurrences can result in the development of GERD. Many individuals can effectively alleviate GERD symptoms through lifestyle adjustments and medication management. In rare cases, surgical intervention may be necessary to relieve symptoms.

What are the causes of Gastroesophageal reflux disease (GERD)?

    Intermittent acid reflux is a common occurrence, often triggered by factors such as overeating, reclining after meals, or specific dietary choices. However, recurrent acid reflux, known as GERD, typically arises from different causes and risk factors, potentially leading to more severe complications.

    GERD can affect individuals of all ages and may develop without a clear cause. It arises when the valve responsible for preventing stomach contents from regurgitating into the oesophagus weakens or malfunctions.

    Several factors increase the likelihood of developing GERD, including:

  • Obesity, or being overweight, can exert additional pressure on the abdomen.
  • Pregnancy affects a significant proportion of expectant mothers.
  • Use of certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants.
  • Smoking or exposure to second-hand smoke can exacerbate GERD symptoms.

    Furthermore, a hiatal hernia, where a portion of the stomach protrudes through an opening in the diaphragm into the chest cavity, can contribute to GERD by reducing pressure on the oesophageal sphincter.

Risk factors of Gastroesophageal reflux disease (GERD)

    While many individuals with a hiatal hernia do not experience symptoms such as heartburn or reflux, a hiatal hernia may facilitate the reflux of stomach contents into the oesophagus.

    Activities such as coughing, vomiting, straining, or sudden physical exertion can elevate pressure within the abdominal region and contribute to developing a hiatal hernia. It is common for otherwise healthy individuals aged 50 and older to have a small hiatal hernia. Although typically associated with middle age, hiatal hernias can affect individuals of all ages.

    Treatment for hiatal hernias is often unnecessary unless there is a risk of strangulation, where the hernia becomes twisted and cuts off blood supply. In such cases, or if a hiatal hernia coincides with severe gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the oesophagus), medical intervention may be required. Your doctor may recommend surgery to reduce the size of the hernia or prevent strangulation.

    Several factors can increase the likelihood of experiencing GERD:

  • Being overweight or obese
  • Pregnancy
  • Delayed stomach emptying (gastroparesis)
  • Connective tissue disorders like rheumatoid arthritis, scleroderma, or lupus

    Additionally, specific dietary and lifestyle choices may exacerbate acid reflux:

  • Smoking
  • Consumption of specific foods and beverages such as chocolate, fatty or fried foods, coffee, and alcohol
  • Large meals
  • Eating shortly before bedtime
  • Certain medications, including aspirin

Symptoms of Gastroesophageal reflux disease (GERD)

    Frequent indicators of GERD encompass:

  • Burning sensation in the chest (heartburn), often occurring post-meals and possibly intensified during nighttime or while reclining
  • Regurgitation of food or sour liquid
  • Upper abdominal or chest discomfort
  • Difficulty swallowing (dysphagia)
  • The feeling of a lump in the throat

    For those experiencing nighttime acid reflux, additional symptoms may include:

  • Persistent cough
  • Inflammation of the vocal cords (laryngitis)
  • Onset or exacerbation of asthma

Complications of GERD

    Long-term inflammation in the oesophagus can result in:

  • Esophagitis is characterized by inflammation of the oesophageal tissue. Stomach acid's corrosive effects can lead to inflammation, bleeding, and occasionally developing an open sore (ulcer) in the oesophagus. Esophagitis often causes discomfort and difficulty swallowing.
  • Oesophageal stricture, wherein the lower oesophagus sustains stomach acid damage, prompts scar tissue formation. This scar tissue constricts the passage of food, leading to swallowing difficulties.
  • Barrett's oesophagus is a condition marked by precancerous alterations to the lining of the lower oesophagus due to acid-induced damage. These changes elevate the risk of developing oesophageal cancer.

When to talk to the doctor

    If you experience chest pain, particularly when accompanied by shortness of breath or pain radiating to your jaw or arm, seek immediate medical attention, as these could be indications of a heart attack.

    Additionally, consider scheduling an appointment with your doctor if you:

  • Encounter severe or recurrent symptoms of GERD.
  • Find yourself relying on over-the-counter heartburn medications more than twice a week.

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