Gastroesophageal Reflux Disease (GERD)

What is GERD?

GERD or commonly referred to as reflux is a digestive disorder wherein the contents of the stomach goes back up into the esophagus (tube between the mouth and stomach). The stomach acid irritates the esophageal lining causing indigestion or a burning sensation in the neck or chest area (heartburn).

How does GERD develop?

• Heartburn (burning chest pain starting from the breastbone towards the neck and throat)
• Chest pressure or burning throat pain occurring after meals, and increasing in severity when lying down or bending
• Feeling of food going back up into the mouth
• Sour or bitter taste
• Hoarseness or sore throat
• Nausea
• Vomiting
• Difficulty in swallowing or feeling of a lump in the throat
• Frequent burping
• Dental carries (due to stomach acid damaging tooth enamel)
• Bad breath
• Persistent cough
• Breathing problems or asthma
• Difficulty sleeping

Who are at risk for GERD?

Several medical conditions predispose patients to developing GERD due to increased abdominal pressure and/orpoor closure of the LES such as:

• Pregnancy
• Obesity
• Gastroparesis (delayed emptying of the stomach to the small intestine)
• Connective tissue diseases (rheumatoid arthritis, lupus, scleroderma)

Diet and lifestyle may also affect the closing of the LES leading to reflux:

• Large meals
• Lying down immediately after meals
• Fatty or fried food
• Spicy food
• Pepper
• Mint (spearmint and peppermint)
• High-fat dairy products
• Chocolate
• Alcohol
• Caffeinated drinks (coffee, tea)
• Carbonated beverages (soda)
• Citrus fruits and juices
• Vinegar
• Tomatoes and tomato sauce
• Garlic and onions
• Certain prescription and over-the-counter medications (aspirin, naproxen, ibuprofen)
• Iron supplements

How is GERD diagnosed?

GERD is initially diagnosed based on the symptoms and findings of a routine physical examination.

The doctor may consider performing endoscopy after a trial of oral medications. During endoscopy, the doctor inserts a camera attached to a long flexible tube into the patient’s mouth to examine the esophagus and stomach. Not all patients need this procedure. However, patients exhibiting alarm symptoms or complications are strongly recommended to undergo endoscopic evaluation. Symptoms such as involuntary weight loss, bleeding or obstruction, anemia, dysphagia (difficulty or discomfort in swallowing), and uncontrolled symptoms despite adequate medical treatment warrant further investigation. Endoscopy is also recommended for older patients (above 50 years old) and those who have prolonged symptoms (at least 5 years).

Medications prescribed to manage symptoms of GERD include:

• Antacid – neutralizes stomach acid to provide temporary or partial relief (e.g., aluminum hydroxide, magnesium hydroxide, calcium carbonate, etc.)
• Proton pump inhibitor (PPI) – blocks the production of stomach acids and facilitates healing of the esophagus (e.g., rabeprazole, esomeprazole, omeprazole, etc.)
• Histamine H2 receptor antagonist (H2-blocker) – reduces the secretion of stomach acids (e.g., ranitidine, famotidine, etc.)
• Prokinetic – speeds up the emptying of the stomach contents into the intestines (e.g., mosapride, metoclopramide, etc.)
• Medication to strengthen the LES - increases LES pressure and reduces reflux (e.g., baclofen)

What is the prognosis of a patient with GERD?

GERD is discomforting but not life-threatening. Depending on the frequency of symptoms, GERD can be mild (occurring at least 1x/week) or moderate to severe (occurring at least 2x/week). Patients with mild to moderate GERD may be adequately managed with medications together with dietary and lifestyle modifications. However, patients with severe conditions or those who cannot take medications due to contraindications might need surgical interventions.

If unmanaged GERD can lead to several complications such as esophageal stricture (narrowing of the esophagus), ulcers, and Barrett’s esophagus (increased risk for cancer).

Of note, GERD may mimic a heart attack. Patients with symptoms of chest pain accompanied by difficulty of breathing, arm or jaw pain should immediately consult a doctor to rule out a heart attack.

How is GERD prevented?

• Identify triggers, keep a food and activity diary
• Abstain from GERD-inducing food and beverages
• Quit smoking
• Eat at least 2-3 hours before going to bed
• Elevate your head at least 6-10 inches when lying down
• Consume smaller servings
• Eat slowly and chew thoroughly
• Lose weight and/or maintain a healthy weight
• Avoid constricting clothes
• Take only medications prescribed by the doctor
• Disclose all medications and supplements during medical consultation
• Do not abuse pain medications
• Ask a doctor before taking in herbal remedies
• Chew gum after meals for the saliva to neutralize the refluxed acid
• Try stress-relieving activities

For more information on GERD, consult your physician.