Gastroesophageal reflux disease (GERD)

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Overview

Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder characterized by the regurgitation of gastric contents into the esophagus. It is one of the most commonly diagnosed digestive disorders in the US with a prevalence of 20%, resulting in a significant economic burden in direct and indirect costs and adversely affects the quality of life. GERD is caused by multiple different mechanisms that can be intrinsic, structural, or both, leading to the disruption of the esophagogastric junction barrier resulting in exposure of the esophagus to acidic gastric contents. Clinically, GERD typically manifests with symptoms of heartburn and regurgitation. It can also present in an atypical fashion with extra-esophageal symptoms such as chest pain, dental erosions, chronic cough, laryngitis, or asthma. Based on endoscopic and histopathologic appearance, GERD is classified into three different phenotypes: non-erosive reflux disease (NERD), erosive esophagitis (EE), and Barrett esophagus (BE). NERD is the most prevalent phenotype seen in 60-70% of patients followed by erosive esophagitis and BE seen in 30% and 6-12% of patients with GERD, respectively. Over the years, the mainstay in the management of GERD has been lifestyle modifications, and proton pump inhibitors (PPIs). However, medically refractory GERD is becoming increasingly common, requiring a tailored approach in the management of GERD.

Symptoms

A burning sensation in your chest (heartburn), usually after eating, which might be worse at night.

Chest pain.

Difficulty swallowing.

Regurgitation of food or sour liquid.

Sensation of a lump in your throat.

Causes

The term “gastroesophageal” refers to the stomach and esophagus. Reflux means to flow back or return. Gastroesophageal reflux is when what’s in your stomach backs up into your esophagus.


In normal digestion, your LES opens to allow food into your stomach. Then it closes to stop food and acidic stomach juices from flowing back into your esophagus. Gastroesophageal reflux happens when the LES is weak or relaxes when it shouldn’t. This lets the stomach's contents flow up into the esophagus.

Risk factors

Smoking.

Eating large meals or eating late at night.

Eating certain foods (triggers) such as fatty or fried foods.

Drinking certain beverages, such as alcohol or coffee.

Taking certain medications, such as aspirin.

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Complications

Sometimes GERD leads to serious complications:


Esophageal ulcer: Stomach acid eats away at your esophagus until an open sore forms. These sores are often painful and may bleed. They can make it hard to swallow.


Esophageal stricture: Stomach acid damages the lower part of your esophagus and causes scar tissue to form. This scar tissue builds up until it narrows the inside of the esophagus and makes it hard to swallow food.



Barrett’s esophagus: Acid reflux changes the cells in the tissue that lines your esophagus. The lining gets thicker and turns red. This condition is linked to a higher chance of esophageal cancer.


Lung problems: If reflux reaches the back of your throat, it can cause irritation and pain. From there, it can get into the lungs (aspiration). If this happens, your voice may get hoarse. You could also have postnasal drip, chest congestion, and a lingering cough. If your lungs get inflamed, you can develop asthma, bronchitis, and possibly even pneumonia.


Prevention

Maintain a healthy weight. ...

Stop smoking. ...

Elevate the head of your bed. ...

Don't lie down after a meal. ...

Eat food slowly and chew thoroughly. ...

Avoid foods and drinks that trigger reflux. ...

Avoid tight-fitting clothing.