Risk Factors of GERD & Acid Reflux Disease
GERD Information You Can Trust
Gastroesophageal reflux disease (GERD), also known as acid reflux, is a digestive disorder that affects the ring muscles between the stomach and esophagus and the lower esophageal sphincter. It is a normal process that occurs in both children and adults. The food we eat is carried from the mouth to the stomach through the esophagus. This tube-like structure comprises muscles and tissues which expand and contract to push food towards the stomach. At the end of this tube, there is a circular ring called lower esophageal sphincter (LES), which expand to allow entry of food into the stomach and contract to prevent a return of food into the esophagus.
Causes of GERD
Sometimes, the lower esophageal sphincter (LES), at the end of the food pipe, can become relax thus allowing food back into the esophagus. In most cases, this occurs immediately after meals. GERD occurs when LES fails to close such that the stomach content or acid flows back into the esophagus. The reflux disturbs the lining of your esophagus and as a result causing GERD. Generally, damage to the esophagus is likely to arise when reflux is very acidic, frequent, or if the esophagus cannot clear acid as quickly as it should. In such instances, a person would feel heartburn.
Some doctors believe a hiatal hernia can weaken the LES thus increasing the risk of gastroesophageal reflux. A Hiatal hernia happens when the upper side of the stomach moves towards the chest through an opening in the diaphragm. Most people with a hiatal hernia might not have a reflux problem or heartburn.
Other factors that contribute to GERD include lifestyle and dietary choices, especially foods which have a lot of sugar, fats, or alcohol. Besides this, smoking may cause the LES to relax. Bending or lying down can also cause heartburn.
Symptoms of GERD
The main symptom of GERD is persistent acid indigestion or heartburn. A person usually feels a burning on the chest area that moves upwards towards the throat. One would feel as if the food is returning to the mouth. The pressure, burning or pain because of the heartburn can last for up to 2 hours. Other common symptoms include:
- Non-burning chest pain or the upper part of the abdomen
- Persistent hoarseness
- Bad breath
- Respiratory problems
- Pain or difficulty in swallowing
- Nausea or vomiting
- Wearing away of the teeth
- A persistent sore throat or sense of lump in your throat
- Experiencing a choking sensation immediately when you wake up
How Common is GERD?
Occasional acid reflux is common among all people, sometimes for unknown reasons. According to the American College of Gastroenterology, about 60 million of the US population experience heartburn, at least once every month, and about 15 million suffer from heartburn daily. It is common among persons who are obese, smoking, pregnant or taking certain medication such as sedatives, antihistamines, asthma medication, and antidepressants.
Is GERD Genetic?
Even though a majority of people assume that GERD is caused by certain food, lifestyle habits, or stressful situations, scientist suspect that it is caused by both genetic and environmental factors. With this in mind, one's genes can play a role in causing structural problems in the esophagus which in turn causes GERD.
GERD Diagnosis
There are several possible tests to diagnose GERD. It is usually diagnosed based on the symptoms and response to treatment.
For persons who have shown symptoms of GERD but have no evidence of complication, doctors can recommend a dietary and lifestyle changes as a trial treatment. When the symptoms are not severe and the diagnosis of GERD is not clear, one of the following tests may be conducted.
- Upper gastrointestinal (GI) endoscope - A tube with a camera being inserted into the esophagus to inspect the condition of the esophagus. A biopsy may also be taken in the process.
- Esophageal PH and impedance monitoring - the test involves measuring the acid levels in the esophagus while sleeping or eating. A wireless esophageal monitoring may also be used to monitor the pH level constantly for about 48 hours.
- Esophageal manometry - The test is used to measure the strength of the muscles in the esophagus while eating.
- Upper GI series - X-ray is taken to reveal physical abnormalities that might cause GERD.
GERD Treatment
If you experience excess chest pain, difficulty in swallowing food, bleeding or choking, then it could be an indication of a more serious problem and you should seek treatment immediately. If lifestyle changes do not lead to improvement of symptoms, then doctors will recommend anti-reflux surgical operations. Generally, surgical treatments involve strengthening the lower esophageal sphincter and repairing the hiatus hernia.
Endoscopic Procedures
These involve a number of surgical procedures which include tightening the sphincter muscles through sewing. Radiofrequency may also be used to tighten the sphincter muscles.
Fundoplication
This treatment involves sewing the top part of the stomach, especially around the esophagus. This will increase the pressure on the lower part of the esophagus thus reducing the occurrence of reflux.
What are the Complications of GERD?
While a majority of GERD patients might not experience serious complications, especially when it is treated on time, patients with severe GERD might develop a number of complications.
- Stricture - frequent reflux can cause narrowing of the esophagus which is caused by scar tissue. As a result, it can lead to a blockage which can, in turn, prevent smooth flow of food to the stomach.
- Ulcers - When the esophagus is exposed to too much acid from the stomach, it can form ulcers.
- Barrett's esophagus - It occurs when the squamous cells (cells in the lower esophagus) is replaced with intestinal cells. This will lead to repeated damage to the esophageal lining.
- Lung and throat complications - If acid reaches the throat, then it might cause inflammation of the vocal cords, hoarse voice, and a sore throat. It can also be inhaled into the lungs which might cause aspiration pneumonia.
Expected Recovery Outcomes for GERD
Generally, GERD requires a long term therapy. In most cases, laparoscopic anti-reflux operations are less likely to result in other complication than esophageal operations. According to American Society for Gastrointestinal and Endoscopic Surgeons (SAGES), surgical operations are effective in 85 -93% of the cases.
GERD, If Left Untreated
Long standing reflux will damage the tissue lining in the esophagus thus causing pain and inflammation. If unattended, GERD can also lead to several complications. In adults, untreated GERD can cause a permanent damage to the esophagus and can even lead to cancer.
GERD Re-Occurrence Statistics
Generally, patients who sleep immediately after eating have a higher chance of GERD recurrence. Various studies have shown that about 25% of patients experience a recurrence.