What is GERD?

Gastro-esophageal reflux disease or acid-reflux disease (GERD) is a condition in which the contents of the stomach reflux backwards into the esophagus (food pipe). Since the stomach contents are acidic in nature, this damages the inner lining of the food pipe and causes symptoms of heartburn, pain, etc.

Some amount of reflux of stomach contents is normal in all individuals but not everyone develops GERD. The main reason behind this is that only in some individuals this refluxed fluid is more acidic and remains in the esophagus for longer duration thus causing GERD. Dietary causes and certain faulty habits are frequently responsible for initiating this condition in individuals who are prone to develop it.

At the junction of the food pipe (esophagus) and the stomach is a muscular gateway (called lower esophageal sphincter or LES). Under normal circumstances, this sphincter remains contracted so that no contents of the stomach can go back into the esophagus but when this sphincter becomes relaxed due to any reason or is weak, it may allow the contents of the stomach to flow back into the esophagus causing inflammation of the lining of the oesophagus. There can also be many other causes of GERD which will be discussed in details later.

GERD Causes

There are multiple causes responsible for initiating GERD, and different causes may be functioning in different individuals or even in the same individual at different times. The commonest causes responsible for GERD have been listed below:

        

:: Functional abnormalities of the lower esophageal sphincter

-> Abnormally weak contractions of the sphincter 
-> Abnormal relaxations of the sphincter 
Both of the above contribute to increases chances of backflow of the stomach contents into the esophagus.

:: Hiatus Hernia:

A condition in which there is protrusion of the stomach up into the opening normally occupied by the esophagus in the diaphragm [the muscle that separates the chest (thoracic) cavity from the abdomen.

:: Abnormal esophageal contractions:

Co-ordinated esophageal contractions cause the forward movement of food from the esophagus into the stomach. When the wave of contraction is defective, the refluxed acid is not pushed back into the stomach and it can cause damage to the lining of the esophagus.

:: Delayed emptying of the stomach:

When food remains in the stomach for a longer duration, the stomach is distended for longer time and this increases the chances of reflux of the stomach contents.

There are several other contributing factors for GERD which are as follows:

Dietary habits:  Fatty and fried foods, chocolates, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings, pungent foods, etc

Habits:  Use of alcohol, cigarettes; poor posture (slouching) especially after meals

Drugs:  Calcium channel blockers, antihistamines, theophylline, nitrates,

Eating habits:  Large meals, eating soon before sleeping

Other contributory conditions: Obesity, pregnancy, diabetes, rapid weight gain, etc.

Stress:  Though this has not been directly linked to GERD, most patients report an increase in their symptoms during stressful times.

GERD Symptoms

Uncomplicated GERD presents with the following symptoms commonly:

• Heartburn:  This is the commonest presentation of GERD. Patients often complain of burning pain in the middle of chest region (retrosternal). The pain may also be present in the upper part of the abdomen and sometimes travels up to the throat. Occasionally the pain may be sharp or pressing instead of burning. The pain is worse after meals and can last upto a couple of hours. Symptoms may be worse on lying down.
• Regurgitation:  The refluxed stomach contents may come into the throat or mouth and this may occur especially on bending or sleeping. There may be a feeling of ‘something stuck in the throat'.
• Dry cough, hoarseness of voice, bad taste in the mouth are other symptoms caused due to the regurgitation of the food.
• Occasionally patients may develop nausea (though this is not very frequent) and GERD should always be considered in patients who have unexplained nausea.
• In children, the common symptoms are vomiting, coughing and other respiratory problems.