Gastroesophageal reflux disease (GERD) is a chronic digestive condition defined by the flow of stomach contents back into the esophagus, the tube connecting the throat to the stomach. This recurring backwash of acid can lead to symptoms and, in some cases, damage to the esophageal lining.
GERD is a formal medical diagnosis that distinguishes it from occasional digestive discomfort. As a long-term disorder, its management often needs to be maintained even after initial symptoms are controlled. The condition is diagnosed when reflux becomes a persistent issue that impacts daily life.
GERD vs. Acid Reflux and Heartburn
Acid reflux, heartburn, and GERD are often used interchangeably but have different meanings. Acid reflux is the physiological event of stomach acid moving backward into the esophagus. This can happen to anyone occasionally, causing a sour taste in the mouth or the sensation of food coming back up.
Heartburn is the primary symptom of acid reflux, not a condition. It is a burning pain in the center of the chest that can radiate toward the neck and throat. This sensation often worsens after meals, in the evening, or when lying down.
GERD is the chronic, more severe form of acid reflux. A physician may diagnose GERD when acid reflux occurs more than twice a week and leads to persistent symptoms or esophageal damage. This persistent exposure to stomach acid defines the disease and can lead to more significant health issues.
Common and Atypical Symptoms
While heartburn is the most recognized symptom of GERD, other indicators exist. One is regurgitation, where stomach contents and acid flow back into the throat or mouth, causing a sour or bitter taste. Another frequent symptom is dysphagia, the sensation of difficulty swallowing or feeling that food is stuck in the esophagus.
GERD can also cause atypical symptoms that may not seem related to a digestive disorder. A persistent dry cough, especially at night, can be a sign of acid irritating the throat and airways. Some people experience hoarseness or laryngitis due to acid reaching the vocal cords.
Other less obvious symptoms include a lump in the throat (globus sensation) and non-cardiac chest pain. This chest pain can be sharp and radiate to the back, making it important to differentiate from heart-related conditions. Increased salivation, bad breath, or erosion of tooth enamel can also occur as stomach acid reaches the mouth.
Underlying Physical Causes
The primary physical cause of GERD is the improper functioning of the lower esophageal sphincter (LES). The LES is a ring of muscle at the bottom of the esophagus that acts as a valve, opening to allow food into the stomach and closing to keep contents from flowing back. In individuals with GERD, this valve may be weak or relax when it is not supposed to, allowing stomach contents into the esophagus.
Several factors can weaken the LES or increase pressure within the abdomen, which pushes stomach contents upward. These include:
- A hiatal hernia, a condition where part of the stomach pushes up through the diaphragm muscle.
- Obesity, as excess body weight increases intra-abdominal pressure.
- Pregnancy, which can lead to temporary GERD as the growing uterus puts pressure on the stomach.
- Smoking, which is known to weaken the LES muscle.
- Certain medications, including some blood pressure drugs, antidepressants, and sedatives, that can relax the sphincter.
Long-Term Health Implications
If not managed effectively, the persistent exposure of the esophageal lining to stomach acid can lead to health problems. One of the most direct consequences is esophagitis, which is the inflammation and swelling of the esophagus. This can cause pain and lead to the formation of ulcers in the esophageal tissue.
Over time, chronic inflammation can cause scar tissue to form. This scarring can lead to esophageal strictures, a narrowing of the esophagus. Strictures make it more difficult to swallow food, creating a feeling of blockage.
A more serious complication is Barrett’s esophagus, a condition where the tissue lining the esophagus changes to become more like the lining of the intestine. This cellular change is a precancerous condition because it increases the risk of developing esophageal adenocarcinoma. This potential for long-term damage underscores the importance of diagnosis and consistent management for GERD.