Gastro-oesophageal reflux disease, commonly known as GERD, is a widespread digestive condition characterized by the frequent backflow of stomach contents into the oesophagus. This reflux can irritate the lining of the oesophagus, leading to discomfort and potential long-term issues. While occasional reflux is a normal occurrence, GERD involves persistent and often bothersome symptoms that affect daily life. It represents a more chronic form of acid reflux, requiring attention and management.
How Gastro-Oesophageal Reflux Disease Develops
GERD develops primarily due to a dysfunction of the lower oesophageal sphincter (LES), a muscular ring located at the junction of the oesophagus and the stomach. The LES normally acts as a one-way valve, relaxing to allow food and liquids to pass into the stomach and then contracting tightly to prevent stomach contents from flowing back up. When the LES weakens or relaxes inappropriately, it fails to close properly, allowing stomach acid and digestive enzymes to ascend into the oesophagus.
The oesophagus lacks the protective lining found in the stomach, making it vulnerable to the corrosive effects of stomach acid. This exposure leads to irritation and inflammation of the oesophageal lining. Over time, repeated acid exposure can damage the delicate tissues. The frequency and duration of these reflux episodes contribute to the severity of the condition.
Recognizing the Signs
The most common symptom of GERD is heartburn, a burning sensation in the chest that often rises from the stomach towards the neck. This discomfort occurs after eating, when lying down, or bending over. Another frequent sign is regurgitation, where stomach acid or undigested food flows back into the throat or mouth. Difficulty swallowing, known as dysphagia, may occur, feeling like food is sticking in the throat or chest.
Beyond these typical symptoms, GERD can manifest with less common signs. These atypical symptoms include a chronic cough, particularly at night, or persistent hoarseness and throat clearing. Non-cardiac chest pain may also occur, which can be mistaken for heart-related issues. Dental erosion and recurrent sore throats are also observed due to chronic acid exposure.
Understanding the Causes
Several factors contribute to the development or worsening of GERD. Dietary habits play a notable role, with certain foods and beverages, such as fatty or fried foods, spicy dishes, citrus fruits, chocolate, caffeine, and alcoholic drinks, relaxing the LES or increasing stomach acid production. Smoking also weakens the LES. Excess body weight significantly impacts GERD, as abdominal fat increases pressure on the stomach, pushing contents upwards.
Certain medications, including blood pressure drugs, asthma medications, and pain relievers, can relax the LES or irritate the oesophageal lining. Medical conditions such as a hiatal hernia, where part of the stomach pushes up through the diaphragm, can also contribute. Pregnancy can also lead to GERD due to hormonal changes and increased abdominal pressure from the growing uterus.
Managing and Treating Gastro-Oesophageal Reflux Disease
Managing GERD often begins with lifestyle adjustments aimed at reducing reflux episodes and alleviating symptoms. Dietary modifications involve avoiding trigger foods and eating smaller, more frequent meals instead of large ones. Finishing meals several hours before bedtime, typically two to three hours, helps ensure the stomach is less full when lying down. Elevating the head of the bed by six to nine inches using risers helps gravity keep stomach contents from flowing upwards during sleep.
Weight management is a beneficial strategy for individuals with excess weight, as reducing abdominal pressure can lessen reflux. Over-the-counter antacids can temporarily neutralize stomach acid. Longer-acting options include H2 blockers, which reduce acid production, and proton pump inhibitors (PPIs), which significantly suppress acid production. These medications provide sustained relief and are prescribed for more persistent symptoms.
If lifestyle changes and medications do not adequately control GERD symptoms or if complications arise, surgical intervention may be considered. A common surgical procedure is fundoplication, where the top part of the stomach is wrapped around the lower oesophagus and sewn into place. This procedure strengthens the LES, creating a tighter barrier to prevent reflux. Surgery is generally reserved for individuals with severe, persistent GERD that significantly impacts their quality of life despite other treatments.
Potential Complications
Untreated or poorly managed GERD can lead to several oesophageal complications. Chronic exposure to stomach acid can cause inflammation and ulceration of the oesophageal lining, known as esophagitis. Repeated damage can also lead to the formation of scar tissue, narrowing the oesophagus and making swallowing difficult, called an esophageal stricture.
A more concerning complication is Barrett’s oesophagus, where the normal squamous cells lining the oesophagus are replaced by cells similar to those found in the intestine. This cellular change is considered a precancerous condition. Individuals with Barrett’s oesophagus have an increased risk of developing oesophageal adenocarcinoma. Regular monitoring is recommended for those diagnosed with Barrett’s oesophagus to detect any cellular changes early.