By Diana Barnes-Brown for Reflux1
GERD is a fairly common condition of the digestive tract, caused when the muscles that act to close the esophagus (the tube that carries food from the mouth to the stomach) don’t work properly and acid escapes from the stomach, causing indigestion, tissue erosion, and other troubling and potentially dangerous symptoms.
A Closer Look
Some experts estimate GERD, short for gastroesophageal reflux disease, is a condition that affects as much as 7 percent of the population, making it one of the most common digestive disorders.
Thus, the term gastroesophageal is related to the two main parts of the body that are involved in GERD: the gastro-intestinal tract and the esophagus. The gastro-intestinal tract is the medical term used to describe digestive structures including the stomach and intestines, while the esophagus is the tube that leads from the upper throat to the stomach, making it possible for food to enter the stomach for digestion. In the stomach are powerful acids, needed by the body to properly break down food and allow it to be absorbed by the digestion process.
There is no clear cause for the physiological changes that lead to GERD, but medical experts know the condition occurs as a result of digestive acid escaping the stomach and washing backwards – or refluxing – into the esophagus.
Normally, this acid stays put in the stomach, kept in place by the powerful lower esophageal sphincter muscle (LES). When working properly, the LES seals tightly to keep acid in the stomach, where it is prevented from harming the stomach wall by a protective mucus lining, and away from the unprotected tissue of the esophagus. However, when the sphincter fails to shut tightly enough, acid can escape from the stomach and into the esophagus. This causes a number of uncomfortable or painful symptoms, and may lead to potentially serious illnesses down the line if not treated properly.
The most common symptom of GERD is frequent, chronic heartburn. But there are many other possible symptoms, including:
• Regurgitation of acid
• Painful or difficult swallowing
• Hoarseness or laryngitis, especially in the morning
• Chronic sore or irritated throat
• A sour taste in the mouth
• Recurrent or chronic bad breath
• Coughing, choking, or sputtering while asleep/lying down
• Sudden excess saliva
• Dysphagia (feeling of something being stuck in the esophagus)
• Chest pain
After months or years of exposure to acid, the tissue of the esophagus may also undergo cellular changes, resulting in a pre-cancerous condition known as Barrett’s esophagus.
Diagnosis of GERD is the work of a physician, and those who think they have symptoms of the disorder should call their medical caregiver and set up an appointment so that the process can begin as soon as possible. GERD can usually be diagnosed by its symptoms alone, although physicians may also want to examine the esophagus, mouth, and gums for swelling as well as signs of Barrett’s esophagus with the help of an endoscopic camera (a small, telescope-like camera that allows doctors to look at the inside surface of the esophagus). They may also want to have patients try one of a range of special acid-stopping drugs called a proton pump inhibitors; if the drug is effective in stopping symptoms, the patient who took it likely has GERD.
Once GERD is diagnosed, there are a number of possible treatment options. Often, drug therapy is a central part of treatment, at least until the condition quiets down enough for other methods to be sufficient. Drugs currently used to treat GERD include H2 blockers, which reduce acid in the stomach and proton pump inhibitors, which limit acid secretion by interfering with the production process. Over the counter heartburn medications are generally not recommended, as they can actually trick the stomach into producing more acid by neutralizing what is already there.
Dietary modifications such as avoidance of alcohol and high fat and high acid foods (including orange juice, tomatoes, coffee, butter, and heavy or creamy sauces) are also recommended, and those who smoke are urged to quit.
In rare cases, surgery is used to repair structural malformations or tissue damage, but this is generally saved as a last-ditch effort, because of the possibility of complications and the frequent success of more conservative treatments.