We’ve all felt uncomfortable bloating or experienced a touch of heartburn resulting from acid reflux. In its occasional form, acid reflux is generally a mild and transient condition, usually resolved with some dietary adjustments or over-the-counter remedies.
However, if heartburn is a frequent companion in your life, it might be a sign of a more serious condition called Gastroesophageal Reflux Disease (GERD).
With GERD awareness week being the week of Thanksgiving, we thought it would be helpful to discuss the difference between occasional heartburn and GERD. This article will tell you everything you need to know about GERD, including the main risk factors that increase your risk of developing it and how you can effectively manage and treat it.
WHAT IS GERD?
GERD is short for Gastroesophageal Reflux Disease. The easiest way to define GERD is that it’s a more severe form of gastroesophageal reflux (GER), better known as acid reflux.
Typically, you can get rid of acid reflux through dietary adjustments or over-the-counter remedies. However, when that horrible burning sensation in your chest becomes more severe and persistent, it likely indicates the presence of GERD.
GERD is a chronic condition in which stomach acid regularly flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest discomfort This occurs when the lower esophageal sphincter (LES), a muscular ring that separates the esophagus from the stomach, weakens or malfunctions, allowing stomach acid to irritate the lining of the esophagus over time.
GERD affects millions of people worldwide. It is slightly more common with age and in men than women but can affect anyone, including infants. While heartburn is the primary symptom, it can also manifest in various ways.
If you are experiencing persistent heartburn or other GERD symptoms (which we will discuss a little further down), it is important to seek medical attention to determine the underlying cause. Left untreated, GERD can lead to esophageal damage and other issues.
IS GERD THE SAME AS ACID REFLUX?
The short answer is no, they are not the same, but they are closely related. Acid reflux and its most common symptom, heartburn, occur when stomach acid occasionally flows back into the esophagus, causing a burning sensation in the chest or throat.
Acid reflux is a common issue that most people experience occasionally. In these cases, it is temporary, and discomfort is usually triggered by specific factors like dietary choices, large meals, or lying down after eating.
On the other hand, GERD is a more severe and chronic form of acid reflux. The key distinction lies in the frequency and intensity of symptoms. If you struggle with heartburn more than twice a week, it’s more likely due to GERD.
In GERD, stomach acid flows back into the esophagus repeatedly and persistently, leading to potential complications. This ongoing exposure to acid can cause damage to the esophagus over time, resulting in symptoms that go beyond heartburn, such as difficulty swallowing, chest pain, and respiratory issues.
So, while acid reflux and GERD may share heartburn as a symptom, they are not the same. If you’re experiencing frequent and persistent heartburn, you should consult a doctor specializing in GI disorders to determine if GERD is the underlying cause.
Proper diagnosis and management of GERD is crucial to prevent long-term complications.
WHAT ARE THE SYMPTOMS OF GERD IN ADULTS?
If you suffer from GERD, you are probably very familiar with its symptoms. They include more than occasional heartburn and indigestion most people experience on and off throughout their lives. GERD is essentially acid reflux amplified.
Symptoms that might indicate your heartburn is GERD might include one or more of the following:
- Food or liquid coming back up into the mouth after eating (regurgitation)
- Persistent and often severe burning in the chest and throat
- Sudden and excessive production of saliva (water brash)
- A bad (often sour) taste in the mouth
- The feeling of a lump in your throat
- Frequent throat clearing
- Difficulty swallowing
- Esophageal spasms
- Hoarseness/Laryngitis
- Sore throat
- Chest Pain
- Dry cough
- Nausea
- Burping
- Bloating
GERD is not something that should be ignored. It must be managed and monitored by your physician to prevent severe complications. Managing GERD often requires medication and, in some cases, surgical intervention.
WHAT ARE THE CAUSES AND RISK FACTORS FOR GERD?
Many wonder if it’s possible to prevent GERD. While complete prevention may not always be achievable, knowing the key factors behind GERD can help reduce your risk of developing this condition.
Several factors contribute to LES weakening and the development of GERD. By understanding these factors, you can take proactive steps to lower your risk of esophageal damage.
Excess Weight
Being overweight is one of the most significant GERD risk factors. When you are overweight, excess abdominal fat places pressure on your stomach and the lower esophageal sphincter (LES), a muscle that separates the esophagus from the stomach. When the LES doesn’t close properly or weakens, stomach acid and digestive juices flow back into the esophagus, resulting in GERD symptoms.
Considering that a malfunction in the LES primarily causes GERD, you can see how being overweight is one of the leading risk factors for GERD. Weight loss will dramatically improve your symptoms. Talk to your physician about effective weight management strategies such as a healthy diet and moderate exercise.
Drinking plenty of water can also help. Water makes you feel fuller and helps diminish food cravings that lead to weight gain. These interventions may help you lose excess weight so that your GERD symptoms will improve.
Age
GERD risk tends to increase with age due to several factors. One key reason is that as people get older, the muscles that support the lower esophageal sphincter (LES) and aid in digestion can weaken. This weakening of the LES can lead to a higher likelihood of stomach acid refluxing into the esophagus.
Additionally, the natural wear and tear on the esophageal tissues over time can make them more vulnerable to the corrosive effects of stomach acid, further elevating the risk of GERD.
Pregnancy
Pregnancy often causes hormonal changes that can affect the function of the LES. The increased pressure on the abdomen as the baby grows can also lead to a higher risk of acid reflux.
Furthermore, the elevated levels of the hormone progesterone during pregnancy can lead to relaxation of the LES, making it easier for stomach acid to flow back into the esophagus. These combined factors make pregnant women more susceptible to GERD during this period.
Cigarette Smoke and Nicotine
Individuals who smoke or are exposed to secondhand smoke are at an increased risk of developing GERD. Exposure to cigarette smoke can weaken the LES and impair its ability to prevent stomach acid from refluxing. Additionally, cigarette smoke can damage the esophageal lining, making it more susceptible to acid-induced damage.
Smoking itself also reduces saliva production, which helps neutralize stomach acid. And Nicotine, a component of tobacco, relaxes the LES, which further contributes to the weakening of its protective function, making it easier for stomach acid to flow back into the esophagus.
Diet
Dietary choices play a significant role in GERD development. Consuming large meals, particularly before bedtime, can increase abdominal pressure and force stomach acid into the esophagus.
Additionally, certain foods and beverages, such as fatty, spicy, acidic, or citrusy items, can directly irritate the esophageal lining and relax the LES, leading to acid reflux. Similarly, excess caffeine and alcohol consumption can relax the LES and promote acid reflux, further contributing to GERD risk.
Try to limit these foods and beverages. A diet that includes these elements can create conditions conducive to acid reflux and GERD symptoms..
Certain Health Conditions and Medical Disorders
If you have certain medical conditions and disorders, they could increase your chances of developing GERD; however, it’s important to note that simply having these diseases or taking these medications does not guarantee that you will get it.
Hiatal Hernia
When the top half of your stomach bulges through the big muscle that separates your abdomen and chest, it’s called a hiatal hernia.
A minor hiatal hernia is usually unproblematic. You might not even know you have one unless your doctor notices it when looking for another problem. A significant hiatal hernia, on the other hand, can cause food and acid to back up into your esophagus, causing heartburn.
The exact cause of hiatal hernia is not fully known. However, it’s believed that it is most likely due to the weakness of supporting tissue. Acid reflux is also a common cause of hiatal hernia.
By maintaining a healthy weight, you can decrease your chances of developing a hiatal hernia, which can lead to GERD. Obesity raises your risk for a hiatal hernia, weakening your LES valve and increasing your risk for GERD.
Other things you can do to decrease the chances of developing a hiatal hernia include eating smaller meals, avoiding foods that trigger heartburn, not smoking, and doing exercises that strengthen stomach muscles.
The symptoms of a hiatal hernia are frequently relieved by self-care or medication. A large hiatal hernia may necessitate surgery.
Celiac Disease or Gluten Intolerance
It is well documented that people diagnosed with celiac disease or gluten intolerance have a higher risk of developing GERD. However, the connection between GERD, celiac disease, and gluten intolerance still requires more study.
Researchers have yet to establish whether consuming gluten, a protein found in wheat, directly triggers GERD symptoms or if GERD is merely associated with gluten intolerance and celiac disease.
If you have a gluten intolerance, your symptoms may overlap with those of celiac disease, but these conditions are distinct. Gluten intolerance signifies an inability to digest gluten effectively, often resulting in gas, diarrhea, and abdominal discomfort.
Celiac disease, in contrast, is not an intolerance but an autoimmune condition where the body’s immune system reacts to gluten, leading to a diverse range of gastrointestinal symptoms. People with celiac disease can also experience malnutrition and dermatitis herpetiformis, a recurring rash with bumps and blisters.
If you recognize these common symptoms, consult your doctor for celiac disease testing. GERD can develop in individuals with long-standing celiac disease, but it appears to be more prevalent in those recently diagnosed.
If you have either of these conditions, avoiding gluten significantly reduces your risk of developing GERD.
Hypothyroidism
Hypothyroidism, a condition where the thyroid gland doesn’t produce sufficient thyroid hormones, can be a risk factor for GERD. The link lies in the fact that hypothyroidism can slow down the digestive process, leading to delayed stomach emptying.
This delay can increase the pressure on the lower esophageal sphincter (LES), allowing stomach acid to flow back into the esophagus more easily, potentially causing GERD.
Diabetes
People with diabetes, especially poorly controlled diabetes, may have an increased risk of developing GERD. High blood sugar levels can affect the functioning of the LES, potentially allowing stomach acid to reflux into the esophagus.
Additionally, diabetes-related nerve damage can disrupt the normal digestive process, further contributing to GERD symptoms.
Asthma
Asthma and GERD are often seen together, with one condition exacerbating the other. While the exact connection is still under study, it is believed that the acid reflux from GERD can trigger or worsen asthma symptoms.
Conversely, asthma-related coughing and breathing difficulties can increase abdominal pressure, potentially leading to GERD.
Certain Autoimmune Disorders
Autoimmune disorders, like scleroderma, can increase the risk of GERD. Scleroderma affects the connective tissues of the body, including those in the esophagus. The changes in these tissues can weaken the LES and hinder the proper movement of food through the digestive tract, making acid reflux more likely.
Gastroparesis
Gastroparesis, a condition where the stomach muscles don’t function properly, can slow down the emptying of the stomach. This delay can lead to the accumulation of stomach contents and increased pressure on the LES, making reflux more probable.
Chronic Obstructive Pulmonary Disease (COPD)
COPD, a lung condition that includes chronic bronchitis and emphysema, can elevate the risk of GERD. The increased pressure in the chest due to frequent coughing and breathing difficulties can promote acid reflux into the esophagus.
Renal Disease (Fluid Retention)
Renal disease, especially when accompanied by fluid retention, can lead to an increased risk of GERD. Fluid retention can cause abdominal distension, which places pressure on the LES and contributes to acid reflux.
Congestive Heart Failure (Fluid Retention)
Congestive heart failure often involves fluid retention in the body. The accumulation of fluids can increase pressure on the stomach and LES, making it easier for stomach acid to flow back into the esophagus, thus increasing the risk of GERD.
Certain Medications
There are medications associated with an increased risk of GERD, often due to their effects on the lower esophageal sphincter (LES), delayed stomach emptying, or changes in stomach acid production. Additionally, some medications are known to cause weight gain, a leading GERD risk factor.
If you are experiencing GERD symptoms and believe it might be due to a medication you are taking, never stop taking your medication. Talk to your doctor about an alternative, a dosage reduction, or adding another medication.
For example, swapping out or lowering your dosage might help slow weight gain if you take antihistamines, beta-blockers, corticosteroids, or psychotropic medications, while diuretics may help prevent excess weight related to fluid retention.
Also, if you have hypothyroidism, thyroid hormone replacement therapy can help normalize your metabolism so that weight gain is less of a problem.
Some medications said to be connected to GERD include:
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, can irritate the stomach lining and lead to increased stomach acid production. This irritation can potentially relax the LES, making it easier for stomach acid to flow into the esophagus.
Antihistamines
Antihistamines are known for reducing stomach acid production, which can be helpful for certain conditions. However, reduced stomach acid can also lead to delayed digestion and gastric distension, potentially contributing to GERD symptoms.
Beta-Blockers (B-Blockers)
Beta-blockers are medications used to treat high blood pressure and certain heart conditions. Some beta-blockers may relax the LES, allowing for acid reflux into the esophagus.
Psychotropic Medications
Some psychotropic medications, like antidepressants and antipsychotics, can affect the digestive system and lead to delayed stomach emptying. This delayed emptying can contribute to GERD symptoms. Weight gain is also a common side effect of many anxiety and depression drugs, which can contribute to GERD.
Corticosteroids
Corticosteroids are potent anti-inflammatory drugs that sometimes weaken the LES, making them less effective in preventing acid reflux. Additionally, corticosteroids can lead to weight gain, a common GERD risk factor.
Calcium Channel Blockers
These medications are often used to treat high blood pressure and certain heart conditions. They can relax the LES, potentially leading to acid reflux.
Opioid Pain Medications
Opioids can slow down digestion, leading to delayed stomach emptying and an increased risk of GERD.
Bisphosphonates
Bisphosphonates are used to treat osteoporosis and can sometimes irritate the esophagus, potentially leading to GERD symptoms.
IS GERD GENETIC?
Research has shown that individuals with a family history of GERD are more likely to develop the condition themselves. This genetic link may involve inherited traits related to the function of the lower esophageal sphincter (LES).
An inherited tendency for a weak or malfunctioning LES can increase the risk of GERD. However, it’s important to note that genetics alone do not determine the outcome. Environmental factors, lifestyle choices, and dietary habits also play a significant role in the development and severity of GERD.
If you have a family history of GERD, it’s important to be mindful that external factors can trigger or exacerbate the condition in individuals with a genetic predisposition. Be cautious of your lifestyle choices and seek medical advice if you experience symptoms to effectively manage and reduce your risk of GERD.
DOES GERD CAUSE BARRETT’S ESOPHAGUS?
Those with long-standing GERD are often diagnosed with Barrett’s Esophagus, a chronic regurgitation of acid from the stomach into the lower esophagus.
Barrett’s Esophagus is a condition in which the cells lining the lower esophagus change due to continuous exposure to stomach acid. Over time, this can lead to a condition known as intestinal metaplasia, where the normal esophageal lining is replaced by cells resembling those found in the intestine.
While not everyone with GERD develops Barrett’s Esophagus, the risk increases with the duration and severity of GERD symptoms.
DOES GERD CAUSE CANCER?
Most people with GERD will not develop cancer. However, it is possible and the risk increases with the duration and severity of GERD symptoms, making it crucial to seek appropriate medical management to mitigate this risk.
Studies and research have indicated a correlation between long-standing GERD and an increased risk of developing two types of esophageal cancer: esophageal adenocarcinoma and esophageal squamous cell carcinoma.
Esophageal adenocarcinoma is a type of cancer with a notable link to GERD. Over time, repeated exposure of the lower esophagus to stomach acid can lead to cellular changes, ultimately increasing the risk of esophageal adenocarcinoma.
Esophageal squamous cell carcinoma is less common but also associated with GERD, particularly in individuals with severe and long-standing reflux.
Early detection and effective management of GERD can significantly reduce the risk of associated cancers. If you are concerned about the potential link between GERD and cancer or have a family history of esophageal cancer, consult a healthcare professional for guidance and regular monitoring.
HOW IS GERD DIAGNOSED?
Diagnosing GERD typically involves a combination of clinical evaluation, patient history, and specialized tests to confirm the presence of the condition and determine its severity.
Your healthcare provider will begin by taking a detailed medical history, asking about your symptoms, their frequency and severity, as well as any factors that exacerbate or alleviate them.
They will also likely ask about your diet, lifestyle, and medication use. It’s crucial that you answer these questions honestly.
A physical examination may also be conducted to assess any signs or symptoms related to GERD, such as weight loss or abdominal pain.
Sometimes, healthcare providers may prescribe a proton pump inhibitor (PPI) to see if it alleviates your symptoms. A positive response to this medication can support the diagnosis of GERD.
To obtain a definitive diagnosis, specialized tests and procedures may be recommended. This might include one or more of the following:
Endoscopy
This procedure involves the insertion of a flexible tube with a camera (endoscope) into the esophagus to directly visualize any damage or inflammation. Endoscopy allows healthcare providers to assess the severity of GERD and exclude other conditions.
pH Monitoring
This test measures the acidity in the esophagus over a 24-hour period. It is valuable for identifying acid reflux episodes and their frequency.
Esophageal Manometry
Esophageal manometry assesses the pressure and coordination of contractions in the esophagus, providing insights into the function of the lower esophageal sphincter (LES).
Barium Swallow X-ray
In this test, a barium solution is swallowed, and X-rays are taken to visualize the passage of barium through the esophagus. It is effective for identifying structural abnormalities.
Biopsy
In cases where Barrett’s Esophagus is suspected, a biopsy may be conducted during an endoscopy to confirm the presence of abnormal cells.
IS GERD CURABLE?
GERD is not typically considered curable in the conventional sense. The reason is partially because once the lower esophageal sphincter (LES) is damaged, it may not be fully repairable.
However, this doesn’t mean GERD lacks effective management and relief options. GERD is very treatable. Successful management, tailored to the individual, allows many people with GERD to lead a comfortable and symptom-free life.
HOW IS GERD TREATED?
Once diagnosed, healthcare providers at a GERD Treatment Center can tailor a treatment plan to effectively manage and alleviate GERD symptoms. Treatment will vary based on the individual’s specific condition and the severity of their symptoms.
When the LES is weakened, lifestyle modifications and dietary changes become essential. Elevating the head of the bed, avoiding large meals before bedtime, and identifying and avoiding trigger foods can significantly improve symptoms.
Medications, such as proton pump inhibitors (PPIs) and H2 blockers, are commonly prescribed to reduce stomach acid production and provide relief from discomfort. In many cases, a combination of lifestyle adjustments and medication can effectively manage GERD.
Surgical interventions may be considered for individuals with severe GERD or complications like Barrett’s Esophagus. While these procedures cannot repair the LES, they aim to reinforce or correct structural issues contributing to reflux.
NON-SURGICAL TREATMENT OPTIONS FOR GERD
Non-surgical treatment options for GERD primarily revolve around lifestyle changes, medications, and dietary modifications. These approaches typically do the trick for when symptoms are mild to moderate.
Non-surgical GERD treatment options might include:
Sleeping Habits and Posture Changes
These include raising the head of the bed, avoiding lying down right after eating and maintaining a healthy weight.
Lifestyle Adjustments
Quitting smoking, reducing alcohol consumption, and managing stress can alleviate GERD symptoms.
Dietary Changes
Identifying and avoiding trigger foods that worsen symptoms, such as spicy, acidic, or fatty foods.
Prescription Medications
Your healthcare provider might prescribe a medication such as Proton Pump Inhibitors (PPIs) and H2 blockers to reduce stomach acid production and provide symptom relief.
Over-the-Counter (OTC) Medications
Your physician might suggest antacids and alginate medications to provide quick relief from heartburn and acid reflux.
SURGICAL TREATMENTS FOR GERD
Surgical interventions are the next step to consider when medication management is not effectively controlling your GERD symptoms, your GERD is worsening, and other non-surgical approaches have not provided sufficient symptom relief. Additionally, surgical options may be explored when complications such as Barrett’s Esophagus are present.
Fundoplication is a general term for a surgical procedure to treat GERD. There are different surgical techniques within the category of fundoplication that your surgeon can use to address GERD and acid reflux.
Among these fundoplication techniques performed by a GERD surgeon, three of the most common and effective surgical procedures are: LINX Reflux Management System, Nissen (laparoscopic Nissen fundoplication), and TIF (transoral incisionless fundoplication).
These three surgical treatments have demonstrated effectiveness in addressing GERD by either reinforcing the natural anti-reflux barrier or creating a new one, thus reducing or eliminating the occurrence of reflux.
LINX Reflux Management System
The LINX system is a groundbreaking GERD treatment. It is a minimally invasive procedure that involves the implantation of a small, flexible band of magnetic beads around the lower esophagus. These beads help support the lower esophageal sphincter (LES) and reinforce its natural barrier function.
When the LES is weakened, stomach acid can flow back into the esophagus, causing GERD symptoms. The LINX device helps prevent this reflux, improving symptoms without affecting normal swallowing.
Nissen (laparoscopic Nissen fundoplication)
Laparoscopic Nissen fundoplication is considered a highly effective and durable surgical treatment for GERD, offering long-term symptom relief.
The Nissen fundoplication is a surgical technique performed laparoscopically, which involves creating a new valve mechanism by wrapping the top of the stomach around the lower esophagus.
This procedure strengthens the LES, effectively preventing the backflow of stomach acid into the esophagus.
TIF (transoral incisionless fundoplication)
TIF is a less invasive surgical procedure performed through an endoscope inserted into the mouth, avoiding external incisions.
During TIF, tissue folds are created at the gastroesophageal junction, essentially recreating the anti-reflux barrier. This minimizes acid reflux and helps alleviate GERD symptoms.
TIF is a good option for individuals seeking surgical relief with reduced invasiveness and a shorter recovery period.
WHAT HAPPENS IF GERD IS LEFT UNTREATED?
Long-term or untreated GERD can raise your risk for severe digestive complications. The constant exposure to stomach acid can result in cellular changes in the esophagus, which, over time, may progress to more serious conditions, including esophageal adenocarcinoma, a type of esophageal cancer.
Individuals with long-standing GERD may also risk developing Barrett’s Esophagus, a chronic condition characterized by the regurgitation of stomach acid into the lower esophagus.
Additionally, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) emphasizes that untreated GERD can have far-reaching consequences, including respiratory problems. Stomach acid that repeatedly washes into the esophagus can not only cause discomfort but also reach the airways, potentially leading to coughing, wheezing, and other respiratory issues.
Seeking prompt and appropriate treatment for GERD is vital to prevent these potential complications and safeguard your long-term health. If you suspect you have GERD, consult a healthcare professional for guidance and effective management.
GERD Awareness in November
November is important for bringing awareness to GERD. November is designated as GERD Awareness Month, a time when attention is drawn to the nearly one in five Americans who experience chronic acid reflux and its related symptoms.
It’s a time to recognize that GERD can affect not just physical health but also mental well-being and health-related quality of life. This condition can even hinder a person’s ability to function and work.
During this month, there are several actions you can take to raise awareness and support those affected by GERD. Consider scheduling a screening or check-up to monitor your own digestive health. Encourage family and friends to do the same, as early detection and management can significantly improve the quality of life for those with GERD.
Also, be mindful during the week of Thanksgiving, which coincides with National Gastroesophageal Reflux Disease (GERD) Awareness Week. Overindulging during holiday feasts can often lead to heartburn, bloating, and regurgitation symptoms. However, it’s important to remember that you may have GERD when these symptoms occur regularly despite normal eating habits.
SEEKING SURGICAL TREATMENTS FOR GERD
At The Surgical Clinic, we have a GERD treatment center with a team of bariatric surgeons in Nashville, providing several different surgical treatments for acid reflux, heartburn, and GERD.
We understand that every patient is unique, and an evaluation with one of our GERD specialists is the first step to determining your best treatment option.
Visit our online GERD center to learn more about your symptoms and treatment.