Gastroesophageal reflux (GERD) is a chronic medical condition in which the gastric acid flows from the stomach to the esophagus, causing damage and uncomfortable symptoms. GERD is the most common digestive disease with up to 20% of Americans suffering from it; this is a concern because if GERD is not treated properly it can lead to serious conditions like esophageal cancer.
How Does GERD Start?
The esophagus is a long tube that transports the food from the pharynx to the stomach. The esophagus has a muscle layer that contracts to help move the food to the stomach. Right where the esophagus meets the stomach, the muscle layer becomes thicker, creating a sphincter. This prevents the content of the stomach from returning to the esophagus. In other words, food should only travel in one direction from the esophagus to the stomach.
The stomach is a specialized organ whose function is to break down the food, and pass it to the intestine. Just like the esophagus, the stomach is a muscle layer that contracts to aid digest the food. However, the main function of the stomach is to produce gastric acid. This is a secretion high in hydrochloric acid, water and electrolytes, which break down the food. The cells of the stomach are able to tolerate the erosive effects of the gastric acids, while other body organs will be damaged by it. This is why it is important that the gastric acid stays only in the stomach and does not go to the esophagus.
Gastroesophageal reflux happens when, because of different reasons, the integrity of the esophageal sphincter is compromised, causing the gastric acid to travel upwards to the esophagus.
What Causes GERD?
1. Changes on the esophageal sphincter can cause GERD, yet it is not fully clear why in some patients the esophagus sphincter stops working
2. Hiatal hernia: this occurs when the top of the stomach bulges up into the diaphragm (the muscle that divides the thorax and abdomen). This compromise the integrity of the esophageal sphincter causing GERD
3. Stress: stressful experiences can cause an increment in the secretion of gastric acid, which acts as a risk factor to develop GERD and gastric ulcers
4. Food: certain foods like red meats, spicy food, and fried food are a risk factor for GERD
5. Drinks: coffee and alcohol alter the function of the esophageal sphincter
6. Smoking: cigarettes are a risk factor for developing cancer and GERD
Is GERD Dangerous?
The esophagus tissue is not designed to tolerate the gastric acid. Literally, the acid burns the mucosa of the esophagus, resulting in pain and burning sensation. The hazard with GERD is that because of the constant contact with the gastric acid, the cells of the esophagus mucosa have modified themselves to survive. This process is called metaplasia. The changes that happened on the esophagus cells have the name of Barrett’s esophagus, and this is a precancerous condition. Another consequence that can happen is the sclerosis of the esophagus that causes the diameter of the esophagus to get smaller, defaulting eating. Concisely, GERD increases the risk of developing esophagus cancer.
How Can I Know If I Have It?
The symptoms of gastroesophageal reflux are secondary to the action of the gastric acid in the esophagus. Here are some GERD symptoms to look out for:
1. Heartburn sensation: most patients will complain of having a burn sensation on the center of the chest post-meals
2. Regurgitation: patients have the feeling that the food is coming back to their mouths again
3. Nauseas: because of regurgitation, some patients will feel nauseous. Vomit can also be present
4. Pain in the top center part of the abdomen: the pain can be intense, and happens mostly after eating
5. Chronic cough and laryngitis: the gastric acid can travel all the way back to the larynx, causing irritation. Chronic cough is the debut symptom for some patients with GERD
In most cases, your doctor should be able to diagnose you with GERD based on your symptoms; however, it is crucial to determine the severity of the changes to the esophagus. To do so, an endoscopy is necessary. This is a test where a camera is introduced through the oral cavity, allowing the doctor to observe the changes on the mucosa, and take a sample for a biopsy to determine the exact changes that happened to the tissue of the esophagus.
What Is The Treatment?
1. Lifestyle changes: this is the first stage of the treatment, and most GERD gets better with simple changes in your everyday life. Avoiding red meats, spicy foods, cigarettes and alcohol can be enough to ease the symptoms
2. Medical: when lifestyle changes are not enough, medication is needed. The drugs used to treat GERD focus on decreasing the secretion of gastric acid. The group of medications most commonly used are proton bomb inhibitors (medicines that line the stomach reducing acid production)
3. Surgical: for patients with hiatal hernia, surgery can correct the defect on the diaphragm, correcting GERD completely
Gastroesophageal reflux can be very painful, and potentially dangerous. Please visit your healthcare provider if you think that you have any symptoms of GERD.
