Acid Reflux & GERD

Gastroesophageal reflux disease (GERD), often simply called acid reflux when symptoms are milder or occasional, is a chronic condition where stomach acid or contents flow backward (reflux) into the esophagus—the tube connecting the mouth to the stomach. This happens because the lower esophageal sphincter (LES), a ring of muscle acting as a valve at the junction of the esophagus and stomach, weakens or relaxes inappropriately, allowing acid to escape upward. Occasional acid reflux is common and usually harmless, but when it occurs frequently (more than twice a week) and causes symptoms or complications, it is diagnosed as GERD.

GERD affects about 20% of adults in Western countries and can significantly impact quality of life if untreated.

Symptoms

The most common symptoms include:

Heartburn — a burning sensation in the chest that often rises toward the throat, typically after eating, when lying down, or bending over.

Regurgitation — a sour or bitter-tasting acid backing up into the throat or mouth.

Difficulty swallowing (dysphagia).

Chest pain (non-cardiac).

Chronic cough, hoarseness, or sore throat (especially in the morning).

Feeling of a lump in the throat.

Excessive salivation or nausea.

Some people experience "silent" or atypical GERD with few classic symptoms but extraesophageal issues like chronic cough, asthma-like wheezing, or laryngopharyngeal reflux (LPR, affecting the throat and voice box).

Causes and Contributing Factors

The primary issue is LES dysfunction, but multiple factors contribute:

Hiatal hernia (part of the stomach pushes up through the diaphragm).

Delayed stomach emptying (gastroparesis).

Increased abdominal pressure (from obesity, pregnancy, tight clothing).

Certain foods/drinks (spicy/fatty foods, chocolate, caffeine, alcohol, citrus, tomatoes).

Smoking, large meals, eating close to bedtime.

Medications (e.g., NSAIDs, some blood pressure drugs, antidepressants).

Stress and brain-gut axis dysregulation can worsen symptoms by affecting motility and sensitivity.

Diagnosis

Diagnosis often starts with symptom history and response to a trial of proton pump inhibitors (PPIs). If symptoms persist or alarm features are present (e.g., difficulty swallowing, unexplained weight loss, vomiting blood, anemia), further tests may include:

Upper endoscopy (to check for esophagitis, Barrett's esophagus, or strictures).

Esophageal pH monitoring or impedance testing.

Manometry (to assess LES pressure and esophageal motility).

Complications

Untreated or poorly managed GERD can lead to:

Esophagitis (inflammation/ulcers in the esophagus).

Barrett's esophagus (precancerous changes).

Esophageal stricture (narrowing).

Increased risk of esophageal cancer (rare).

Dental erosion, chronic sinus issues, or worsened asthma.

Conventional Management

First-line approaches include lifestyle changes (weight loss if overweight, elevating head of bed, avoiding triggers, smaller meals, not eating before bed) and medications:

Antacids or H2 blockers for mild cases.

PPIs (e.g., omeprazole, esomeprazole) as the most effective for healing esophagitis and controlling symptoms (used at lowest effective dose/shortest duration).

For refractory cases: endoscopic therapies (e.g., transoral incisionless fundoplication) or surgery (fundoplication).