Gastroesophageal Reflux Disease (GERD) or Chronic Heartburn: Causes, Symptoms, Treatment

Gastroesophageal reflux disease (GERD) is also known as peptic esophagitis, reflux esophagitis, or chronic heartburn is a condition where the contents of the stomach such as food or liquids, regurgitate or leak backwards from the stomach into the esophagus causing irritation of the esophagus and heartburn along with other symptoms. GERD is a condition where there is back flow of the stomach contents into the esophagus which causes symptoms in a patient. Many of the patients respond well to conservative treatment such as making lifestyle changes and taking medications like antacids and proton pump inhibitors.

After the food is consumed, it passes from the throat to the stomach via esophagus (food pipe/swallowing tube). From the stomach, the food is prevented from moving backwards into the esophagus by a circle of muscle fibers known as the esophageal sphincter or LES. If there is any problem with the functioning of this sphincter muscle, then the food, liquid and stomach acid tends to leak back into the esophagus resulting in a condition known as acid reflux or gastroesophageal reflux. Acid reflux causes symptoms in a patient and may also damage the esophagus.

• Alcohol (probably).
• Obesity.
• Pregnancy.
• Hiatal Hernia.
• Scleroderma.
• Smoking.
• Certain medications may worsen the reflux such as anticholinergics, beta-blockers, calcium-channel blockers, dopamine-active drugs for Parkinson’s disease, bronchodilators for asthma, progestin for birth control or abnormal menstrual bleeding, sedatives, and tricyclic antidepressants.

• A sensation of food being stuck behind the breastbone (sternum).
• Burning pain (heartburn) behind the breastbone which may be increased by eating, bending, stooping or lying down; occurs or worsens at night and is relieved by antacids.
• Feeling of nausea after eating.

• Regurgitation of food or bringing back up of the food.
• Coughing or wheezing.
• Difficulty in swallowing.
• Hiccups.
• Change in voice or hoarseness.
• Sore throat.

• Bleeding.
• Choking.
• Coughing.
• Shortness of Breath.
• Feeling Full After Eating Only A Small Amount.
• Recurrent Vomiting.
• Hoarseness of Voice.
• Loss of Appetite.
• Weight Loss.
• Dysphagia (difficulty swallowing) or Odynophagia (pain with swallowing).

Tests may not be required if the symptoms are mild. For severe and persistent symptoms the following tests are done:

• Esophagogastroduodenoscopy (EGD).
• Barium Swallow.
• Continuous Esophageal pH Monitoring.
• Esophageal Manometry.
• If the stool occult blood test is positive, then it helps in the diagnosis that the bleeding is from irritation in the esophagus, stomach or intestines.

• Making lifestyle changes help a lot in treating the symptoms.
• Avoid foods which are aggravating the symptoms.
• Changes in the sleep routine are also beneficial.
• Avoid drugs/painkillers like aspirin, ibuprofen or naproxen as they cause further irritation. For relieving pain, always take acetaminophen (Tylenol).
• Always take medicines with lots of water.
• When your physician prescribes a new medicine for you, always remember to ask if the new med will cause worsening of your heartburn.
• Over-the-counter antacids can be used after meals and at bedtime, although their effect may not be long lasting. Some of the common side effects of antacids are diarrhea or constipation.
• There are other over-the-counter and prescription drugs for GERD which work more slowly than antacids, but are beneficial in giving longer lasting relief. These are proton pump inhibitors (PPIs) which help in decreasing the production of acid in the stomach. H2 blockers (antagonists) also help in reducing the amount of acid which is released in the stomach.
• Surgery such as anti-reflux operations (fundoplication etc.) can be considered for those patients who have persistent symptoms despite making lifestyle changes and trying all the above mentioned medicines. Symptoms improve after the surgery, but medicines may still be required for the heartburn.
• There are also new therapies available for reflux, which can be done through an endoscope.

Prognosis is good as majority of the patients respond well to lifestyle changes and medications. Although there are many patients who require continuing with taking medications in order to control their symptoms.

Complications of Gastroesophageal Reflux Disease (GERD) or Chronic Heartburn Include: Asthma, Barrett’s esophagus, bronchospasm, dental problems, voice hoarseness or chronic cough, esophageal ulcer and stricture, which is a narrowing of the esophagus because of scarring.