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 Gastroesophageal
reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does
not close properly and stomach contents leak back, or reflux, into the
esophagus. The LES is a ring of muscle at the bottom of the esophagus that
acts like a valve between the esophagus and stomach.
Heartburn is a painful or burning sensation in the chest or upper abdomen.
The symptom is similar to heart attack, but actually it has nothing to do with the
heart. Heartburn occurs when refluxed stomach acid touches the lining of the
esophagus. The fluid may even be tasted in the back of the mouth, and this is
called acid indigestion. Occasional heartburn is common but does not
necessarily mean one has GERD. Heartburn that occurs more than twice a week
may be considered GERD.
Sometimes GERD can cause serious complications. Inflammation of the
esophagus from stomach acid may cause bleeding or ulcers. In addition, scars
from tissue damage can narrow the esophagus and make swallowing difficult.
Some people even develop Barrett's esophagus, which
over time can lead to cancer.
Causes
The causes of GERD are not clear. A hiatal hernia may contribute. A hiatal
hernia occurs when the upper part of the stomach is above the diaphragm, the
muscle wall that separates the stomach from the chest. The diaphragm helps the
LES keep acid from coming up into the esophagus. When a hiatal hernia is
present, it is easier for the acid to come up. In this way, a hiatal hernia
can cause reflux. A hiatal hernia can happen in people of any age; many
otherwise healthy people over 50 have a small one.
Other factors that may contribute to GERD include
- alcohol use
- overweight
- pregnancy
- smoking
Also, certain foods can be associated with reflux events, including
- citrus fruits
- chocolate
- drinks with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, like spaghetti sauce, chili, and pizza
Symptoms and Diagnosis
The main symptoms for GERD are persistent heartburn and acid
regurgitation. Some people have GERD without heartburn. Instead, they
experience pain in the chest, hoarseness in the morning, or trouble
swallowing. GERD can also cause a dry cough and bad breath.
If the heartburn does not improve with lifestyle
changes or drugs, one of the following procedures may be necessary to look
for abnormalities in the esophagus.
- Barium swallow radiograph. It uses x rays to help spot
abnormalities such as a hiatal hernia and severe inflammation of the
esophagus. With this test, you drink a solution and then x rays are taken.
Mild irritation will not appear on this test, although narrowing of the
esophagus—called stricture—ulcers, hiatal hernia, and other problems
will.
- Upper endoscopy is more accurate than a barium swallow radiograph
and may be performed in a hospital or a doctor's office. The doctor will
spray your throat to numb it and slide down a thin, flexible plastic tube
called an endoscope. A tiny camera in the endoscope allows the doctor to
see the surface of the esophagus and to search for abnormalities. If you
have had moderate to severe symptoms and this procedure reveals injury to
the esophagus, usually no other tests are needed to confirm GERD.
The doctor may use tiny tweezers (forceps) in the endoscope to remove a
small piece of tissue for biopsy. A biopsy viewed under a microscope can
reveal damage caused by acid reflux and rule out other problems if no
infecting organisms or abnormal growths are found.
- Ambulatory pH monitoring examination. The doctor puts a
tiny tube into the esophagus that will stay there for 24 hours. While you
go about your normal activities, it measures when and how much acid comes
up into your esophagus. This test is useful in people with GERD symptoms
but no esophageal damage. The procedure is also helpful in detecting
whether respiratory symptoms, including wheezing and coughing, are
triggered by reflux.
Reference:
National Digestive Diseases Information Clearinghouse, USA.
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