Gastroesophageal reflux disease, or GERD, affects at least an estimated 5% to 7% of the global population—men, women, and children. Although common, GERD often is unrecognized—its symptoms misunderstood. This is unfortunate because GERD is generally a treatable disease. Serious complications can result if it is not treated properly. Persistent heartburn is the most frequent—but not the only—symptom of GERD. (The disease may be present even without apparent symptoms.) Heartburn is so common that it often is not associated with a serious disease, like GERD. All too often, GERD is either self- treated or mistreated.
GERD is a chronic disease. Treatment usually must be maintained on a long-term basis, even after symptoms have been brought under control. Issues of daily living, and compliance with long-term use of medication need to be addressed as well. This can be accomplished through follow-up, support, and education. Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures. It is essential for individuals who suffer persistent heartburn or other chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available.
Gastroesophageal refers to the stomach and the esophagus. Reflux refers to the back-flow of acidic stomach contents into the esophagus. There is no known single cause of GERD. It occurs when the esophageal defenses are overwhelmed by acidic gastric contents that reflux into the esophagus. A band of muscles at the junction of the stomach and esophagus called the lower esophageal sphincter (LES) normally acts, in conjunction with the diaphragm, as a barrier to prevent reflux of stomach contents into the esophagus. If that barrier is relaxed at inappropriate times or is otherwise compromised, reflux occurs.
GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD. GERD is often accompanied by persistent symptoms, such as chronic heartburn and regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed when complications become evident.
Symptoms of GERD vary from person to person. The majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications. Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a "benign" condition.
Heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition and consultation with a physician is advised. Even occasional heartburn—if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing—may signal a more serious condition. People with long standing chronic heartburn are at greater risk for complications including stricture or a potentially pre-cancerous disease that involves a cellular change in the esophagus called Barrett's esophagus.
Chronic heartburn is the most common symptom of GERD. Acid regurgitation (refluxed material into the mouth) is another common symptom. But numerous less common symptoms other than heartburn may be associated with GERD. These may include:
Chest pain may indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation. Possible heart conditions must always be excluded first.
A diagnosis of GERD should be made by a physician. The disease can usually be diagnosed based on the presentation of symptoms alone. GERD can occur, however, with no apparent symptoms. Diagnostic tests may be used to confirm or exclude a diagnosis or to look for complications such as inflammation, stricture, or Barrett's esophagus.
GERD is a recurrent and chronic disease for which long-term medical therapy is usually effective. It is important to recognize that chronic reflux does not resolve itself. There is not yet a cure for GERD. Long-term and appropriate treatment is necessary.
Treatment options include lifestyle modifications, medications, surgery, or a combination of methods. Over-the-counter preparations provide only temporary symptom relief. They do not prevent recurrence of symptoms or allow an injured esophagus to heal. They should not be taken regularly as a substitute for prescription medicines—they may be hiding a more serious condition. If needed regularly, for more than two weeks, consult a physician for a diagnosis and appropriate treatment.
Lifestyle changes involve avoiding certain things that may aggravate symptoms, such as dietary changes or changes in daily routine. Diet does not cause GERD. Nevertheless, gastroesophageal reflux and its most frequent complaint of heartburn can be aggravated by foods. Certain medications can aggravate symptoms. Make sure you tell your physician any medications you are using. Heartburn is a burning sensation in the chest behind the breastbone. If you have this symptom, there are a number of things that you may be doing that cause gastroesophageal reflux and cause you to experience heartburn.
Below is a list of foods to avoid that may trigger GERD
Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that you sleep with your head raised. If these changes do not work, the doctor may prescribe medicine for you. In some cases, you may need surgery.
Antacids may temporarily relieve heartburn by neutralizing stomach acid. Other over-the-counter drugs that reduce acid production are available for short term and occasional relief of heartburn. If heartburn occurs on two or more days per week despite the measures discussed above, you should consult your family doctor.
Remember: The most frequent symptoms of GERD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GERD.