What is gastroesophageal reflux disease (GERD)?
For most people, heartburn it’s an occasional displeasure that occurs after overfilling the stomach or enjoying foods with a little too much spice. For others, it gets more severe and comes along with other symptoms associated with acid reflux. Often referred to as Gastroesophageal Reflux Disease, or GERD, acid reflux affects as many as 50% of infants and can occur in adulthood as well.
When you swallow food or drinks, you expect it to travel down to your stomach where your body will break it down and distribute its nutrients throughout your body. That action is controlled by your lower esophageal sphincter (LES), which is a muscle that connects the bottom of the esophagus and the stomach.
When the LES is operating efficiently, it will open as food or liquid enter the esophagus, allowing it to move into the stomach before closing again.
Acid reflux occurs when the LES relaxes or opens when it should remain shut. That allows contents of the stomach to travel back up the esophagus, causing that all too familiar burning sensation in the chest and lower throat. In some cases, stomach contents may reach the mouth and lead to vomiting.
Occasional acid reflux due to overeating or eating certain types of food isn’t a serious medical concern. When it becomes more frequent, it may receive a diagnosis of GERD. The difference is the level of severity and the way the condition is managed over time.
One of the most common symptoms is the familiar burning sensation known as heartburn. You may feel the burn in your chest and into your throat after eating, especially if you lay down immediately after a heavy meal.
Some other common acid reflux symptoms include:
- Stomach pain or discomfort
- Unexplained or frequent vomiting
- Gagging or choking sounds
- Unexplained or frequent cough
- Nighttime coughing
- Wheezing or difficulty breathing
- Chest rattle
- Morning throat soreness
- Sour or acidic taste in mouth
- Repeat colds
When experienced by infants or children, they may cry and get extremely fussy after eating. They may also not eat enough to sustain proper growth, which is why prompt diagnosis and treatment of GERD is important.
In infants, acid reflux is often caused by the LES opening while milk is still digesting due to a weaker or less developed muscle. Most infants will outgrow acid reflux as the muscle strengthens with time. Others may be diagnosed with GERD due to excessive vomiting or difficulties breathing during frequent acid reflux attacks.
For adults, GERD is often caused by overeating or consuming certain types of foods. Foods’s high in fat as well as peppermint and chocolate are known to impact the tone of the LES muscle, stimulating it to remain open too long after the food is consumed.
Foods that increase the acidity of the stomach may also increase the risk of GERD. Think about acidic citrus fruits like oranges and grapefruit and foods that contain a lot of strong spices. Some people may find that they have more heartburn after certain types of food, which gives them an opportunity to control their acid reflux before it requires a GERD diagnosis and treatment.
Who gets GERD?
Most people will experience heartburn at some point, but not everyone will develop GERD and require medical intervention. GERD is common in newborns as well as adults over the age of 40. It’s also common for some women to experience acid reflux possibly to the extent of GERD during pregnancy. Obesity is also a contributing factor for many people.
Why is GERD of concern?
GERD symptoms range from mild to extremely uncomfortable and even painful. They can interfere with daily life by making it more difficult to enjoy food and focus on daily activities due to discomfort.
If content from the stomach continuously leaks into the windpipe, it can potentially lead to any of the following complications:
- Sudden infant death syndrome
When the esophagus is routinely in contact with acidic stomach acid, it can cause ulcers, which in turn may lead to bleeding and possibly anemia. Some people may also develop esophagitis, which is inflammation in the esophagus due to exposure to stomach acid. That inflammation can lead to further complications, like abnormal cells in the lining of the esophagus and narrowing or stricture of the esophagus.
The longer GERD symptoms go untreated, the greater the risk for complications. It’s important to have all possible acid reflux causes explored with a medical professional to lower that risk.
How is GERD diagnosed?
Depending on the symptoms and patient’s medical history, your doctor will conduct an evaluation or order one or more of the following before determining if GERD is the accurate diagnosis:
- Upper gastrointestinal (GI) series
- Chest x-ray
- pH Testing
- Esophageal manometric studies
- Gastric emptying studies
Mild to moderate GERD symptoms are often treated through lifestyle changes, including but not limited to the following options:
- Eliminating or reducing consumption of foods known to cause acid reflux symptoms
- Consuming smaller meals so that the stomach isn’t overfilled
- Not lying down for at least two hours after meals to avoid acid reflux symptoms
- Increasing activity levels and exercising while watching food portions to lose weight
- Adjusting feeding and burping schedules and bottle position for newborns
- Identifying any medications that may cause acid reflux as a side effect
When lifestyle changes don’t help, other GERD treatment options may include:
- Prescription medication
- Calorie supplementation for newborns struggling to consume adequate amounts of milk
- Tube feedings
How do we decide if surgery is needed?
Surgery is the last resort for GERD treatment. Medical providers must first determine that there are no other adequate treatment options. In most cases, surgery is recommended when one or more of the following become concerns:
- Slow growth in children with severe GERD symptoms
- Frequent breathing problems
- Severe irritation of the esophagus that may cause complications
What can I expect from surgery?
Most GERD surgeries are now performed laparoscopically, which is a less invasive procedure that avoids a large incision and minimizes pain and recovery times. Small incisions on the abdomen are used to insert a thin tube holding a camera and the required surgical tools. The surgeon watches a video monitor to guide the instruments throughout the surgery.