Introduction

Gastro-oesophageal reflux disease, also known as Gerd or GORD, is a prevalent condition where stomach acid flows back into the oesophagus, causing discomfort and unpleasant symptoms. The condition often arises from a weakened muscle at the bottom of the oesophagus and can lead to heartburn and an unpleasant taste in the mouth. While it can be a minor inconvenience for some, others may suffer from severe, long-term effects. There are many measures and medications available to manage GERD, and in some cases, surgical intervention may be necessary.¹ Let us further explore the causes, symptoms, and treatment options for GERD.

Signs and Symptoms of GERD 

Here are some signs and symptoms of gastro-oesophageal reflux disease:

Signs of GERD:

• Oesophagitis
• Bad breath
• Bloating
• Pain when swallowing or difficulty swallowing

Symptoms of GERD:

• Heartburn (occurs frequently after eating)
• Acid reflux (when stomach acid returns to your mouth, causing an unpleasant, sour taste)
• Feeling or being sick
• Persistent cough
• Chest pain
• Nausea
• Pain while swallowing
• Loss of appetite
• Persistent vomiting
• Bleeding in the digestive tract, such as vomit that contains blood or looks like coffee grounds, stool that contains blood. 
• Unexplained weight loss.^1,2

When to See a Doctor

It is advisable to seek medical attention from your healthcare provider if:

• You are worried about your symptoms.
• You are experiencing symptoms several times a week.
• If medications are not helping.
• Your symptoms are severe.
• You have difficulty swallowing.
• You are displaying possible signs of a more serious problem such as persistent vomiting, vomiting blood, or unexplained weight loss.¹

Causes of GERD

Gastroesophageal reflux disease (GERD) can occur when the lower oesophageal sphincter weakens or relaxes at inappropriate times. Certain factors that may cause the lower oesophageal sphincter to malfunction and lead to GERD include: 

• Being overweight or obese
• Smoking
• Pregnancy
• Certain medications such as benzodiazepines, calcium channel blockers, asthma medications, NSAIDs, and tricyclic antidepressants can cause GERD or exacerbate GERD symptoms.
• Hiatal hernia may also increase the likelihood of developing GERD or worsen GERD symptoms. ²

Risk Factors for GERD

GERD (Gastroesophageal Reflux Disease) has both non-modifiable and modifiable risk factors that can lead to its symptoms. Here are some factors that can contribute to GERD:

Non-modifiable factors:

• Age: Age is a risk factor for GERD symptoms in adults. People aged over 50 have a 30% higher risk of GERD symptoms than younger respondents.
• Sex: Gender may also play a role, with some studies suggesting that women are more likely to develop GERD, while men are more likely to develop reflux oesophagitis.
• Genetic factors: Genetic factors may also contribute to the development of GERD, with twin studies indicating that genetic factors account for 31% to 43% of cases. ^3,11

Modifiable factors:

• Obesity: Excessive body weight (obesity) can increase the risk of GERD symptoms.
• Alcohol consumption: Moderate to high alcohol consumption and smoking are also risk factors for GERD.
• Postprandial activity: Symptoms of GERD can be triggered by vigorous physical activity after a meal, also known as postprandial activity.
• Lack of physical activity: A lack of regular physical activity can also increase the risk of GERD
• Foods: Certain foods, including fatty, greasy, sour, and spicy foods/products, orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, and carbonated beverages, may aggravate GERD symptoms.
• Eating habits: Eating habits such as irregular meal patterns, consuming large meal volumes, and eating meals just before bedtime may also be associated with GERD symptoms.

It’s crucial to identify modifiable risk factors for GERD to prevent and manage its symptoms effectively through dietary interventions.³

Diagnosis of GERD

Diagnosis of GERD can involve the following steps:

• Physical examination and medical history review
• Patient describes their symptoms and medical history
• Treatment without diagnostic tests may be initiated if typical GERD symptoms are present, such as heartburn and regurgitation.

Diagnostic tests may be performed if:

• Symptoms are atypical
• Reflux severity raises concerns about oesophageal damage
• Symptoms fail to respond to initial treatment
• Anti-reflux surgery is being considered

Diagnostic procedures for GERD may include:

• Upper endoscopy: This is a procedure used to examine the oesophagus, stomach, and small intestine.
• Reflux testing: Reflux testing or 24-hour pH impedance is used to evaluate reflux activity.
• Oesophageal pH monitoring: This includes catheter or capsule monitoring, which is the most accurate diagnostic method to detect stomach acid in the oesophagus. It helps doctors to confirm GERD diagnosis, assess treatment effectiveness, and study the relationship between diet, sleep, and symptoms in relation to acid reflux.
• Oesophageal manometry: These tests are done to make sure symptoms are not caused by other conditions and to evaluate muscle contractions and the function of the lower oesophageal sphincter in GERD.
• Barium esophagram: It is an X-ray study performed to detect abnormalities and evaluate oesophageal motor function

Diagnostic tests are necessary to evaluate the complications and rule out other serious conditions.^4,5

Treatment of GERD

Treatment for GERD may include the following:

Lifestyle changes and it includes:

• Eating smaller and more frequent meals
• Avoiding trigger foods like coffee, chocolate, tomatoes, alcohol, fatty or spicy food
• Not wearing tight clothing
• Raising the head of your bed by up to 20cm
• Trying to relax
• Maintaining a healthy weight
• Stop smoking
• Check with your healthcare provider about medications and their impact on symptoms.

Medications

GERD can be treated with medicines but it’s important to talk to your doctor first. Some of the medications may include:

• Antacids can be used to relieve mild symptoms but should not be used every day or for severe symptoms without discussing it with your doctor. They may cause side effects like diarrhoea or constipation.
• H2 blockers and PPIs (Proton pump inhibitors): They both may lower the amount of acid your stomach makes. H2 blockers may help provide relief to the oesophagus, but PPIs may be better at treating GERD symptoms and may give relief to the oesophageal lining.
• However, it is important to note that PPIs may have side effects like headache, diarrhoea, and upset in stomach. Talk to your doctor about the risks and benefits of taking PPIs.
• If antacids, H2 blockers, and PPIs don’t improve symptoms, your healthcare provider may recommend other medicines.

Surgery 

Surgery is recommended if other treatments have not been effective or if you wish to stop taking long-term medications. Here are some surgical treatments for GERD:

• Fundoplication: This is the most common surgery for GERD. During this surgery, a surgeon sews the top of your stomach around the end of your oesophagus to add pressure to the lower oesophageal sphincter and prevent reflux. This surgery can be performed using either laparoscopic or open techniques.

• Bariatric surgery: If you have GERD and obesity, weight-loss surgery may be recommended. Gastric bypass surgery is the most common type of weight-loss surgery for GERD. This surgery can help you lose weight and reduce GERD symptoms.

• Endoscopy: In some cases, doctors may recommend endoscopic procedures to treat GERD. During these procedures, doctors use an endoscope to sew the top of your stomach around the lower oesophageal sphincter or to deliver radiofrequency energy to the sphincter. However, these procedures are not used very often.^1,6

Prevention of GERD

• Keep a healthy weight: Maintaining a healthy weight may be a good step to prevent GERD (Obesity increases abdominal pressure and makes reflux worse).
• Avoid trigger foods and medications:  Avoiding trigger foods such as fatty and fried foods, carbonated beverages, garlic and onions, chocolate, peppermint, and spearmint, acidic vegetables including tomatoes and tomato sauces, citrus fruits, and certain medications like muscle relaxers and blood pressure medications.
• Eating habits: Eat smaller, more frequent meals, and drink smaller amounts of water throughout the day to avoid putting pressure on the LES. Chewing gum can also help neutralize stomach acid.
• Lying down right after a meal: Wait at least 2-3 hours after eating before lying down or bending over. Take a walk after meals and avoid bedtime snacks.
• Head elevation: Elevate your head and torso while sleeping to help gravity keep stomach contents down. Use a foam wedge or wooden blocks to raise the head of your bed.
• Quit smoking and avoid alcohol: Smoking and drinking alcohol may weaken the lower oesophageal sphincter and increase stomach acid production.
• Clothing: Wear loose-fitting clothes (avoid pressure on your stomach).
• Notice your symptoms: Keep a record of your symptoms to help your doctor to understand your condition.
• Relaxation: Practice stress-reducing techniques like visualization, breathing exercises, or meditation, and get enough sleep and exercise regularly.
• Seek medical treatment: If your symptoms persist make sure you contact your healthcare provider immediately.⁷

Complications of GERD

GERD can lead to various complications, especially if left untreated. Some of the possible complications of GERD include:

• Erosive esophagitis: Stomach acid can damage the lining of the oesophagus, causing erosions or ulcers that may bleed. This condition can be detected through stool tests.
• Oesophageal stricture: Acid damage can cause scarring and narrowing of the oesophagus, leading to a partial blockage that can make it difficult to swallow. This is caused by the formation of scar tissue due to repeated damage.
• Barrett’s oesophagus: GERD can cause the replacement of normal oesophageal cells with a different type of cell, which may increase the risk of developing oesophageal cancer over time. Regular upper endoscopies are recommended for people with this condition to monitor for early signs of cancer.
• Lung and throat problems: Backflow of stomach acid into the throat can cause inflammation of the vocal cords, sore throat, or hoarseness. Inhaling acid into the lungs can lead to pneumonia or asthma symptoms and even permanent lung damage.
• Dental problems: Repeated episodes of acid reflux can damage tooth enamel over time.⁸

Research Facts About GERD

Here are some interesting facts about GERD:

• GERD is a common condition that affects up to 20% of the population in Western countries.
• A study found that being overweight or obese increases the risk of GERD symptoms by up to 51%, and the risk increases with higher body mass index (BMI) values in women.^9,10

FAQ’s

Disclaimer: The information included at this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.

References

1. Gastroesophageal reflux disease [Internet]. [cited 2023 May 15]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord 
2. Symptoms & causes of ger & gerd – niddk [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 15]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes 
3. Taraszewska A. Risk factors for gastroesophageal reflux disease symptoms related to lifestyle and diet. Roczniki Państwowego Zakładu Higieny. 2021;72(1):21-8. Available from: https://pubmed.ncbi.nlm.nih.gov/33882662/#:~:text=Lifestyle%20risk%20factors%20that%20may,lack%20of%20regular%20physical%20activity. 
4. Diagnosis of ger & gerd – niddk [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 15]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/diagnosis 
5. Gastroesophageal reflux disease (GERD) [Internet]. [cited 2023 May 15]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/gastroesophageal-reflux-disease-gerd 
6. Treatment for ger & gerd – niddk [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 15]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment 
7. Tips to prevent reflux disease – Compliments of johns hopkins medicine; [Internet]. [cited 2023 May 15]. Available from: https://www.hopkinsmedicine.org/international/_downloads/JHI130231%20Tipsheet%2010%20tips%20to%20prevent%20Reflux%20Disease-5%20JHMI.pdf 
8. Kahrilas PJ. Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics). Uptodate [consultado Abril 2020] Disponível em: http://www. uptodate. com. 2022 Jun. Available from: https://www.uptodate.com/contents/gastroesophageal-reflux-disease-in-adults-beyond-the-basics 
9. Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/ 
10. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA. Association Between Body Mass Index and Gastroesophageal Reflux Symptoms in Both Normal Weight and Overweight Women. New England Journal of Medicine. 2006 Jun;354(22):2340–8. doi:10.1056/nejmoa054391. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782772/ 
11. Kim SY, Jung HK, Lim J, Kim TO, Choe AR, Tae CH, Shim KN, Moon CM, Kim SE, Jung SA. Gender specific differences in prevalence and risk factors for gastro-esophageal reflux disease. Journal of Korean medical science. 2019 Jun 2;34(21). Available from: https://www.jkms.org/pdf/10.3346/jkms.2019.34.e158