GERD (Gastroesophageal Reflux Disease)

January 2000

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by Charles H. Booras, MD

 

What is it and what are its risks?

Gastroesophageal reflux disease (also called GERD) is the medical term for chronic heartburn. GERD occurs when a small valve (the lower esophageal sphincter) between the stomach and esophagus leaks, causing digestive fluids, bile and stomach acid to ‘back up" from the stomach into the esophagus.

As many as 10 percent of Americans have episodes of heartburn every day, and 44 percent have symptoms at least once a month. In all, GERD affects an estimated 25 to 35 percent of the U.S. population.

Esophagitis (inflammation of the esophagus), a complication of GERD, tends to become a recurring, chronic condition. Other complications of GERD include strictures (narrowing of the esophagus due to scar tissue), ulceration and Barrett's esophagus (a severe, chronic inflammation of the lower esophagus). Patients with Barrett's esophagus have a greater risk of developing esophageal cancer (even though the overall risk remains quite low). Younger age at onset of GERD and longer duration of symptoms seem to increase the risk of esophageal cancer.

The contribution of hiatal hernia to GERD is another source of controversy. Although the incidence of prolonged reflux appears to be increased with hiatal hernia, patients may have a hiatal hernia without reflux or reflux without a hiatal hernia.

What are the common signs of GERD?

Frequent heartburn is the most common symptom of GERD and often occurs after meals. Heartburn is a pain in the middle of your chest. It is often described as an uncomfortable, rising, burning sensation behind the breastbone. Sometimes the pain can be so strong that you think you're having a heart attack. GERD is the most common cause of non-cardiac chest pain (pain that is not found to be originating from the heart).

Other major symptoms of GERD include; regurgitation of gastric acid into the mouth; difficult and/or painful swallowing; nausea; cough, and worsening of asthma.

GERD can cause other signs, too.

You can have GERD without even having heartburn. It can cause throat problems like a sore throat or a lump in your throat or feeling like you always have to clear your throat. GERD can also cause hoarseness or a burning feeling in your mouth. You might be more hoarse when you first get up in the morning (the acidic juices and bile from your stomach can more freely flow up the esophagus and into your throat when you are lying down). You may feel like food is sticking in your throat. GERD may also make you feel like you're choking or that your throat is tight. A dry cough is another sign. GERD can also cause bad breath and even a pain in your ears.

Diagnostics

If you have bad heartburn and acid backing up into your esophagus, you probably have GERD. Many times, doctors can be fairly certain a person has GERD just by symptoms alone.

Our simplest test is a diagnostic trial of a high-dose proton pump inhibitor (Prilosec®, Prevacid®, or Aciphex®) for two weeks. Other tests, like an "upper GI" x-ray or Endoscopy, are used when the diagnosis is in doubt or complications (such as weight loss) are a concern. Both tests have limitations in their diagnostic accuracy, thus we mainly use them to see if your esophagus is ulcerated or narrowed by scar tissue and also to rule out cancer of the esophagus.

see also GERD Lifestyle Modifications and Treatment

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