What Is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, or “GERD” for short, is when the stomach contents backflows into the gullet, causing pain and other problems. There are several different causes, meaning that there are also various treatment options. As well as causing problems with body function, research shows that GERD also reduces the quality of life of those who suffer from it. For example, it can lead to sleep disturbance.

What Is “Gastro” and “Esophageal”?

Gastro is a word that refers to the stomach (also gastric). Esophageal refers to the esophagus, which is your gullet. This is the muscular tube that connects your mouth to your stomach and is what food passes down when you swallow. There are valves at the end of the esophagus. The top valve mostly protects your windpipe (so that food doesn’t go into your lungs). The bottom valve works to stop stomach contents backflowing into the esophagus.

What Is Reflux?

The stomach is an acidic environment, so that food can be digested. Gastroesophageal reflux is when the acidic stomach contents backflows up and into the esophagus. The stomach lining is protected against this acid, in a way that the esophagus is not. Therefore, acid “escaping” in the form of reflux can irritate the esophagus, resulting in damage to the esophagus lining.

What Are the Symptoms of GERD?

GERD symptoms are categorized into two groups:

• Typical symptoms: These include heartburn, regurgitation, and chest pain (not related to heart problems).
• Atypical or extra-esophageal: These include asthma and cough, voice problems and a sore throat, and tooth damage. These symptoms result from irritation or damage by the acid.

What Causes GERD?

There are many different causes of GERD. It is also noted that being obese can combine with other problems, to make GERD more likely.

• Hiatal hernia: This is when weakness in the diaphragm muscle that sits above the stomach allows the stomach to bulge up and through the muscle. The stomach is “squeezed”, and the contents can backflow up the esophagus.
• Esophageal motor disorders: This refers to a variety of problems with movement of food through the esophagus and down into the stomach. These problems can result in reflux. You can find out more information on these disorders in this The Waiting Room blog post.
• Impaired acid clearance: Problems in clearing acid once it is in the esophagus, meaning the acid has a longer time to cause irritation.
• Problems with the esophageal lining and immune processes are also thought to contribute towards the development of GERD.

How Is GERD Diagnosed?

• Clinical evaluation: Information from the patient about their symptoms and their other health concerns can help draw the conclusion that GERD is present.
• Endoscopy: This involves looking inside and down the esophagus with a tiny camera on a thin, bendy tube. Medicine is given for sedation and comfort. Pictures can be taken, and also sometimes samples or swabs of the esophagus lining for laboratory testing.
• Functional tests: The main ones are called pH impedance monitoring and esophageal manometry.

How Are Functional Tests Carried Out?

pH impedance monitoring tests the levels of acid. “pH” is a measurement of how acidic something is. A tiny tube is passed through the nose and down to the stomach. This is painless. The tube stays in position for up to 24 hours and measures acid levels up and down its length. The measurements are sent to a computer and compared to measurements from research studies, so that the level of acid can be correctly assessed.

Esophageal manometry also uses a tiny tube passed through the nose, to measure inside the esophagus and down to the stomach. It measures pressure changes during swallowing and takes about half an hour. It can give information about movement through the esophagus, and muscle and valve control.

What Types of GERD Are There?

GERD is categorized by whether there is damage to the mucus lining of the esophagus.

Non-erosive reflux disease (known as NERD) is reflux without mucosal damage. Acid presence is measured using the above-mentioned pH impedance test. This test is important for diagnosing NERD, since the main feature is acid, rather than mucosal damage.

Erosive esophagitis (known as EE) is reflux with mucosal damage. This is best seen and diagnosed with an endoscopy test.

Are There Further Complications of GERD?

If GERD is not treated, the irritation to the esophagus can result in stricture, blockage, or cancer. Therefore, to avoid these long-term problems, it is important to monitor the condition and treat it correctly.

How Is GERD Treated?

Lifestyle changes are important for reducing GERD. A special diet and weight loss help.

Medicines can also be used. These work by suppressing acid, and can help up to 7 out of 10 patients.

Surgery can be carried out to repair hernias or strengthen or repair the stomach valve.

What Should You Do If You Have Symptoms of GERD?

If you are concerned about your health in any way, you should speak to a healthcare professional. They will complete a personalized assessment and provide you individual advice and treatment. If you experience heartburn, chest pain or other discomfort, it is important to seek help quickly, in case your symptoms are caused by an urgent problem not related to gastroesophageal reflux (such as a heart problem).

Note: One of the authors of this paper makes a declaration about lecture fees, consulting fees, and research support received from pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest. For more detail, see the Conflict of Interest Statement at the end of the paper.