Gastroesophageal reflux disease (GERD) is an advanced and chronic form of acid reflux. While acid reflux can dramatically decrease quality of life, GERD treatment is necessary so that there isn’t damage to the esophagus that requires more intensive intervention. Read on to learn what the difference between GERD and acid reflux is, the symptoms of GERD, and when to seek medical intervention.
What Is GERD?
GERD is caused by the same problem that causes heartburn and acid reflux—stomach acid leaks and makes its way back to your esophagus from the stomach, which causes a burning sensation, regurgitation, and other problems.
The esophagus is the tube that connects your throat to the stomach. At the bottom end of the esophagus and the top of the stomach is a muscle called the lower esophageal sphincter (LES). It is a valve, and its job is to close after food enters the stomach so it can be digested. In those with acid reflux and GERD, however, the LES works improperly. Either it flutters open and closed when it should remain closed, or in some cases, the LES can stay “stuck” open. This allows the stomach acid to travel back to the esophagus from the stomach because the valve isn’t working.
The terms GERD and acid reflux are sometimes used interchangeably, but they are two different conditions. Heartburn and acid reflux are more common and not as serious and can often be treated with over-the-counter medications and food and lifestyle changes. However, GERD is considered chronic acid reflux and requires GERD treatment. Chronic acid reflux is defined as having two or more episodes of acid reflux or heartburn per week over several weeks.
Patients should also seek a gastroenterologist consultation if they have been self-treating their acid reflux with over-the-counter medications and remedies, and symptoms are not improving.
What Are the Symptoms of GERD?
The symptoms of GERD are variable and are different from person to person. However, they should be noticeable. The most common symptoms of GERD include:
- Chronic and persistent heartburn
- Regurgitation (food, liquid, and/or stomach acid leaking into the throat)
- Dysphagia (difficulty swallowing)
- Feeling as if there is a “lump” in the throat
GERD can also cause other symptoms, such as:
- Chest pain
- Chronic cough
- Disrupted sleep
- New onset of asthma or worsening asthma
- Hoarseness and/or laryngitis
- Bad breath
- Dry cough
If you have chronic acid reflux comorbid with some of these symptoms, you should seek a gastroenterologist to treat GERD. Without treatment, stomach acid can heavily damage the esophagus, which could lead to conditions such as Barrett’s esophagus, a precursor to esophageal cancer. The amount of acid leaking into the esophagus can vary, but it still requires GERD treatment.
What Causes GERD?
The precise cause of GERD is chronic acid reflux caused by a poorly functioning lower esophageal sphincter. The constant backwash of stomach acid into the esophagus not only causes discomfort and affects quality of life, but the acid can damage the esophagus over time, causing inflammation.
Risk Factors for GERD
While the cause of GERD is clear, many risk factors can contribute to the development of GERD. Some of these factors you can change, such as avoiding foods that trigger GERD. Other risk factors you can’t change, but it’s important to know what they are if you have a predisposition to develop acid reflux.
Some risk factors of GERD that relate to existing medical conditions include:
- Delayed gastric (stomach) emptying
- Hiatal hernia (when the stomach pushes into the diaphragm)
- Scleroderma and other connective tissue conditions
When it comes to lifestyle habits, certain things can trigger GERD. These include:
- Drinking alcohol
- Drinking coffee
- Eating large meals
- Eating too late at night
- Eating and immediately lying down
- Eating fatty and fried foods
- Taking some medications, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
Those of all ages can develop GERD, but it is more common after age 40. It’s estimated that up to 20 percent of the US population is affected by chronic acid reflux and GERD.
When Should You Speak to a Doctor About GERD?
GERD is often accompanied by chest pain, which may even warrant an emergency visit. If your chest pain is combined with shortness of breath, arm pain, or jaw pain. These are all symptoms of a heart attack.
However, most cases of acid reflux that feel like chest pain simply need GERD treatment and a diagnosis. If you’re experiencing chronic acid reflux (more than twice a week) and OTC medications are not helping, you should also speak to a doctor.
Your physician will diagnose GERD in one or more of the following:
- Upper GI endoscopy. During this diagnostic, you will be given light sedation, and a long, flexible tube is inserted into your mouth and down through the esophagus. There is a tiny camera at the end that allows your gastroenterologist to see the condition of your esophagus.
- Esophageal manometry. This test looks at the muscle contractions in the esophagus as you swallow. It can measure esophageal muscle contractions, force, and coordination of the muscles.
- X-rays. You may be asked to swallow a barium pill or drink a liquid. These substances “light up” your esophagus on X-ray so your physician can get a better look.
If you receive a diagnosis of GERD, your provider will next look at treatment.
If OTC medications, such as proton pump inhibitors (PPIs) and H-2 receptor blockers, have not helped your GERD, your physician may then try prescription-strength PPIs or H2 blockers, both of which reduce or affect the stomach acid to relieve symptoms. However, taking PPIs in the long term can cause unwanted side effects, such as a higher risk of hip fracture.
Surgery for GERD as GERD treatment is reserved for the most severe of cases and includes procedures such as:
- A LINX device. A ring of beads is inserted into the esophagus to allow food and liquid to pass but prevent the backwash of stomach acid.
- Fundoplication. Using laparoscopy, your physician wraps the top of the stomach around the LES to prevent stomach acid from leaking through.
- Transoral incisionless fundoplication (TIF). This is a relatively new procedure where the LES is wrapped and tightened by fasteners to limit the escape of stomach acid.
Depending upon your case, your doctor may recommend clinical trials, if you are interested in experimental treatments. The National Institute of Diabetes and Digestive and Kidney Diseases often has clinical trials to opt into.