Gastroesophageal reflux disease (GERD):

GERD

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GERD

Overview of GERD
Symptoms of GERD
Heart burn or chest pain which leads to heart attack
How GERD develops
Complications of GERD
When to seek medical care for GERD
Diagnosis of GERD
Living with GERD
GERD in elderly
GERD during pregnancy
GERD in infants and children
How can one prevent heart burn

Overview of GERD

Gastroesophageal reflux is a normal physiological phenomenon experienced intermittently by most people, particularly after a sumptuous meal. Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit. Although highly prevalent in Western countries, where the prevalence of monthly heartburn is about 29–44%,studies had revealed an increase in its frequency in Asian regions caused by the recent globalization, westernization and the associated lifestyle changes.¹ Nonerosive reflux disease (NERD) appears to be the most common type of GERD among Asian patients accounting for 50– 70% of cases.²

Gastroesophageal reflux disease has two distinct entities, the classic severe acid reflux with erosive esophagitis and its complications, and NERD with minimal or no esophagitis.³ Barrett’s esophagus, a subset of the former group has an increased risk of adenocarcinoma. Diagnosis of GERD is usually made on clinical grounds. Endoscopy is reserved for patients with distressing symptoms or in order to detect Barrett’s esophagus. The therapy is aimed at eliminating or reducing the symptoms and improving the quality of life.

Symptom of GERD

Symptoms of GERD

Gastroesophageal reflux disease patients present a variety of symptoms, most commonly heartburn and regurgitation.Less common GERD-associated symptoms include chest pain, a range of ear, nose and throat (ENT)

Heartburn or Chest Pain Which Leads to Heart Attack

Heartburn or chest pain which leads to heart attack

In the USA, more than five million people present to the emergency departments each year with complaints of chest pain.⁴However, many people misunderstand the pain for being a heart attack, when they are only

How GERD develops

Gastroesophageal reflux disease is usually caused by a defect in the relaxation of the lower esophageal sphincter (LES), which consequently allows the stomach contents to reflux into the unprotected lining of the esophagus.

Complications of GERD

Only a minority of patients develops complications of GERD. One complication is the inflammation of the esophagus from stomach acid, which further leads to bleeding and ulcers, a condition called esophageal erosions or esophagitis. Another complication is formation of esophageal strictures––narrowing of the esophagus caused by scar tissue located mainly in the distal esophagus.

In some patients, the normal esophageal lining or epithelium may be replaced with abnormal epithelium, a condition called Barrett’s esophagus, which has been linked to cancer of the esophagus or esophageal adenocarcinoma. Patients with esophageal cancer has a median survival of 2 years and less than 10% of patients survive for 5 years.⁸

Current literature also recognizes pulmonary aspiration, asthma, inflammation of the vocal cords or throat and disturbed sleep as other complications, which may arise from GERD.

When to Seek Medical Care for GERD

Most problems with heartburn are short-term and mild. However, prescription medications and more intensive intervention are needed in the presence of the following:

Heartburn several times a week

Heartburn that causes night awakenings

Difficulty swallowing

Persistence of symptoms even after taking medications

Regurgitation of blood

Weight loss

Diagnosis of GERD

Living with GERD

Many people manage the discomfort of heartburn with simple lifestyle modifications and over-the-counter (OTC) medications. Nevertheless, a 2006 review suggested that evidence for most dietary interventions is only

GERD in Elderly

Although GERD is less symptomatic in older patients, the presentation is much more severe as this group tends to have impaired motility of the esophageal muscles, larger hiatus hernias and is more recumbent. Older patients often have complications including erosive esophagitis, peptic stricture, Barrett’s esophagitis, ENT and pulmonary complications. Endoscopy is indicated in all elderly patients with GERD regardless of symptom severity. Treatment of GERD in elderly patients is the same as in younger groups.

GERD during Pregnancy

Heartburn is a frequent complaint during pregnancy. The cause is possibly owing to hormonal changes. Lifestyle modifications and OTC antacids are generally safe. H₂RBs are considered safe but should only be used under the advice of a clinician. Proton pump inhibitors should be used during pregnancy only if clearly needed.

GERD in Infants and Children

Vomiting is the most common symptom of gastroesophageal reflux in infants. Other coexisting symptoms such as irritability, poor feeding or failure to thrive differentiates GERD from physiologic reflux. Symptoms of GERD in pre-school children include intermittent vomiting, upper abdominal pain, night-time awakening and respiratory symptoms. Older children and adolescents with GERD exhibit symptoms similar to those seen in adults.

As in adults, treatment options for pediatric GERD include lifestyle changes, pharmacological therapy and surgery. Lifestyle changes in infants include alterations in formula composition and infant feeding techniques. In infants and children who remain symptomatic despite dietary and lifestyle modifications, medications specially H₂RBs are recommended.

How can one prevent heartburn?

Many cases of heartburn can be prevented by simple lifestyle modifications in the diet and daily activities similar to those recommended after the problem occur. Such as:

Keep ideal body weight.

Avoid foods and drinks such as tomatoes, citrus fruits, garlic, spicy and oily foods, alcohol, tea and coffee that trigger the problem (a study by Stanford University researchers disputes the effect of coffee, acidic and spicy foods in causing heartburn).⁹

Eat frequent small meals instead of three large meals.

Avoid eating just before exercise.

Stop smoking.

, ibuprofen and other nonsteroidal antiinflammatory drugs.

Avoid lying down for 2–3 hours after eating.

FAQ and Answers for GERD

Health videos relating to GERD

Written by: Healthplus24 team
Date last updated: July 11, 2011

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References

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Goh KL. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview. J Gastroenterol Hepatol. 2004; 19 (Suppl 3): S22–S25.
Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol. 2007; 41(2): 131–137.
Pilotto A, Franceschi M. Gastro-esophageal reflux disease in the elderly. In: Pilotto A, Malfertheiner P, Holt P, eds. Aging and the Gastrointestinal Tract. Interdisciplinary Topics in Gerontology Basel: Karger Press, 2003; 32: 100-117.
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Heartburn/GERD – Causes (2007). Mayoclinic.com.
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