One of the most common symptoms of GERD is heartburn, although this does not occur in all cases.
Heartburn is often described as a burning sensation. It usually develops in your upper abdomen or chest, just below the breastbone. Severe heartburn can sometimes feel like a heart attack, but chest pain caused by GERD usually feels worse when bending over, lying down and after eating. If you are not sure it is important to seek medical help.
Acid reflux is the regurgitation of stomach acid into the throat and mouth. It usually leaves a sour taste in the back of the mouth and/or throat.
Problems swallowing (dysphagia) is less common than heartburn and acid reflux but nonetheless is present in nearly a third of all GERD cases. It occurs when acid reflux damages the esophagus causing narrowing.
Less common symptoms include:
- sore throat/ laryngitis (inflammation of the voice box – larynx)
- a chronic cough – worse at night
- nausea and/or vomiting
- tooth decay – due to acid.
Most people with GERD will not develop any complications. However, in some cases, long-term GERD can lead to several possible complications and these include:
Scarring and narrowing of the esophagus
This is an uncommon complication of GERD, but having chronic acid reflux means that the lining of your oesophagus is continuously being damaged. This may result in scar tissue developing, eventually causing narrowing of the esophagus – known as an oesophageal stricture.
Constant irritation of the oesophagus can cause ulcers to develop. They can potentially be painful and cause difficulty swallowing, they may also bleed. Ulcers usually disappear once the other symptoms associated with GERD – like acid reflux – are under control.
Chronic bouts of GERD can cause abnormal cell growth in the lower section of the esophagus. This change in cells increases the risk of developing esophageal cancer.
Causes of GERD
There is a circular ring of muscle called a sphincter at the bottom of your esophagus. When the sphincter is working correctly, it acts as a valve which opens to allow food into your stomach and closes to prevent it from travelling back up the esophagus. GERD occurs when the sphincter is not working correctly, allowing stomach acid to leak into the esophagus. In most cases, it is not known what the cause of a weakened sphincter is, however, experts have identified a number of risk factors:
Smoking or second-hand smoke
There are certain chemicals in cigarettes that can cause the sphincter to relax.
Extra weight can put pressure on the sphincter, weakening it.
Certain food & drinks
Some foods are said to weaken the sphincter, it may differ from person to person, but foods that are said to increase the risk and make symptoms worse are: coffee, alcohol, hot drinks, chocolate, peppermint, spicy food and tomatoes.
Some medication can cause the sphincter to relax, including nitrates (used to treat angina) and calcium channel blockers (used to treat high blood pressure). Additionally, antihistamines, antidepressants, sedatives and non-steroidal anti-inflammatory medication (NSAIDs) e.g. ibuprofen, are said to increase the risk of developing esophagitis – inflammation of the lining of the esophagus caused by leaking stomach acid.
Usually, your doctor will confirm a diagnosis by asking about your symptoms – symptoms associated with GERD tend to be typical. However, if symptoms are severe, do not improve with treatment or your doctor suspects that symptoms are not typical of GERD, it is likely that you will be referred and sent for further testing. Doctors will then advice on an endoscopy, where your insides are examined with the use of an endoscope – a thin telescope-like instrument. Other tests may include but are not limited to a chest X-ray, barium swallow, manometry and a heart tracing to rule out other conditions.
The treatment method of GERD depends on the severity of the condition. If the condition is mild, then you may be advised to adapt your lifestyle, which can help to reduce symptoms. However, if you suffer from severe, chronic GERD, a surgical approach may have to be taken.
While there is not a great deal of research on the link between GERD and lifestyle factors, small changes have been proven to improve symptoms, which is why it is often the first approach taken by doctors. You may be told to:
- stop smoking as this exacerbates symptoms.
- lose weight if you are over weight. This will reduce pressure that excess weight may cause.
- eat slower and smaller meals.
- remove food and drinks from your diet that may cause irritation – coffee, alcohol, tomatoes, spicy food and fatty foods.
- try to stay upright as much as possible.
- ensure that you do not go to bed on a full stomach, you can achieve this by leaving three hours after you eat and two hours after you drink before going to bed.
These are over-the-counter medication and come in liquid or tablet form. The alkaline in the antacids neutralises the stomach acid, making it less corrosive. This reduces any pain associated with acid reflux. If you are taking any tablets, it is important to check with a health care professional before taking antacids, as they can interfere with other medication.
Medication that suppresses acid
If antacids prove unsuccessful, then it is likely your doctor will prescribe acid-suppressing medication. This will be either histamine receptor blockers (H2 blockers) or proton pump inhibitors (PPIs). Although both suppress acid, they do so in different ways. PPIs works better than H2 blockers and doctors often recommend these first.
Prokinetics are sometimes used if another medication has not worked. They are taken as a short-term dose and work by speeding up the process that empties the stomach, leaving less acid to cause irritation.
If all methods of treatment have proven unsuccessful, then surgery may be offered as a treatment for GERD. It may also be recommended if GERD symptoms are persistent and you want a long-term solution other than medication.