GERD (gastroesophageal reflux disease) is a disease that causes irritation of the esophagus due to the chronic reflux (or return) of gastric acid from the stomach to the esophagus, a condition more commonly referred to as heartburn or acid indigestion.
Normally, gastric acid is confined to the stomach by the lower esophageal sphincter (LES), a cluster of muscles located where the stomach and esophagus meet. When the LES barrier opens too frequently or does not close tightly enough, gastric acid flows upward into the esophagus and heartburn is often the result. People generally experience heartburn as a burning pain that starts at the breastbone and moves upward to the throat.
Prolonged exposure to gastric acid can damage the esophagus. This can sometimes cause complications, such as esophageal inflammation & tissue damage, difficulty swallowing (known as dysphagia), and esophageal cancer. Luckily most people with GERD experience mild symptoms with little risk of more serious conditions. However, it is important to work with your doctor to manage this disease and avoid these complications.
While mild, occasional heartburn is experienced by many people, chronic and persistent heartburn is a primary symptom of GERD. Other signs of GERD include:
- Painful swallowing
- Chronic sore throat
- Bad breath
- Tooth enamel erosion
- Gum inflammation
- Hoarseness and laryngitis
- Dysphagia (difficulty swallowing)
- Waterbrash (a sudden increase in saliva)
- Sour taste in the mouth
Severity of symptoms vary by individual; some people don't exhibit any symptoms and aren't aware they have GERD until other complications begin to occur. Heartburn can also mimic chest pain caused by heart disease, so it is important to have any chest pain evaluated by your physician or other health care provider.
Causes and Risk Factors
GERD does not yet have a known cause, although there are risk factors that can increase your chances of developing the disease. They include:
- Overeating and/or being overweight
- Consuming foods that trigger GERD (citrus, chocolate, and fatty foods are a few examples, but they vary by individual)
- Consuming alcohol or caffeine
- Taking certain medications, such as ibuprofen or aspirin
Your physician will take a complete medical history and discuss your symptoms with you. If GERD is suspected, you will be placed on appropriate medication (generally a proton-pump inhibitor) for a trial period to see if the medication lessens your symptoms. If more extensive testing is necessary to confirm the diagnosis or investigate your symptoms further, your doctor might recommend:
- pH testing to monitor the acid levels of your esophagus
- Upper GI series (also known as a barium swallow)
- Upper endoscopy
- Esophageal manometry
Medications, typically proton-pump inhibitors, are generally effective as a treatment for GERD. It is important to note, however, that there is no cure for this disease and long-term treatment is generally required to control its effects. Instituting lifestyle changes can also be a successful strategy for dealing with GERD, including:
- Avoiding foods that aggravate your condition
- Changing when and how much you eat
- Losing weight
- Quitting smoking
- Avoiding alcohol
Dysphagia refers to difficulty or pain during swallowing. Swallowing is a complicated process that involves numerous muscle and nerve networks, starting with the mouth and tongue and ending as food or liquid passes down the esophagus to the stomach. Although dysphagia often signals a problem with the esophagus, weakness at any point in the swallowing system can cause difficulty or pain.
People with dysphagia can find it challenging to eat or drink, and may have problems getting enough calories, fluid, and nutrients to maintain their weight and health. Another concern is infection, such as aspiration pneumonia, which can occur if food or liquids get stuck in the windpipe and can't be dislodged through coughing. They may eventually enter the lungs and trigger pneumonia or other lung problems.
While it is not uncommon for healthy individuals to have trouble swallowing on rare occasions, dysphagia is characterized by chronic difficulty or pain when swallowing. Symptoms include:
- Not getting food or liquid down on the first try
- Coughing, choking, gagging, or pain when attempting to swallow
- Food or liquids coming back up after swallowing
- Feeling that food or liquids are stuck in the throat
- Heartburn or chest pain unrelated to cardiac conditions
- Weight loss due to insufficient food intake
Symptoms may come and go, increase over time, and vary by individual.
Causes and Risk Factors
Dysphagia can be caused by blockages (something obstructing the normal swallowing pathway) or weaknesses in the swallowing muscles. Blockages can occur due to conditions such as GERD, esophagitis (inflammation of the esophagus), or pharyngeal diverticula (small pouches that develop in the throat and trap food particles). Weakness in the swallowing muscles can result from neurological conditions such as muscular dystrophy, multiple sclerosis, and Parkinson's disease, or through neurological damage from a stroke or injury. The aging process can also weaken swallowing muscles, putting the elderly at increased risk for developing dysphagia. Certain types of cancer, such as esophageal cancer, can trigger dysphagia as well.
Your doctor will take a thorough medical history including information about your specific symptoms and their duration (for example, if you feel as though food is getting stuck, where it feels stuck, and how long you have been experiencing this sensation). He or she may also ask you to take a small drink of water in order to observe the problems you have swallowing. Further tests may be required, such as an esophagoscopy, esophageal muscle test, laryngoscopy, or barium x-ray. These tests can help determine the underlying causes of the dysphagia symptoms.
Treatment will vary depending on the cause of the symptoms. If GERD or other heartburn-related conditions are triggering dysphasia, medication to treat these disorders may be used. Blockages may be removed through endoscopy or surgery in order to clear the esophagus. Dilation is also an option if the dysphagia is linked to a narrowing of the esophagus. Weakness in muscles used for swallowing may be treated through physical therapy and targeted exercise. Other patients may benefit from changes in diet to avoid triggering foods, or from learning new ways to eat and drink. For those rare cases when patients still have trouble swallowing after treatment, it may be necessary to insert a feeding tube to ensure they receive the calories and nutrition they need.
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