GERD (Acid Reflux): What Is It, Causes, Symptoms and Treatment

What is GERD?

Gastroesophageal reflux disease (GERD) is a long-term and more severe form of acid reflux. GERD develops when stomach acid flows back into the tube which connects your mouth and stomach (oesophagus). This backflow (acid reflux) can inflame the lining of your oesophagus. This process is also called acid regurgitation or gastroesophageal reflux. However, if the backflow of stomach acid into the oesophagus appears frequently, it results in gastroesophageal reflux disease. Most individuals can control their symptoms with medication or lifestyle alterations.

The prevalence of GERD varies between 10-20 % in Europe and US. GERD prevalence ranges from 7.6 to 30%in India. However, It is <10% in most population studies.

This article reviews the symptoms, causes and treatment of GERD.

Negligence in seeking doctors’ help in time for medical treatment can lead to doctors under-diagnosing and under-treating GERD, resulting in poor symptom control, loss of productivity, decreased quality of life, and an increased risk of complications in affected patients.

Who are at risk for GERD?

GERD can affect anyone. You are more prone to GERD if you

• are overweight or have obesity
• are pregnant 
• take certain medicines
• smoke or subjected to passive smoking

Causes of GERD

Typically, in digestion, the lower oesophageal sphincter (LES) enables food to reach your stomach. Then, LES closes to prevent food and stomach acid from flowing back into your oesophagus. However, if your lower oesophageal sphincter weakens or opens when it should not. It makes stomach contents move up into the oesophagus. LES dysfunction leads to GERD. However, many people have GERD once in a while.

The following factors could impact the lower oesophagal sphincter and cause GERD

• A person who is overweight or obese
• Being pregnant
• Smoking or being exposed to secondhand smoke.

Some medicines can cause GERD or make GERD symptoms worse. Examples include

• Sedatives or tranquillisers include benzodiazepines such as diazepam (Valium) and temazepam (Restoril).
• Calcium channel blockers, statins, angiotensin-converting enzyme (ACE) inhibitors, and nitrates treat high blood pressure and heart disease.
• Certain asthma medicines – Theophylline (Elixophyllin, Theochron)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Tricyclic antidepressants (amitriptyline, doxepin, others)
• Anticholinergics, such as oxybutynin (Ditropan XL), prescribed for overactive bladder and irritable bowel syndrome

A hiatal hernia is a health issue in which the upper portion of the stomach pushes through the diaphragm opening. The muscular diaphragm helps with breathing and has a tiny opening called a hiatus. Through hiatus, the oesophagus (food pipe) passes before joining with the stomach. The joining is referred to as the gastroesophageal junction (GEJ). In a hiatal hernia, the stomach squeezes through the opening of the diaphragm and into the chest, along with the lower oesophagal sphincter (LES). This relaxation of the LES can allow gastric content and acid to back up into the oesophagus and is the leading cause of gastroesophageal reflux disease (GERD). While small hiatal hernias are often asymptomatic and can typically be managed medically, large hiatal hernias often require surgery.

Symptoms of GERD (acid reflux)

The cardinal symptom of GERD is acid reflux. Acid reflux can result in a burning sensation in the upper and mid-chest, possibly involving the neck and throat. Heartburn is a common name for such an experience.

If you experience acid reflux, you may experience a sour or bitter taste in the back of your mouth. Acid reflux may also be responsible for your stomach to regurgitate food or fluids into your mouth.

GERD has different impacts on different people. The most frequent symptoms are

• Heartburn – the burning sensation in the chest
• Food regurgitates back into your mouth from the oesophagus
• Coughing
• Pain in Chest
• Trouble swallowing
• Vomiting
• Sore throat and hoarseness.

Similar symptoms of GERD are observed in infants and children. They are:

• Minor, recurrent vomiting episodes.
• Babies and infants cry uncontrollably, not wanting to eat.
• Difficulty in breathing.
• The frequent sour taste of acid, especially when lying down.
• Hoarse throat
• The child may wake up due to the feeling of choking.
• Halitosis – a medical term for bad breath.
• Infants have difficulty sleeping, especially after eating.

Treatment for GERD

GERD is a persistent health condition that requires long-term treatment. Doctors opt for medications and lifestyle alterations to treat GERD. If symptoms persist, doctors may recommend surgery.

Here are some lifestyle modifications that can provide relief from GERD-

• If you are overweight, try maintaining a healthy weight. 
• Give up smoking if you smoke
• Eat small, lighter meals in the evening.
• Avoid sleeping just after having a meal.
• Place your head at a height (6-8 inches high) on the bed by putting a pillow under your head while sleeping. Doing so avoids the backflow of food into your mouth.

Medicines for GERD

Your healthcare provider might also advise some over-the-counter (OTC) medications like those mentioned below. All of these medicines can cause side effects, so talk with your healthcare provider about which option is the best for you.

1. Antacids

Antacids aid in neutralising stomach acid. Antacids like Tums (calcium-carbonate antacid) relieve mild symptoms of GERD. But taking antacids almost daily means you may need more effective medication.

2. H2 receptor blockers

H2 blockers, or Histamine H-2 blockers, do not work as instantly as antacids. However, they give longer relief and may reduce stomach acid production for 12 hours. It’s essential to remember that one form of H2 blocker, ranitidine (also known as Zantac), was recently discontinued by the FDA for containing the carcinogen N-Nitrosodimethylamine (NDMA).

3. Proton pump inhibitors (PPIs)

PPIs are stronger acid blockers and work more efficiently than H-2 blockers. PPIs are more effective at healing the oesophagal lining, which can become damaged when a person has GERD for a long time.

If you begin taking a nonprescription GERD drug, notify your doctor.

Read more – How to Pick the Best Acidity Medicine

Surgery and other clinical procedures

If your body is not responding well to the long-term medication prescribed for GERD, your healthcare provider may recommend some surgical procedures. Here are some surgical procedures mentioned briefly: 

1. Fundoplication

Fundoplication is a laparoscopic procedure (less invasive). In this procedure, the upper portion of your stomach is wrapped around the lower oesophagal sphincter (LES) to tighten the muscle and prevent the backward flow of food or liquid from the stomach into the oesophagus. Two types of fundoplication are commonly used namely – Nissen fundoplication and Toupet fundoplication. Your surgeon will advise you on the appropriate procedure. 

2. LINX device

The LINX device implantation is also a less invasive surgery. A ring of magnetic beads is enclosed around the joining of the stomach and oesophagus. The magnetic attraction between the beads is powerful enough to keep the joining closed to refluxing acid but weak enough to enable food to pass through. 

3. Transoral incisionless fundoplication (TIF)

A new procedure is applied using an endoscope and needs no surgical incision. In this procedure, the fundus (a unique tissue at the top of your stomach) is folded around the area between your stomach and oesophagus in a tube using polypropylene fasteners that remain in the body. Its advantages include a low rate of complication, quick recovery and high tolerance.

Conclusion

Lifestyle changes like eating small meals and not sleeping immediately after meals can relieve occasional acid refluxes. However, Each one of us may experience occasional heartburn. Over-the-counter antacids also help treat these sporadic occurrences. But if you experience heartburn more than two times a week and minor lifestyle modifications don’t seem beneficial, it indicates GERD.

Once you have been diagnosed with GERD, your doctor may prescribe OTC medication, prescription medicines, or even recommend surgery based on the severity of the condition and what works for you.

To know more about managing Gastroesophageal reflux disease, upload a previous prescription and book an appointment with our medical experts on Truemeds through an app or website. Truemeds is an online pharmacy that provides the highest-quality medications at the lowest prices. Online pharmacy, Truemeds, provides all varieties of drugs, including branded, over-the-counter, and nutritional supplements and generic medicines online at an affordable price. You can save on every purchase (up to 72%) of medicines, and it is free delivered to your doorstep across India. 

Frequently Asked Questions

Disclaimer: This content, including advice and medications, provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your doctor for more details.

References:

• Symptoms & Causes of GER & GERD | NIDDK (nih.gov)
• Long-term management of gastroesophageal reflux disease with pantoprazole – PMC (nih.gov)
• A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry: a case report – PMC (nih.gov)