Gastroesophageal reflux disease (GERD) is the abnormal backflow of stomach acid up into the esophagus, the long, muscular tube that connects the back of the mouth to the stomach. The muscle at the border of the esophagus and stomach, called a sphincter, works as a gate that is normally closed to prevent the contents of the stomach from washing up into the esophagus, opening only when you swallow.
Acid reflux occurs when this sphincter or "gate" opens at the wrong time or is too weak, allowing stomach contents to leak back (or reflux) into the esophagus.
The most common symptom people with GERD suffer is heartburn. Heartburn is pain or discomfort, sometimes described as burning, which rises from the stomach up into the chest. The discomfort often occurs after meals but can happen any time during the day, even waking you up at night. Almost everyone may experience heartburn at some time, but frequent or persistent heartburn more than twice a week over several months is the hallmark of GERD.
Approximately 20 to 40 percent of the U.S. population has some symptoms of GERD. An estimated 25 percent of people suffer from heartburn at least once a month, 12 percent at least once a week, and five percent experience heartburn daily.
Other symptoms of GERD in addition to heartburn include:
a sour or bitter liquid coming into the mouth (also known as "regurgitation" or "water brash")
difficulty swallowing or painful swallowing, especially with dry bread or poorly chewed food
chest pain, which may be confused with the pain of a heart attack
hoarseness, sore throat, feeling of fullness in the throat, choking at night and altered voice
lung problems, which might include wheezing, frequent pneumonia, damaged airways or chronic asthma
Infants with GERD may fail to gain weight, may develop more slowly or may have recurrent respiratory problems.
To understand the causes of GERD, it helps to understand the normal protective mechanisms involved in preventing acid from refluxing into the esophagus.
The lower esophageal sphincter, the muscle at the border of the esophagus and stomach that works as a gate and prevents reflux, may open frequently or have a low pressure. Either can lead to reflux.
A healthy esophagus should also be able to "clear" the acid through regular contractions and by neutralizing the acid with saliva. Additionally, the stomach must empty properly. If any of these mechanisms becomes altered or abnormal, acid can wash up into the esophagus and cause heartburn or other symptoms.
Anything that increases the pressure on the stomach can contribute to GERD by overcoming the lower esophageal sphincter. However, certain other factors can also trigger GERD. For example, smoking causes the lower esophageal sphincter to relax, allowing stomach contents to wash back up into the esophagus and trigger GERD symptoms. Drinking alcohol and taking certain medications can also trigger symptoms.
Pregnant women are particularly vulnerable to acid reflux disease. The symptoms typically get worse in the third trimester when the enlarged uterus pushes up on the stomach. Hormones during pregnancy also cause the digestive system to work more slowly and make the lower esophageal sphincter relax more often. Symptoms typically disappear after childbirth. Acid reflux is also more common in patients who have a hiatal hernia, which means the stomach's normal position has shifted upward so that part of it is in the chest.
GERD isn't always a benign disease. Untreated, chronic GERD can lead to esophageal damage. This damage can include inflammation, ulcers, bleeding and scarring of the esophageal tissues. Advanced or serious conditions caused by GERD include the following:
Erosive esophagitis. This is severe inflammation of the lining of the esophagus.
Esophageal ulcers. These are crater-like sores in the lining of the esophagus, which can bleed and may sometimes cause anemia (low red blood cell counts).
Esophageal strictures. This is the narrowing of the esophagus caused by scar tissue, which can lead to difficulty swallowing and episodes of food being caught in the esophagus.
Barrett's esophagus. This is a condition in which the normal lining of the esophagus is replaced by abnormal cells. Approximately three to seven percent of those with GERD develop Barrett's esophagus. It is most commonly found in Caucasian men over age 50. Patients with Barrett's also have a slightly increased risk of esophageal cancer, so they should have an endoscopy every two to three years to check for cancer.
Respiratory complications. These complications occur when stomach contents wash back up the esophagus and spill into the trachea and down into the lungs, or when stomach contents traveling into the esophagus cause a bronchial reflex that may lead to wheezing, cough, worsening of asthma or infections like pneumonia.
Reflux laryngitis. Inflammation of the voice box may occur when stomach acid spills into the trachea and irritates the vocal cords. The relationship between reflux and laryngitis is not completely clear, so other causes of laryngitis such as allergies, smoking or post-nasal drip should always be investigated.
Dental erosions. Severe GERD can lead to an increased risk of tooth decay due to stomach acids wearing away the tooth enamel.
Increased risk of cancer of the esophagus. People with severe and long-standing GERD have an increased risk of esophageal cancer, even when they don't develop Barrett's esophagus.
Some diseases and conditions can present with similar symptoms to GERD. These include esophageal spasms, esophageal cancer, peptic ulcer disease, gastritis, asthma and coronary artery disease.
There is an association between adult-onset asthma and GERD, especially in those with wheezing that gets worse at night, when lying down or after meals, and in those with no previous history of allergies. The typical symptoms of heartburn and acid regurgitation may not even appear in patients with GERD-related asthma. It is estimated that adults with asthma are twice as likely to have GERD as those without asthma.
One of the most concerning symptoms and conditions that might be confused with GERD is chest pain due to heart disease. The question arises: Is it heartburn or heart attack? There are some differences.
The classic description of cardiac chest pain is crushing, heavy or dull pain below the sternum (chest bone) that may extend up to the neck, shoulders or arms, and shortness of breath. The pain is usually relieved with nitroglycerin.
The chest pain with GERD is typically burning and may extend upward. Pain due to GERD usually occurs after meals and is often relieved by antacids. However, the pain can be so similar to that of chest pain that it is often difficult or impossible to distinguish between the two without sophisticated testing.
NOTE: The symptoms of chest pain that accompany a heart attack are notoriously inconsistent with the classic description, especially in women, who often present with atypical pain, such as abdominal or back pain. If pain lasts for more than few minutes, do not try to diagnose yourself but seek immediate medical attention.
Acid reflux occurs when this sphincter or "gate" opens at the wrong time or is too weak, allowing stomach contents to leak back (or reflux) into the esophagus.
The most common symptom people with GERD suffer is heartburn. Heartburn is pain or discomfort, sometimes described as burning, which rises from the stomach up into the chest. The discomfort often occurs after meals but can happen any time during the day, even waking you up at night. Almost everyone may experience heartburn at some time, but frequent or persistent heartburn more than twice a week over several months is the hallmark of GERD.
Approximately 20 to 40 percent of the U.S. population has some symptoms of GERD. An estimated 25 percent of people suffer from heartburn at least once a month, 12 percent at least once a week, and five percent experience heartburn daily.
Other symptoms of GERD in addition to heartburn include:
a sour or bitter liquid coming into the mouth (also known as "regurgitation" or "water brash")
difficulty swallowing or painful swallowing, especially with dry bread or poorly chewed food
chest pain, which may be confused with the pain of a heart attack
hoarseness, sore throat, feeling of fullness in the throat, choking at night and altered voice
lung problems, which might include wheezing, frequent pneumonia, damaged airways or chronic asthma
Infants with GERD may fail to gain weight, may develop more slowly or may have recurrent respiratory problems.
To understand the causes of GERD, it helps to understand the normal protective mechanisms involved in preventing acid from refluxing into the esophagus.
The lower esophageal sphincter, the muscle at the border of the esophagus and stomach that works as a gate and prevents reflux, may open frequently or have a low pressure. Either can lead to reflux.
A healthy esophagus should also be able to "clear" the acid through regular contractions and by neutralizing the acid with saliva. Additionally, the stomach must empty properly. If any of these mechanisms becomes altered or abnormal, acid can wash up into the esophagus and cause heartburn or other symptoms.
Anything that increases the pressure on the stomach can contribute to GERD by overcoming the lower esophageal sphincter. However, certain other factors can also trigger GERD. For example, smoking causes the lower esophageal sphincter to relax, allowing stomach contents to wash back up into the esophagus and trigger GERD symptoms. Drinking alcohol and taking certain medications can also trigger symptoms.
Pregnant women are particularly vulnerable to acid reflux disease. The symptoms typically get worse in the third trimester when the enlarged uterus pushes up on the stomach. Hormones during pregnancy also cause the digestive system to work more slowly and make the lower esophageal sphincter relax more often. Symptoms typically disappear after childbirth. Acid reflux is also more common in patients who have a hiatal hernia, which means the stomach's normal position has shifted upward so that part of it is in the chest.
GERD isn't always a benign disease. Untreated, chronic GERD can lead to esophageal damage. This damage can include inflammation, ulcers, bleeding and scarring of the esophageal tissues. Advanced or serious conditions caused by GERD include the following:
Erosive esophagitis. This is severe inflammation of the lining of the esophagus.
Esophageal ulcers. These are crater-like sores in the lining of the esophagus, which can bleed and may sometimes cause anemia (low red blood cell counts).
Esophageal strictures. This is the narrowing of the esophagus caused by scar tissue, which can lead to difficulty swallowing and episodes of food being caught in the esophagus.
Barrett's esophagus. This is a condition in which the normal lining of the esophagus is replaced by abnormal cells. Approximately three to seven percent of those with GERD develop Barrett's esophagus. It is most commonly found in Caucasian men over age 50. Patients with Barrett's also have a slightly increased risk of esophageal cancer, so they should have an endoscopy every two to three years to check for cancer.
Respiratory complications. These complications occur when stomach contents wash back up the esophagus and spill into the trachea and down into the lungs, or when stomach contents traveling into the esophagus cause a bronchial reflex that may lead to wheezing, cough, worsening of asthma or infections like pneumonia.
Reflux laryngitis. Inflammation of the voice box may occur when stomach acid spills into the trachea and irritates the vocal cords. The relationship between reflux and laryngitis is not completely clear, so other causes of laryngitis such as allergies, smoking or post-nasal drip should always be investigated.
Dental erosions. Severe GERD can lead to an increased risk of tooth decay due to stomach acids wearing away the tooth enamel.
Increased risk of cancer of the esophagus. People with severe and long-standing GERD have an increased risk of esophageal cancer, even when they don't develop Barrett's esophagus.
Some diseases and conditions can present with similar symptoms to GERD. These include esophageal spasms, esophageal cancer, peptic ulcer disease, gastritis, asthma and coronary artery disease.
There is an association between adult-onset asthma and GERD, especially in those with wheezing that gets worse at night, when lying down or after meals, and in those with no previous history of allergies. The typical symptoms of heartburn and acid regurgitation may not even appear in patients with GERD-related asthma. It is estimated that adults with asthma are twice as likely to have GERD as those without asthma.
One of the most concerning symptoms and conditions that might be confused with GERD is chest pain due to heart disease. The question arises: Is it heartburn or heart attack? There are some differences.
The classic description of cardiac chest pain is crushing, heavy or dull pain below the sternum (chest bone) that may extend up to the neck, shoulders or arms, and shortness of breath. The pain is usually relieved with nitroglycerin.
The chest pain with GERD is typically burning and may extend upward. Pain due to GERD usually occurs after meals and is often relieved by antacids. However, the pain can be so similar to that of chest pain that it is often difficult or impossible to distinguish between the two without sophisticated testing.
NOTE: The symptoms of chest pain that accompany a heart attack are notoriously inconsistent with the classic description, especially in women, who often present with atypical pain, such as abdominal or back pain. If pain lasts for more than few minutes, do not try to diagnose yourself but seek immediate medical attention.
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