GERD Overview

GERD or gastroesophageal reflux disease, also called acid reflux or heartburn, is the condition in which fluid content of the stomach backs up into the esophagus. Since the content is highly acidic, it causes severe burning sensation and damages the lining of the food canal. In addition to acid, the liquid may also contain bile and pepsin. Acid as well as pepsin can cause inflammation and damage. GERD is a chronic condition that has no permanent cure. Even if the injury to esophagus is healed with treatment, because of continued acid reflux the injury will return.

It must be noted that reflux of stomach’s liquid content to esophagus occurs in most individuals and it is normal. But with GERD patients, the content of the liquid is more acidic and, also, it is retained in the esophagus longer than in normal individuals. In the majority of cases, reflux occurs during waking hours when the body is upright. In waking hours, we produce more saliva and swallow it, which takes back the refluxed content to stomach. Saliva contains bicarbonates that neutralizes acid in the esophagus.

It is difficult to pinpoint the cause for GERD on a single factor. Lower esophageal sphincter abnormalities, abnormal esophageal contractions, hiatal hernias, and slow emptying of stomach can cause GERD. Lower esophageal sphincter (LES) is responsible for naturally protecting the esophagus from acid reflux as it acts as a one way valve. When we swallow food, liquid or even small quantities of saliva, LES opens up for few seconds to allow the passage in to stomach but it immediately closes to prevent acid reflux. There can be two types of problems with LES that could cause acid reflux. The weak contraction makes LES to completely prevent flow of acids. Secondly, the opened sphincter can transiently open without associated swallowing and could remain in that condition for a long time. These are called transient LES relaxations and usually occur after meals.

Many individuals having GERD also have hiatus hernia though not every one with hiatal hernia has GERD. In hiatus hernia, a part of stomach pushes up through diaphragm and the position of LES is changed to lie in the chest. It is suggested that the diaphragm surrounding LES also contributes in preventing reflux. Just like LES, the diaphragm surrounding the esophagus also contracts and relaxes to allow swallowing and preventing acid reflux. If the LES moves in to chest region due to hiatus hernia, both LES and diaphragm apply contracting forces but since they act at different locations, the effect is diminished and it allows for flow of acid up into the esophagus.

One of the most effective treatments for GERD is lifestyle changes. These are mainly related to eating habits. As reflux at night is more injurious, it must be prevented by partially elevating the upper part of the body (not just the head). It is also advantageous to have smaller and earlier evening meals that prevent transient LES relaxations. One must avoid chocolates, peppermint, caffeinated drinks, carbonated juices, tomato juice and alcohol. Smoking and fatty acids in diet also cause reflux.

Antacids are commonly used as effective medicines in treatment of GERD. Other drugs prescribed are cimetidine, ranitidine, nizatidine and famotidine. Another class of drugs called proton pump inhibitors block secretion of acid into stomach. PPI drugs approved for GERD treatment are omeprazole, pantaprazole, rabeprazole etc.