Gastroesophageal reflux disease is a chronic digestive problem that affects the lower esophageal sphincter, resulting in the reflux of acid into the esophagus causing heartburn. It is also known as reflux esophagitis.
Between the stomach and the esophagus is a ring of muscles that act as a sphincter, and this is known as the lower esophageal sphincter. The main purpose of having this sphincter is to prevent the food in the stomach from escaping back in to the esophagus. When you eat, the food passes down through your food pipe, or the esophagus, by peristalsis movements. When they reach the bottom of the esophagus, the sphincter relaxes and allows the food to pass into the stomach. As soon as this is done the sphincter closes. During this relaxation, a small amount of acid does pass back into the esophagus. So, reflux of acidic juice into the lower esophagus occurs several times a day in normal individuals.
In gastroesophageal reflux disease, the lower esophageal sphincter is always relaxed, therefore, there is prolonged exposure of the lower esophagus to the acidic juice from the stomach.
This can be mainly due to 2 reasons:
- Excessive reflux – Increased number of episodes of reflux and increased volume resulting in incompetence of the lower esophageal sphincter.
- Normal mechanism for cleansing the lower esophagus is lost.
This prolonged exposure to acid causes heartburn.
It has been found that gastroesophageal reflux disease occurs more commonly in people with a condition known as a hiatus hernia. A hiatus hernia is the protrusion of a part of the stomach through the diaphragmatic hiatus. This leads to an incompetent lower esophageal sphincter as it fails to function normally. However, many patients with GERD do not have hiatus hernia and many people with hiatus hernia do not develop GERD.
What are the clinical features?
Heartburn is the most common symptom of gastroesophageal reflux disease. It is described as a burning type of chest pain which begins behind your breast bone and radiates upwards towards your mouth. Along with this, patients often feel as if the food is coming back into the mouth from the stomach giving a bitter or metallic taste at the back of the tongue.
This heartburn is worse after a meal, when lying down, or bending forward.
Most often, people tend to confuse this chest pain with a heart attack. Patients with a heart attack can present with similar symptoms and therefore it is vital to bear this in mind. If you have a chest pain, make sure to visit your doctor as soon as possible to rule out the possibility of it being a heart attack.
Other less common symptoms of GERD includes, cough, nausea, sore throat, change in voice, and increased production of saliva.
How can you treat Heartburn?
Treating heartburn is really important to prevent the complications of Gastroesophageal reflux disease. The aim in treating GERD is to reduce the amount of acid reflux and reduce the damage on the esophagus caused by the refluxed acidic contents.
Doctors often recommend lifestyle and dietary changes to prevent GERD.
Foods such as chocolate, caffeine, citrus fruits, and food with a high fat content should be avoided as much as possible. In addition, spicy meals should be avoided as well. Lifestyle changes include avoiding lying flat soon after a meal and eating small portions with increased frequency. Your dinner should be consumed at least three hours before you sleep. Stopping smoking will also help you to protect yourself from GERD.
Along with these dietary and life style measures, your doctor may also prescribe you some medication to be taken if you develop any symptoms of GERD. The commonly prescribed drugs are the antacids which help to neutralize the acid in your stomach. This is an over the counter medication and can be purchased without a prescription. This helps to give you a short relief. Along with this, your doctor may also prescribe you a H2 receptor blocker such as Cimetidine, Ranitidine, etc. to reduce the acid in your stomach. Another type of drug that is commonly prescribed for GERD is a proton pump inhibitor (PPI) such as Omeprazole and Pantoprazole.