Many people accept the discomfort of
heartburn as a normal part of life. However, heartburn can significantly interfere with your life; it may also be a symptom of more serious health problems.
If you have heartburn two or more times a week, or if you can't find relief with over-the-counter medications, you may have a condition called gastroesophageal reflux disease. This is also known as acid reflux disease or GERD.
If you or your doctor thinks you may have GERD, you probably have a lot of questions. This article can help answer some of these questions by explaining:
- What your stomach does with the food you eat
- What GERD is and how it's diagnosed
- The factors that can increase your risk of developing it or that can make your symptoms worse
- How GERD is treated.
The eMedTV archives also have a number of other articles that go into more detail about each topic discussed.
Understanding the Digestive System
To better understand GERD, it's important to know what happens in the normal digestive process.
As you chew your food and swallow it, particles travel from your mouth to the esophagus. The esophagus is a muscular tube that contracts and relaxes in a wave-like motion to help move food and liquids down toward your stomach. This is called "peristalsis."
Just before the esophagus gets to the stomach, it travels through your diaphragm. The diaphragm is a broad muscle that separates your stomach from your chest cavity. The opening in the diaphragm where the esophagus travels through is called the hiatus.
The esophagus then joins the stomach at the lower esophageal sphincter, also called the LES. This sphincter acts as a doorway between the esophagus and the stomach. After you swallow, it opens to let food into the stomach. Then the sphincter closes to keep food and stomach juices from going back up into the esophagus. The hiatus also helps close off the entryway to the stomach.
Inside your stomach, strong acids and enzymes make up the stomach juices that break down your food. Your stomach has special mechanisms that help protect it from these strong juices.
Your esophagus doesn't have these same defenses, so it's important for the LES to close off the stomach opening to keep the juices in the stomach. Sometimes, the acidic contents of the stomach do go back up, or reflux, into the esophagus. Some reflux is normal. Much of the time, this never causes any problems because the esophagus has some ways to protect itself. For example, the saliva in your esophagus can help neutralize stomach acid, and gravity and peristalsis help to wash the saliva and stomach juices back down into the stomach.
At other times, reflux can cause the burning, pressure, or pain in your chest or throat that most people call heartburn, acid indigestion. or GERD.
The Impact of GERD on the Digestive System
For people with GERD, the sphincter between the esophagus and the stomach either opens at the wrong time, or is weak and doesn't completely close off the opening to the stomach. When this happens, stomach juices and food particles can flow back up into the esophagus more frequently than normal.
If stomach juices stay in the esophagus for a long time, or if acid reflux happens often, the natural way the esophagus protects itself from stomach juices may simply be overwhelmed. The lining of the esophagus may become irritated, causing
heartburn. Over time, GERD can lead to:
- Bleeding
- The formation of ulcers
- Scarring and narrowing of the esophagus.
Causes of GERD and Risk Factors
The cause or
causes of GERD are not known; however, several factors can increase your risk of developing it. These factors are known as GERD risk factors. These same risk factors can also make your symptoms worse. Just because you have these risk factors, however, it does not "guarantee" that you will have GERD -- it just makes it more likely.
Common risk factors for GERD include:
- Hiatal hernia
- Pregnancy
- Use of tobacco products
- Dietary factors
- Certain medications
- Use of alcohol
- Being overweight or obese
- Stress.
The most common symptom of GERD is heartburn. The pain or discomfort caused by heartburn usually starts in the middle of the chest, and can move up through the throat. With GERD, heartburn can be frequent, constant, and/or severe.
Other common GERD symptoms include:
- Sensation of food stuck in the throat
- Feeling like you are choking or that your throat is tight
- Acidic or sour taste in the mouth (acid indigestion)
- Difficulty or painful swallowing
- Chest pain.
It is also possible for a person with GERD to have one or several of these other symptoms but not have heartburn.
Your healthcare provider can often diagnose this condition just by having you describe your symptoms. As part of making a diagnosis, your healthcare provider may also perform a physical exam to look for signs or symptoms.
If your doctor thinks you have GERD, you may be asked to change your diet or some parts of your lifestyle, and/or to take medication for a time to confirm the diagnosis.
In some cases, tests may be needed to diagnose the cause of GERD. These tests may include:
Treatment for GERD
Several GERD treatment options are available. The one your healthcare provider recommends will depend on a number of factors, such as:
- How severe your symptoms are
- When they occur
- How much they interfere with your life
- What you have tried in the past.
Specific treatments options may include:
Most people are able to find some combination of lifestyle changes and medications that they can use for short- and long-term control of their GERD symptoms.
Possible Complications of GERD
Several complications from GERD can occur if the condition goes untreated. Some of these include:
- Esophageal bleeding.
- Esophageal ulcers.
- Narrowing of the esophagus because of scar tissue (known as an esophageal stricture).
- Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.
- Esophageal cancer. About 1 out of 100 people who have severe damage to the lining of their esophagus develop a form of esophageal cancer.
Many people think of
heartburn as a normal part of life and suffer for a long time before they tell their doctor. However, people who experience heartburn two or more times a week and/or symptoms that are not relieved by over-the-counter medications may have a more serious disease called gastroesophageal reflux disease (GERD).
In many people, the diagnosis can be made simply by describing their symptoms and medical history to their doctor. Additional tests are not always required.
Most people are able to completely relieve or reduce their symptoms by making changes in their diet and/or lifestyle and taking medications. In rare cases, surgery may be necessary to reduce the discomfort. If you experience heartburn on a regular basis, please don't hesitate to tell your healthcare provider. You may have GERD.
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