Many people have heartburn every now and again after eating a large meal, and will be familiar with the unpleasant burning feeling in their chest, just behind their breastbone. Occasional acid reflux is normal too. Up to 20 out of 100 people living in Western countries regularly have problems like heartburn or acid reflux. Although both of these can be unpleasant, they do not usually lead to other health problems. But if you have very frequent or severe heartburn and often have acid reflux, you may have what is known as “gastro-esophageal reflux disease,” or GERD for short. “Gastro-esophageal” means “stomach and food pipe.”
If someone has reflux, some of the contents of their stomach leak out and flow back into their food pipe (also known as “gullet” or “esophagus”), because the entrance to their stomach doesn't close properly. The passage between the food pipe and stomach is closed most of the time. It only opens when the mixture of chewed food and saliva reaches it. It closes again once the food has entered the stomach. This ensures that the contents of the stomach do not flow back.
If the stomach is stretched a lot – for instance after a large meal – the sphincter at the entrance to the stomach might temporarily loosen. Gas or stomach contents might leak up into the food pipe as a result. The sphincter may also sometimes open for no apparent reason. The digestive fluid in the stomach contents irritates the lining of the food pipe, and that is felt as heartburn. If stomach juices stay on the lining of the food pipe for some time, the food pipe might become inflamed and painful.
In some people, stomach contents regularly leak into their food pipe, or a relatively large amount leaks out. It is considered to be GERD if this causes frequent or severe heartburn or acid reflux that affects your quality of life, or if your food pipe has become inflamed.
Heartburn is felt as a burning pain that spreads from the upper stomach, or from the area behind the breastbone, up into the throat. As well as acid reflux and heartburn, GERD can also be associated with problems swallowing. Other possible symptoms include a burning sensation in your throat, a bad taste in your mouth, and stomach noises. People who have GERD often feel very full. They sometimes also feel nauseous and like they need to vomit.
GERD can also cause symptoms that may not be obviously associated with the disease. For example, the stomach juices that leak out can get into your windpipe and make you cough, or attack your teeth. Other non-typical symptoms include a chronic cough, chest pain, asthma, laryngitis and tooth erosion.
Causes and risk factors
In GERD, the sphincter muscle between the food pipe and stomach does not close properly. It is often not clear why.
In some people it is caused by a hiatal hernia. This is where a part of the stomach protrudes up through the diaphragm into the chest. If this happens, the diaphragm can no longer help close the sphincter muscle at the bottom of the food pipe.
There is some debate about whether being overweight, smoking and drinking alcohol can affect the sphincter or increase the risk of GERD in some other way. Many people with GERD find that stress triggers their symptoms, or makes them worse. Certain postures, such as leaning forward or lying down, or eating particular types of food may also make the problem worse.
Reflux symptoms and heartburn might also be caused by a problem with the food pipe. For instance, the food pipe might not move rising stomach juices back down into the stomach fast enough, or it might react very sensitively. The symptoms can also be made worse by medications such as birth control pills and certain drugs against high blood pressure.
GERD is usually a chronic condition and is typically characterized by recurrent attacks. In other words, you may have a symptom-free phase for a while, followed by a phase with more severe symptoms, followed by another symptom-free phase, and so on.
The food pipe does not always become inflamed. In up to two out of three people with reflux symptoms, the membranes lining the food pipe are not affected.
A lot of people who have reflux and heartburn worry about the possible health consequences. But it usually doesn't get worse and cause any major health problems. Sometimes reflux can lead to changes in the mucous membranes lining the lower end of the food pipe. This is known as “Barrett’s esophagus.” It is estimated that 5 out of 100 people who have reflux will develop this condition after some time.
Barrett's esophagus is associated with a somewhat higher risk of esophageal (food pipe) cancer. It is estimated that esophageal cancer will develop within the next ten years in
- less than 1 out of 1,000 people who have reflux but don't have Barrett's esophagus
- 10 out of 1,000 people who have reflux and also have Barrett’s esophagus
Another possible complication is esophageal stricture, which is where the food pipe becomes narrower. This happens if an inflammation causes damage to the food pipe, and scar tissue forms when it heals. The scar tissue can make the entrance to the food pipe narrower and sometimes make it noticeably harder to swallow.
GERD can usually be diagnosed based on typical symptoms. It is therefore important to describe your symptoms to your doctor in as much detail as possible, and tell him or her when and how often they occur. If it is thought that someone might have GERD, doctors sometimes suggest that they have a “trial treatment” known as a PPI test to see if they respond. The test involves taking proton pump inhibitors (PPIs) for about two weeks. PPIs are drugs that reduce the production of stomach acid. If the medication relieves the symptoms, then it is very likely that GERD is causing the symptoms.
People with severe heartburn or GERD can often relieve their symptoms by changing some of their lifestyle habits. For instance, they might try to avoid certain types of food, or drink less alcohol. This is not always easy to do, but it can be worth the effort. There are also medications that can relieve the symptoms. If this does not provide enough relief, surgery might be considered.
Reflux and heartburn can be very distressing. The symptoms can affect your sleep and prevent you from enjoying food and drinks as much as you used to. GERD can affect your general wellbeing and everyday life. Some people stop participating in social activities and call in sick a lot. Many feel helpless if they cannot keep their symptoms under control.
Although treatment is not always pleasant and might take some time to work, a lot of people find that they feel better afterwards and that their GERD is no longer such a problem.
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