John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Gastroesophageal reflux disease (GERD) is a condition in
which the esophagus becomes irritated or inflamed because of acid backing up
from the stomach. The esophagus or food pipe is the tube stretching from the
throat to the stomach. When food is swallowed, it travels down the esophagus.
The stomach produces hydrochloric acid after a meal to
aid in the digestion of food.
The inner lining of the stomach resists corrosion by
this acid. The cells that line the stomach secrete large amounts of protective
mucus.
The lining of the esophagus does not share these
resistant features and stomach acid can damage it.
The esophagus lies just behind the heart, so the term heartburn was coined
to describe the sensation of acid burning the esophagus.
Normally, a ring of muscle at the bottom of the
esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid.
This sphincter relaxes during swallowing to allow
food to pass. It then tightens to prevent flow in the opposite direction.
With GERD, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus.
GERD affects
25% to 40% of the adult population of the United States to some degree at some
point. About 10% of adults experience GERD weekly or daily. Not just adults are affected; even infants and children can have GERD.
Acid Reflux (GERD) Causes
No one knows the exact cause of gastroesophageal reflux. The following are contributing factors that weaken or relax the lower esophageal sphincter, making reflux worse:
Lifestyle: Use of alcohol or
cigarettes, obesity, poor
posture (slouching)
Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
Eating habits: Eating large meals, eating quickly or soon before bedtime
Hiatal hernia is a condition when the upper part of the
stomach protrudes up above the diaphragm (the strong muscle that separates the
organs of the chest from those of the abdomen).
Normally, the diaphragm acts as an additional barrier, helping the lower esophageal sphincter keep acid from backing up into the esophagus.
Hiatal hernia can be caused by persistent
coughing,
vomiting, straining, or sudden physical exertion. Obesity and pregnancy can make the condition worse.
A hiatal hernia makes it easier for the acid to back up.
Hiatal hernia is very common in people older than 50 years
of age.
Hiatal hernia usually requires no treatment. In rare cases when the hernia becomes twisted or is making GERD worse, surgery may be required.
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Heartburn symptoms caused by GERD are usually relieved by drugs called proton pump inhibitors (Prilosec, Prevacid, Aciphex, Protonix, Nexium, Zegerid); however, proton pump inhibitors sometimes do not work well. If your symptoms were not relieved by treatment with proton pump inhibitors, can you please describe your GERD symptoms that did not improve? If you have other treatments that have been effective, please comment on those.
Chronic acid reflux leads to uncomplicated GERD, but not everyone with GERD
has heartburn. The primary symptoms of GERD are heartburn, regurgitation, and
nausea.
Heartburn usually is described as a burning pain in the middle of the chest.
It may start high in the abdomen or may extend up into the neck. Sometimes the
pain may be sharp or pressure-like, rather than burning. Such pain can mimic
heart pain (angina). In other patients, the pain may extend to the back.
Typically heartburn related to GERD is seen more commonly after a meal. Other
symptoms of GERD include:
Hoarseness. If acid reflux gets past the upper esophageal sphincter, it can
enter the throat (pharynx) and even the voice box (larynx), causing hoarseness
or a sore throat.
