What is GERD?

When the reflux of gastric material into the esophagus causes symptoms, tissue damage, or both, the resulting condition is called gastroesophageal reflux disease (GERD). Heartburn and regurgitation are the symptoms most frequently associated with GERD. The reflux of material from the stomach into the esophagus does not invariably result in disease. Indeed, normal individuals daily experience brief, asymptomatic episodes of gastroesophageal reflux that cause no esophageal injury.

Gastroesophageal reflux occurs physiologically in all persons, when gastric contents reflux into the esophagus. However, due to acid neutralization by saliva and prompt esophageal clearance of refluxate, symptoms occur in a minority of people. The typical symptoms of GERD are heartburn, acid regurgitation and difficulty in swallowing. It is difficult to determine at what point reflux results in disease. Fortunately, the vast majority of patients suffering from GERD have an easily controlled disorder. At the other end of the spectrum, there are patients who develop severe damage to the esophagus. Over a period of time GERD causes changes in the inner lining of esophagus called Barrett’s esophagus. These changes may later cause cancer of esophagus.

Why GERD occurs?

There are several mechanisms which prevent the reflux of gastric contents in to the esophagus and protect the inner lining of esophagus. These include:

• Presence of a structure at the lower end of the esophagus called lower esophageal sphincter
• Compression exerted by the diaphragmatic crura

Gastroesophageal reflux disease occurs when these barrier mechanisms fail.

Symptoms

Heartburn is the classic symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach or lower chest and radiating toward the neck, throat, and occasionally the back. It occurs particularly after large meals or after ingesting spicy foods, citrus products, fats, chocolates, and alcohol. The supine position and bending over may worsen heartburn. Nighttime heartburn may cause sleeping difficulties and impair next-day function. Other symptoms of GERD include:

• Acid regurgitation
• Swallowing difficulty
• Water brash - The mouth suddenly fills with saliva as a result of reflex salivary secretion stimulated by acid in the esophagus
• Painful swallowing
• Burping
• Hiccups
• Nausea and vomiting

Some patients have symptoms not related to esophagus. These include:

• Noncardiac chest pain
• Asthma
• Sore throat
• Chronic cough
• Recurrent respiratory infection
• Dental erosion

Diagnosis

A large number of tests are available for evaluating patients with suspected GERD. Many times these tests are unnecessary, as the classic symptoms of heartburn and acid regurgitation are sufficiently specific to identify reflux disease and begin medical treatment. The various tests available include:

• Tests to determine the presence of reflux
• Ambulatory 24-hour pH recording
• Barium meal
• Radionuclide scintigraphy
• Tests to determine whether symptoms are due to reflux
• 24-hour pH recording
• Bernstein (acid perfusion) test
• Tests to determine the presence of mucosal damage
• Endoscopy
• Mucosal biopsy
• Barium meal