GERD: Symptoms, Diagnosis, Treatment

Gastroesophageal Reflux Disease (GERD) is a chronic condition where stomach acid flows back into the oesophagus, causing irritation and inflammation. It is a prevalent condition affecting millions worldwide.

The leading underlying cause of GERD is when the lower oesophageal sphincter (LES) weakens, which serves as a crucial muscular ring acting as a barrier between the oesophagus and the stomach. 

Under normal circumstances, this muscle functions as a barrier, opening when you swallow to facilitate the passage of food into the stomach. Conversely, when the sphincter contracts, it effectively seals off the passage, preventing food and the stomach’s acidic contents from refluxing into the oesophagus. 

In the case of GERD, however, the LES relaxes at inappropriate times or weakens, remaining partially open. This unfortunate scenario allows stomach acid to ascend into the oesophagus, resulting in the symptoms associated with the condition.

GERD vs acid reflux

GERD and acid reflux are related conditions, but they are not quite the same thing. GERD is a chronic and more severe form of acid reflux with persistent symptoms.

GERD vs heartburn

Heartburn is an uncomfortable burning sensation that originates in the chest behind the breastbone and may extend towards the mouth, caused by the reflux of stomach acid (acid reflux) into the oesophagus. 

In summary, GERD encompasses a more extensive array of symptoms and potential complications, extending beyond the persistent occurrence of acid reflux and heartburn.

What are the risk factors of GERD?

Several factors that affect the lower oesophageal sphincter and increase the risk of developing GERD include:

• Obesity: Obesity often leads to elevated abdominal pressure, heightening the risk of stomach acid being pushed into the oesophagus.

• Hiatal hernia: This condition occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity, which can weaken the lower oesophageal sphincter, allowing acid reflux to occur more easily.

• Dietary choices: Spicy foods, fatty foods, chocolate, caffeine, alcohol, and acidic foods can trigger GERD symptoms in some people.

• Pregnancy: Hormonal changes and pressure on the abdomen from the growing uterus can contribute to GERD symptoms in pregnant women.

What are the symptoms?

GERD symptoms vary from person to person, but common ones include:

• Heartburn
• Regurgitation of stomach acid: Sour or bitter-tasting acid backing up into the throat or mouth, especially after eating or when lying down.
• Chest pain
• Difficulty swallowing
• Chronic cough
• Hoarseness of voice
• Feeling of a lump in the throat
• Bad breath

How is GERD diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is based on your reported symptoms, physical examination and investigations.

• Upper gastrointestinal (GI) endoscopy: A thin, flexible tube with a camera (endoscope) is used to examine the oesophagus and stomach lining. Biopsy samples may be taken to look for damage or signs of infection.

• Prolonged oesophageal pH study:  These tests measure the severity of acid reflux.
  The test requires inserting a small tube with a sensor through the nose into the esophagus or placing a wireless sensor during an upper endoscopy. This sensor stays in place for 24 hours.

How is GERD treated?

Lifestyle modifications

• Dietary changes: Avoid trigger foods and beverages that can worsen reflux, such as spicy foods, fatty foods, citrus fruits, tomatoes, chocolate, caffeine, alcohol, and carbonated drinks.
• Eating habits: Eat smaller, more frequent meals, avoid lying down or bending over immediately after eating, and elevate the head of your bed to reduce nighttime reflux.
• Weight loss: If overweight or obese, losing weight can help reduce pressure on the stomach and decrease reflux symptoms.
• Smoking cessation: Quitting smoking can improve symptoms and reduce the risk of complications associated with GERD.

Medications 

For mild symptoms:

• Antacids are used for short-term relief of heartburn symptoms as they neutralise stomach acid (e.g., Gaviscon).
• Histamine receptor antagonists decrease acid production in the stomach. They are more efficient than antacids at relieving heartburn, and their effects stay longer (e.g., cimetidine, famotidine).

For moderate to severe symptoms: 

• Proton pump inhibitors (PPIs) are most effective at reducing stomach acid. Some PPIs are accessible over-the-counter, whereas prescriptions may be necessary for higher doses (e.g., omeprazole, pantoprazole).

Surgery

In severe cases of GERD that do not respond to lifestyle modifications and medications, or in cases of complications like hiatal hernia, oesophageal strictures, or Barrett’s oesophagus, surgical intervention like fundoplication may be considered.

Is GERD a serious problem?

Left untreated, GERD can be a serious condition. While occasional acid reflux is common and usually not a cause for concern, GERD involves chronic and frequent reflux of stomach acid into the oesophagus, which can lead to various complications and significantly affect quality of life.

Chronic exposure to stomach acid can lead to complications such as oesophagitis, Barrett’s oesophagus, and an increased risk of oesophageal cancer. Seek immediate medical attention if you experience persistent GERD symptoms.

A question that often arises is, “Is GERD curable?” For some people, GERD may be a temporary issue that resolves with lifestyle modifications, medications, or other interventions. They may experience occasional flare-ups or periods of remission but not require ongoing treatment.

In many instances, treatment may need to be sustained over an extended duration. Despite the use of daily medication, a considerable number of individuals with reflux may still experience ongoing symptoms.

How to prevent GERD?

Preventing acid reflux involves lifestyle changes and dietary adjustments to reduce its occurrence.

Foods to avoid

Consider limiting or avoiding:

• Spicy foods
• Citrus fruits and juices
• Tomatoes and tomato-based products
• Chocolate
• Mint
• Fried and fatty foods
• Carbonated beverages
• Caffeine
• Alcohol

Lifestyle changes

• Maintain a healthy weight to reduce pressure on the abdomen and risk of acid reflux. 
• Eat smaller, more frequent, and well-balanced meals instead of large meals to prevent overeating.
• Avoid eating late and allow at least three hours between your last meal and bedtime to reduce acid reflux symptoms.
• Sleep on your left side to help direct stomach fluid away from the upper right side of the stomach where the oesophagus connects. 
• Quit smoking because smoking can weaken the lower oesophageal sphincter, causing frequent episodes of acid reflux.
• Reduce stress via meditation, yoga, or deep breathing exercises because chronic stress may exacerbate acid reflux symptoms.

Make an appointment at Pantai Hospitals

GERD is a chronic condition that can significantly impact your quality of life. If you suspect you may have GERD, get in touch with us to book an appointment today for a consultation, or visit our team of Gastroenterologists at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.