Gastro-esophageal reflux (GERD)

Have you ever had burning feeling in the chest or feeling nauseous and have excessive salivation?

It may be GERD. GERD stands for gastro-esophageal reflux which is a condition where the acid that is normally in your stomach backs up into the esophagus causing bothersome symptoms. The esophagus is the tube that carries food from your mouth to your stomach.

GERD is relatively common and many people experience it from time to time.

What are the symptoms of GERD?

• Heartburn, which is a burning feeling in the chest.
• Regurgitation, which is when acid and undigested food flow back into your throat or mouth.

Other symptoms might include:

• Stomach or chest pain (sometimes confused with heart problems)
• Trouble swallowing
• Having a raspy voice or a sore throat
• Unexplained dry cough
• Nausea or vomiting
• Metallic or sour taste in mouth

Symptoms of GORD can occur over minutes, but typically occurs over hours.

What causes GERD?

When you swallow food, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to enter into your stomach. Then the sphincter closes again when there’s no food or fluid intake.

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed hence explains the symptoms experienced.

Image source from Mayo Clinic

What are the risk factors of GERD?

• Overweight or obese
• Smoking
• Consumption of alcohol, coffee, chocolate
• Consumption of certain foods (triggers) such as fatty or fried foods
• Eating large meals or eating late at night
• Pregnancy
• Older age
• Use of certain medications (Nitrates, calcium channel blockers, β2-adrenoceptor agonists)

What can you do to treat and prevent GERD?

• Limiting foods that can commonly induce reflux such as high fat meals, alcohol, coffee, chocolate, citrus fruits, tomato products, spicy food, carbonated beverages. 
• Weight loss if obese or overweight
• Eating smaller meals
• Drinking fluids mostly between meals rather than with meals
• Avoiding lying down after eating
• Avoiding eating or drinking 2-3 hours before bedtime or vigorous exercise
• Elevating the head of the bed (if symptoms occur at night)
• Stop smoking

If lifestyle modifications are not effective in preventing GERD and you still experience symptoms, medications may be needed such as.

1. An antacid such as an Aluminium/Magnesium hydroxide mixture (e.g. Mylanta)
2. H₂-receptor antagonist: Ranitidine
3. A proton pump inhibitor e.g. esomeprazole

When to see a doctor?

If you experience any of the signs and symptoms below, go to see a doctor immediately for further investigation, there may be some underlying disease.

• Significant weight loss
• Recurrent vomiting
• Swallowing difficulties epigastric mass,
• Cardiac chest pain
• Evidence of gastrointestinal blood loss (vomiting blood, dark stools, iron deficiency or anaemia)
• Daily symptoms
• Symptom control not reached with PPI therapy in 2 weeks
• Taking long-term NSAID  (or medicines suspected of aggravating reflux symptoms)

Reference:

1. Gastroesophageal reflux disease (GERD)

2. GERD

3. Swallowing disorder, causes, risk factors, symptoms, diagnosis and Management of GORD

4. Patient education: Acid reflux and gastroesophageal reflux disease in adults (The Basics)

Written by

Ms Caryn Lee