HotButton SymptomsGastroesophageal reflux diseases (GERD) occur when the lower esophageal sphincter (LES) does not close properly, thus allowing gastric contents to reflux back into the esophagus and/or mouth. The LES is a ring of muscle at the bottom of the esophagus at the level of the diaphragm that acts like a valve, opening to allowed swallowed food to pass while eating, then closing to prevent reflux upward. Some degree of reflux is a normal process in healthy individuals, and may only cause brief episodes, sometimes related to what we eat. In contrast, people with GERD experience bothersome and frequent symptoms as a result of reflux, which may lead to more serious problems over time.

Causes:

A hiatal hernia (HH) is the most common cause of GERD, a result of a weakness in the lower esophageal sphincter muscle which is comprised of the layers of the esophageal muscle as well as the surrounding muscles of the diaphragm. A HH can occur in anyone at any age, however it happens more commonly in people who are overweight or in instances where there is an increase in intra-abdominal pressure. This can be a results of heavy lifting, exercise, pregnancy, chronic coughing, or it just may be spontaneous.

Other factors that may contribute to GERD and symptoms include:

  • Smoking
  • Chewing tobacco
  • Alcohol use
  • Excess weight
  • Pregnancy
  • Diabetes
  • Delayed gastric emptying
  • Asthma
  • Spicy foods
  • Citrus
  • Chocolate
  • Peppermint
  • Caffeine
  • Fried and fatty foods
  • Carbonated beverages
  • Onions/garlic
  • Tomato-based foods
  • Medications – in particular NSAIDS (anti-inflammatory meds)

Acid Reflux Symptoms:

People who experience heartburn at least 2-3 times per week on an ongoing basis may have GERD. This chronic reflux of gastric contents over time can be associated with other symptoms, including the following:

  • Pain in the central upper abdomen
  • Burning or non-burning chest pain
  • Difficulty swallowing (called dysphagia), or food getting stuck or hung-up in the chest
  • Painful swallowing
  • Persistent sore throat
  • Sensation of a lump in the throat
  • Persistent cough
  • Taste of acid and/or regurgitation of foods to the throat

Complications of Acid Reflux:

Chronic GERD may result in damage to the lining of the esophagus due to long-standing exposure of gastric contents. Others can have chronic reflux with no damage, and still others can experience GERD symptoms without any damage, called NERD (non-erosive reflux disease). When complications do occur, some conditions we may encounter are the following:

  • Erosive esophagitis/ulcers
    This may or may not cause burning, and in some cases can lead to blood in the stool and/or chronic anemia. Without treatment, it can lead to scarring or stricturing of the esophagus, or Barrett’s Esophagus.
  • Esophageal Stricture
    Damage from acid exposure to the esophageal lining can lead to scarring and stricturing, resulting in difficulty swallowing.  The narrowing is caused by scar tissue that develops as a result of ulcerations that then heal. These narrowed areas are usually short in length and close to the LES, and can be diagnosed as well as treated at the time of an upper endoscopy, by performing a dilation or stretching of the stricture.
  • Barrett’s Esophagus
    This is a condition of longstanding acid reflux, where the normal cells that line the esophagus (squamous cells) are replace by a different cell type (intestinal metaplasia). People who are diagnosed with Barrett’s Esophagus require long term treatment of their GERD, and should have periodic upper endoscopy (EGD) with biopsy. This is because a small percentage of those with Barrett’s esophagus can progress to esophageal cancer, but by doing periodic endoscopic surveillance with biopsy, this can be detected early or even before cancer occurs, as the cells begin a transformation that can precede cancer. By catching this change at an early stage, this would allow a non-invasive treatment to eradicate the Barrett’s mucosa and return it to normal.
  • Esophageal cancer
    There are 2 main types of esophageal cancer, adenocarcinoma and squamous cell carcinoma. A major risk factor for adenocarcinoma is Barrett’s Esophagus. Squamous cell carcinoma is not generally associated with Barrett’s or GERD. With regular endoscopic surveillance and biopsy, these esophageal cancers can be detected early or even before the cells actually become cancerous. Keep in mind that only a small percentage of those with GERD develop Barrett’s, and with regular surveillance of Barrett’s an even smaller percentage will develop adenocarcinoma.
  • Asthma
    GERD is common in those with asthma and has been identified as a trigger mechanism. Anywhere from 35-85% of those with asthma have reflux esophagitis. Due to GERD, sometimes a person can aspirate small amounts of gastric contents into the upper bronchial airways, triggering off wheezing and asthmatic symptoms.
  • Chronic LPR (chronic laryngitis)
    Reflux patients with laryngitis present with a change in voice character or hoarseness due to LPR. Other symptoms could include chronic throat clearing, Globus sensation (sensation of a lump in the throat) or a choking sensation.
  • Chronic cough
  • Recurrent pneumonia

Midwest Heartburn Center
Midwest Gastroenterology
3601 NE Ralph Powell Rd.
Lee’s Summit, Missouri 64064
816-836-2200