Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a disorder of the esophagus that causes frequent symptoms of heartburn. The esophagus is the tube connecting the mouth to the stomach. GERD occurs when a muscular ring called the lower esophageal sphincter (LES) is weakened, which permits irritating stomach contents to pass up into the esophagus, resulting in heartburn. Sometimes regurgitation of acid and food as high as the mouth can occur. Chronic irritation of the esophagus by stomach acid can eventually cause ulceration and scarring and might lead to cancer of the esophagus, especially in people who smoke and/or consume large amounts of alcohol.
What are the symptoms of GERD?
People with GERD have heartburn, which usually feels like a burning pain that begins in the chest and may travel upward to the throat. Many people also feel a regurgitation of stomach contents into the mouth, leaving an acid or bitter taste. Some people with GERD may also have coughing while lying down, increased production of saliva, and difficulty sleeping after eating.
How is it treated?
Conventional treatment consists of the avoidance of stomach acid stimulants (e.g., coffee, alcohol), certain drugs (e.g., anticholinergics), specific foods (fats, chocolate), and smoking. Medications may also be prescribed to control stomach acidity which include histamine H2 inhibitors famotidine, nizatidine, ranitidine, proton pump inhibitors, and omeprazole, and antacids.
Dietary changes that may be helpful:
Whether lowering dietary fat is important for people with GERD is somewhat unclear. Historically, low-fat diets have been recommended to patients with GERD because fatty foods appeared to be associated with increased heartburn and fatty foods had been shown to weaken the LES in both healthy people and people with GERD. A number of recent studies, however, have found no correlation between the fat content of a meal and subsequent symptoms of heartburn and reflux. Another study found that hospitalizations due to GERD were no more likely for people who ate high-fat diets than for those on low-fat diets. One study compared different fast foods for their likelihood to cause reflux symptoms and found that chili and red wine caused more symptoms than higher-fat foods such as hamburgers and French fries.
Eating foods or drinking beverages flavored with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LES and can contribute to symptoms in people with GERD. Chocolate also relaxes the LES and can cause heartburn. Acidic beverages like juices, coffee, and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol, and milk.
Lifestyle changes that may be helpful:
Smoking weakens the LES and is a strong risk factor for GERD. A study of infants with GERD found that exposure to cigarette smoke in the environment is associated with reflux, leading the authors conclude that secondhand smoke contributes directly to GERD in infants. No similar studies on environmental smoke have been done with adults. Psychological stress and alcohol have also been shown to be associated with the weakening of the LES and symptoms of GERD.
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