Gastroesophageal reflux disease, or GERD, affects at least an estimated 5% to 7% of the global population—men, women, and children.  It occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What Causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include being overweight, alcohol use, smoking, and pregnancy.  In addition, certain foods such as citrus fruits, garlic and onions, chocolate, caffeinated beverages, fried and fatty foods, spicy foods, mint flavorings, and tomato-based foods (e.g. pizza, spaghetti sauce, chili) can be associated with reflux events.

What Are the Symptoms of GERD?

Although it is common, GERD is often unrecognized because its symptoms are misunderstood. While the disease may be present without any apparent symptoms, the most frequent symptom is persistent heartburn.  In fact, heartburn is so common that it often is not associated with a serious disease, like GERD. All too often, GERD is either self- treated or mistreated. However, anyone experiencing heartburn twice a week or more may have GERD.

People can have GERD without having heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

In infants and children, GERD may cause repeated vomiting, coughing, and other respiratory problems. Most babies grow out of GERD by their first birthday.

GERD and Weight Gain

A new study published in the in the June 1 issue of the New England Journal of Medicine finds that Symptoms of GERD appear to be directly related to body-mass index, even if a person is not overweight.  Previous researchers have already established that overweight and obese people are at an increased risk for GERD, but there have been questions about the link between body-mass index (BMI) and GERD.

10,545 women from the Nurses’ Health Study completed a questionnaire regarding GERD symptoms. Reserachers found that women with a BMI of less than 20 had a 33 percent lower chance of having GERD symptoms compared to women with a BMI of 20 to 22.4.  Women with a BMI of 22.5 to 24.9 had a 38 percent higher risk of GERD symptoms than those with a BMI of 20 to 22.4.  Having a BMI of more than 25 is considered to be overweight.

Interestingly, even those women who had a normal BMI at the start of the study who later had an increase of more than 3.5 in their BMI had an increased risk of GERD symptoms.  The researchers reported seeing a linear trend that shows GERD risk increasing as BMI increases.

How is GERD Treated?

GERD is a chronic but generally treatable disease. However, serious complications can result if it is not treated properly.  Treatment usually needs to be maintained on a long-term basis, even when symptoms are under control.

Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures. It is essential for individuals who suffer persistent heartburn or other chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available.

Making healthy lifestyle changes is one of the most important things you can do to impact your treatment of GERD.  Here is a simple list of what you can do:

• Don’t smoke; if you do smoke, quit;
• Avoid drinking alcohol;
• Maintain a Healthy Weight and lose weight if needed;
• Eat small meals;
• Wear loose-fitting clothing;
• Avoid lying down for 3 hours after a meal;
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help.

However, if your condition is more serious, certain medications (including over-the-counter antacids) or surgery may be recommended.  Keep in mind that antacids have side-effects.  Most brands have one of three basic salts to neutralize the acid in your stomach:  magnesium, calcium, and aluminum.  Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation; therefore, these salts are often combined in a single product to balance these effects. Calcium carbonate antacids can be a supplemental source of calcium but can also cause constipation.  If symptoms persist, further tests will be needed to determine the course of treatment that is best for you. If you have been using antacids for more than 2 weeks, you should see a doctor.

Long-Term Complications of GERD

Sometimes GERD can cause serious complications.  Inflammation of the esophagus from stomach acid causes bleeding or ulcers.  In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult.  Some people develop Barrett’s esophagus, where cells in the esophagus lining take on an abnormal shape and color, which over time can lead to cancer.

In addition, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

Sources:  Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD), NDDIC; About GERD, International Foundation for Functional Gastrointestinal Disorders; “Even Small Weight Gains Up GERD Risk”, HealthDay (May 31, 2006).