What is GERD?
GERD stands for gastroesophageal reflux disease. It happens when stomach acid, fluids, or food flow back up into your food pipe, also called the esophagus. The acid irritates the lining of your esophagus, causing inflammation and symptoms, usually heartburn. Over time, the stomach acid breaks down the lining of the esophagus. This can cause damage like sores, scarring, and other problems.
Some people have a type of GERD called non-erosive esophageal reflux disease, or NERD, where you have a normal esophagus lining despite the acid reflux. The acid doesn’t damage your lining, though it can still cause symptoms. Some experts think NERD is an early stage of GERD that will eventually advance to an erosive type. Others think it’s one type of GERD on a spectrum of many variations.
GERD vs. acid reflux
GERD is sometimes called acid reflux, but GERD is a more severe form. Everyone has acid reflux or heartburn at some point, like when you burp and taste acid in your mouth. When you have GERD, it interferes with your daily life.
Stages of GERD
There are different stages of GERD, and symptoms vary depending on the stage. The severity and frequency of your symptoms determine the stage of your GERD. They include:
- Stage 1: mild GERD with symptoms less than once a week
- Stage 2: moderate GERD with symptoms a few times a week
- Stage 3: severe GERD with daily symptoms
- Stage 4: GERD with complications
If you leave GERD untreated or it worsens over time, complications can develop. In that situation, GERD can advance to more severe diseases. These include:
- Erosive esophagitis, in which the acid causes ulcers or open sores in your esophagus lining
- Esophageal strictures, where scarring makes your esophagus more narrow, restricting the room in the pipe
- Barret’s esophagus, a condition in which the damage causes pre-cancerous changes to your esophageal lining
- Esophageal cancer
What are the symptoms of GERD in adults?
The most common symptom of GERD is heartburn, a burning sensation in your chest after meals or when you lie down. There are lots of other symptoms of GERD in adults, including:
- Regurgitation, or bringing back up swallowed food or liquids
- Sour or bitter taste in your mouth
- Chest pain
- Trouble swallowing
- Throat clearing
- Coughing or wheezing
- Sore throat
- Cavities or tooth enamel break down
- Bad breath
- Feeling a lump in your throat
Sometimes acid stays in your throat, and you breathe it into your lungs. The acid irritates your lung tissues and can cause symptoms of lung diseases. Complications can include times when food gets stuck in your food pipe, which can also lead to food impaction.
What causes GERD?
The cause of GERD is a weak or irregular lower esophageal sphincter. This is a muscle at the bottom of your esophagus that acts as a valve to your stomach.
Usually, you chew your meal and swallow. Your sphincter then opens up to allow the food into your stomach. For some people, the muscle relaxes too often or for too long. This lets fluid flow back in the wrong direction.
Some factors can affect your esophageal muscle and lead to weakness, including:
- Obesity or being overweight, in which the extra weight puts pressure on your esophagus
- Pregnancy, where higher levels of progesterone hormone cause the muscle to relax
- Caffeine and alcohol intake
Sometimes a hiatal hernia can also interfere with the muscle. In a hiatal hernia, your stomach pushes through a small opening in your diaphragm called a hiatus. Normally your esophagus passes through the hiatus to connect to your stomach. If your stomach pushes up through this opening, this can cause problems with your esophagus muscle.
What are the GERD treatment options?
GERD treatment involves lifestyle changes and diet first, and then medication and surgical procedures as needed.
The first step to managing GERD is to change your lifestyle. Sometimes changing how and when you eat and other habits are enough to relieve symptoms. You should:
- Stop smoking
- Limit alcohol
- Eat smaller meals
- Avoid eating within 3 hours of bedtime
- Stay upright after eating, which means no bending over, lifting, or laying down
- Lose weight
- Cut back on caffeine
- Prop yourself up in bed
Exercise can help you lose weight, but wait a few hours after eating before you workout. Bending over and jumping around can aggravate your symptoms.
If you have GERD, you might experience symptoms like bloating, belching, and burping every time you eat. Some foods can relax your esophagus muscle and trigger acid reflux, worsening your symptoms. But food can affect GERD in different ways:
- High-fat foods lower the pressure in your lower esophagus, which eventually causes it to open
- Acidic foods raise your stomach acid levels, adding more acid to the mix
- Certain chemicals in foods or drinks affect the muscle movements in your esophagus
- High-fat foods take longer to digest and slow down stomach emptying
Sometimes changing what you eat can help your symptoms. Avoid:
- Fast food
- Fried foods
- Tomatoes and tomato-based products
- Citrus fruits
- Carbonated drinks
If lifestyle and diet changes don’t help, you might need medication. These can help lower the amount of stomach acid you make, neutralize your stomach acid, block stomach acid production totally, or strengthen your sphincter muscle. Medications can include:
- Over-the-counter or prescription H-2 receptor blockers
- Over-the-counter or prescription proton pump inhibitors
- Prescription baclofen
In most cases, you can control GERD with medication. If nothing helps or you don’t want to take medication long-term, surgery to tighten the esophageal muscle might be an option.
GERD is a chronic disease. There is no cure, but you can manage the condition with medication and changes to your eating and lifestyle habits. You’ll need ongoing treatment, but serious complications are rare.
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Cooper University Health Care: "The Stages of GERD."
Harvard Medical School Harvard Health Publishing: "What is GERD or Gastroesophageal reflux disease."
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