Dr Aidin Rawshani

Gastroesophageal reflux disease (GERD): symptoms, causes, evaluation, treatments, risks


What is acid reflux and GERD?

Acid regurgitation occurs when the contents from the stomach (gastric acid) move up into the esophagus, in some cases up to the oral cavity. It is also called dyspepsia or gastroesophageal reflux (GERD) in medical language. Acid gastric contents may cause pain in the upper abdomen, central in the abdomen (duodenal dyspepsia), behind the sternum in the chest and in the oral cavity.

Where the symptoms occur depends to some extent on where the acidity of the stomach goes. The stomach acid accumulates in the stomach and can be pushed down in the small intestine when eating, this is perceived as pain in the central abdomen shortly after eating. If the acidic gastric contents move upwards into the esophagus as a result of leakage, the individual usually experiences pain behind the sternum, central in the chest and in some cases also in the oral cavity. Gastric acid that reaches the oral cavity is usually perceived as an iron taste in the mouth. This is called reflux symptoms. Reflux symptoms may occur sporadically in perfectly healthy individuals.

If you have symptoms of acid regurgitation more than twice a week, you may have a condition called gastroesophageal reflux disease (GERD). If left untreated, it can sometimes cause serious complications.


Acid regurgitation can cause an uncomfortable burning sensation in the chest, which can radiate up to the neck, shoulders and jaw. This feeling is often described as a heartburn. If you have acidic regurgitation in the oral cavity, you can get a sour or bitter taste in the oral cavity. In some cases, GERD can cause difficulty swallowing. It can sometimes lead to breathing problems, such as a chronic cough or asthma.

At GERD, the dynamics of reflux symptoms are often typical. Symptoms may occur after meals, when bending forward, when lifting weights and when lying down. The disease is usually chronic with either continuous or intermittent disorders. Atypical symptoms are often described as a non-stinging pain behind the sternum, swallowing disorders, coughing and hoarseness.


The lower esophageal sphincter (LES) is a circular muscle band at the end of the esophagus. When it works properly, it relaxes and opens when swallowing. Then it tightens and closes again afterwards. Leakage of gastric acid occurs when your LES does not tighten or close properly. This allows gastric juices and other contents from the stomach to rise into the esophagus. At GERD there is almost always a hernia in LES, which leads to a decrease in the rest pressure in the sphincter (the cause of hernia of LES is not known). Reflux problems can also occur without a hernia, in these cases it is more due to a disturbed motor function of the stomach.

Treatment options

To prevent and alleviate symptoms of GERD, your doctor may encourage you to change your eating habits or other behaviours.

Medicinal products obtained without a prescription

Antacids (gastric acid neutralizing drugs) H2 receptor blockers of proton pump inhibitors (PPI) are the most common treatment option. In some cases, they may prescribe stronger H2 receptor blockers or PPI. If the symptoms are severe and do not respond to other treatments, surgery may be recommended.

Some over-the-counter and prescription medicines may cause side effects. Read more about the medications available to treat GERD.

Surgical treatment options

In most cases, lifestyle changes and medications are sufficient to prevent and alleviate symptoms of GERD. Sometimes surgery is needed to correct the problem. For example, your doctor may recommend surgery if lifestyle changes and medications alone have not stopped your symptoms. They can also suggest surgery if you have developed complications of GERD. There are several types of operations available to treat GERD.

How to diagnose GERD?

If your doctor suspects that you may have GERD, they will perform a physical examination and ask about any symptoms you have experienced. They can use one or more of the following procedures to confirm a diagnosis or control complications of GERD:

Barium contrast with X-ray: after drinking a barium solution, radiological methods are used to examine the upper gastrointestinal tract and sphincter that prevent leakage into the stomach.Endoscopy: a flexible tube with a small camera is inserted into the esophagus to examine the esophagus and stomach, during This study can also take a sample of the stomach tissue (biopsy) if necessaryOphageal manometry: a flexible tube is inserted into the esophagus to measure the strength of the esophageal muscleEsophageal pH monitoring: a monitor is placed in the esophagus to find out when and if gastric acid gets up into the esophagus.

GERD in infants

Approximately two-thirds of all children under 4 months of age have symptoms of GERD. Up to 10 percent of 1-year-old children are affected by it. It is normal for babies to spit up food and vomit occasionally. But if your child spits up food or vomits frequently, they may have GERD.

Signs and symptoms of GERD in infants

Refusal to eatProblems swallowHicAirritability during or after food intake Weight loss or poor growthRecurrent cough or pneumonia difficulty sleeping

If you suspect that your child may have GERD or any other state of health, make an appointment with his doctor.

Risk factors for GERD

Factors that may increase the risk of developing GERD

Obesal esophageal hernia of the diaphragm

Lifestyle factors that may increase the risk of GERD

SmokingEating large mealLie down or fall asleep shortly after eatEating certain types of foods, such as deep fried or spicy foodDrinking certain types of drinks, such as soft drinks, coffee or alcohol Use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen

If you have any of these risk factors, measures to change them can help you prevent or manage GERD.

Complications resulting from GERD

Most people with GERD do not suffer serious complications, but in rare cases it can lead to serious or even life-threatening health problems.

Potential complications of GERD:

Esophagitis: an inflammation of the esophageal stricture: esophagus becomes narrow and narrow Barrett’s esophagus: implies permanent changes in the mucosa of your esophageal esophageal cancer: affects a small percentage of all people with Barrett’s esophageal asthma: chronic cough or other breathing problems that can occur if you inhale gastric acid in the lungstooth enamel: erosion, gum disease (paradontitis) or other dental problems

To reduce the risk of complications, it is important to take measures to prevent and treat the symptoms of GERD.

Diet and GERD

In some people, certain types of foods and drinks trigger symptoms of GERD. Common foods that trigger symptoms include:

Foods with high fat content Spicy foods chocolate citrus fruitsAnastomate garlic mintAlcohol coffee

Home cure for GERD

There are several lifestyle changes and folk remedies that can help alleviate GERD symptoms.

Tips that Can Relieve GERD Symptoms

Stop smokingEat smaller mealsUse chewing gum after eatAvoid lying down after eatAvoid food and drinks that trigger your symptoms Avoid wearing tight clothesExercise techniques that will help you relax

Although more research is needed, some people report that they experience relief from acid regurgitation after taking dietary supplements, tinctures or teas containing these herbs. But in some cases, herbal remedies can cause side effects or interact with certain medications. Examine the potential benefits and risks of using herbal remedies to treat GERD. Always discuss the use of herbal remedies with your treating doctor or other healthcare professional.

Anxiety and GERD

Anxiety can aggravate some of the symptoms of GERD. If you suspect anxiety makes your symptoms worse, consider talking to your doctor about strategies to alleviate it.

A few things you can do to reduce anxiety

Limit your exposure to experiences, people and places that make you feel anxiousExercise relaxation techniques, such as meditation or deep breathing exercisesAdjust your sleep habits, exercise or other lifestyle behaviorIf your doctor suspects you have an anxiety disorder, they may refer you to a psychologist or psychiatrist for diagnosis and treatment. Treatment of anxiety disorder may include medication, cognitive therapy or a combination of both.

Diabetes and GERD

The incidence of GERD is increasing. There definitely seems to be a connection between overweight and GERD. In fact, people who are overweight are 50% more likely to develop GERD compared to normal weight individuals, people suffering from obesity have a 200% increased risk. It may be that abdominal obesity causes LES to relax, one hypothesis is that molecules and other chemicals released from adipose tissue can cause a relaxation in LES.

We know that many people with type 2 diabetes are overweight, so it makes sense that GERD is more common in these individuals. But it also seems that type 2 diabetes is a risk factor for GERD, regardless of body weight. A study published in 2008 in the World Journal of Gastroenterology found that GERD affects about 40% of all people with diabetes. The researchers also found that GERD is more common in people with diabetes who also had neuropathy, or nerve damage, which is a common complication of diabetes. People in this study who had diabetes and neuropathy were more likely to get GERD, regardless of weight, compared to people without neuropathy.

Gastroparesis, which is a type of neuropathy affecting the digestive tract, this diabetes-related complication increases the risk of GERD. In gastroparesis, the stomach becomes very slow in emptying the contents of the stomach into the small intestine, resulting in nerve damage around the stomach. Food remains in the stomach for too long, which increases the pressure in the stomach. This pressure can cause the LES to relax, which allows reflux of the gastric contents into the esophagus. Other symptoms of gastroparesis include nausea, vomiting, bloating and early feeling of satiety.

Pregnancy and GERD

Pregnancy may increase your chances of experiencing acid reflux. If you had GERD before you became pregnant, your symptoms may get worse.

Hormonal changes during pregnancy can cause the muscles of the esophagus to relax more often. A growing fetus can also put pressure on the stomach. This can increase the risk of gastric acid entering the esophagus.

Many drugs used to treat acid reflux are safe to take during pregnancy. However, in some cases your doctor may advise you to avoid certain antacids or other treatments. Learn more about the strategies you can use to deal with acid regurgitation during pregnancy.

Asthma and GERD

Some studies have reported that more than 75 percent of all people with asthma also experience GERD. More research is needed to understand the exact relationship between asthma and GERD. It is possible that GERD can exacerbate asthma symptoms. However, asthma and some asthma medicines may increase the risk of getting GERD. If you have asthma and GERD, it is important to deal with both conditions.


Irritable Bowel Syndrome (IBS) is a condition that can affect your large intestine. Common symptoms include:

Abdominal painbloatingConstipation diarrhea According to a recent study, GERD-related symptoms are more common in people with IBS than in the population in general.

If you have symptoms of both IBS and GERD, make an appointment with your doctor. They may recommend changes to your diet, medications or other treatments.

Drinking alcohol and GERD

In some people with GERD, some foods and drinks can make symptoms worse. These dietary triggers may include alcoholic beverages. Depending on your specific triggers, you may be able to drink alcohol in moderation. However, for some people, even small amounts of alcohol trigger the symptoms of GERD. If you combine alcohol with fruit juices or other mixers, these “drinks” can also trigger symptoms.

The difference between GERD and heartburn

Heartburn is a common symptom of reflux of gastric acid. Most people experience the symptoms sporadically, and in general, temporary heartburn is not a cause for concern. But if you get heartburn more than twice a week, you might have GERD. GERD is a chronic type of acid regurgitation that can cause complications if left untreated.

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