What is GERD? Symptoms can vary from one individual to another, but GERD is a stomach condition where the stomach acid get regurgitated / refluxed back up into the esophagus.
The main symptoms of GERD are acid indigestion or heartburn, acid reflux and nausea, although there are a number of other symptoms that can be present with GERD. Not everyone will have the same combination of symptom.
Reflux / Regurgitation
The Majority of people who have GERD have acid reflux where stomach contents are regurgitated into the esophagus. In the majority of cases, the stomach acid is only regurgitated into the lower part of the esophagus causing acid indigestion or heartburn. Some people report stomach contents being refluxed into the top of the esophagus and it can even reach the back of the mouth. In cases where there is regular reflux of stomach contents into the mouth some dental erosion can take place due to the acid.
Reflux can cause heartburn with stomach acid being regurgitated or refluxed into the esophagus causing burning to the lining. This causes a pain, often talked of as a burning sensation in the centre of the chest, behind the breast bone. The sensation can also be felt in the neck and back of the throat. Some sufferers describe it as feeling like a pressure in the chest, a sharp pain and is sometimes confused with a heart condition such as angina.
Heartburn tends to happen soon after eating, simply because this is when the most stomach acid is produced and because of the increased pressure in our stomachs it is also when when acid is most likely to be refluxed into the esophagus. It can also happen frequently at night.
Nocturnal acid reflux causing heartburn comes about because when we are lying down it is easier for stomach acid to be regurgitated. Saliva production also reduces at night as does our swallow reflex, letting refluxed stomach acid to stay in contact with the lining of the esophagus for longer. This can allow acid to be aspirated into the lungs at night causing irritation to the lining of the lungs.
Nausea / Vomiting
Although one of the more uncommon symptoms, unexplained vomiting or nausea are both considered possible symptoms.
When acid from the stomach refluxed into the throat, it can attack the lining, larynx and voice box leading to damage to the vocal chords. This can lead to patients experiencing hoarseness in the mornings.
Inflammation of the lining esophagus caused by regurgitated stomach acids is known as esophagitis.
Esophageal Ulcers / Ulcerated Esophagus
In cases where esophagitis is particularly severe, the esophageal lining can develop ulcers with small sections of the lining destroyed by the corrosive effect of acid. In severe cases where ulcers become further damaged by acid, it can develop into bleeding in the esophagus.
As the lining of the esophagus heals it can lead to scar tissue forming resulting in strictures of the esophagus. Scar tissue is less flexible and often builds up effectively narrowing the esophagus making it hard to swallow, a condition known as dysphagia.
Coughs and Asthma Like Symptoms
Damage to the esophagus can lead to a chronic cough in some GERD patients. In some cases stomach acid can be aspirated (breathed into) the lungs causing irritation and damage to the lining of the lungs. If allowed to continue this can lead to chest infections, pneumonia and scarring of the lungs, a condition known as pulmonary fibrosis
In prolonged or severe cases of acid reflux the lining of the esophagus can change to resemble the stomach lining. Our stomachs have a mucus layer that protects them from the effects of stomach acid. In people who have developed Barretts, the cells in the lower esophagus change to develop a protective mucus membrane in response to the repeated exposure to acid. As cells change they can be left susceptible to developing cancer and there is an increased incidence of cancer of the esophagus in people with Barrett’s Esophagus.
Most GERD cases can be treated effectively with lifestyle changes and with the help of medication. Where this fails to be effective there are various surgical procedures that can be tried.