Burning question: What causes GERD? How to find fast relief

Recognize the burning symptoms of gastroesophageal reflux disease so you can find fast relief and get back to enjoying the foods you love

 

By Adam B. Gorelick, MD, Gastroenterology, Nuvance Health

 

Nothing can ruin a tasty meal faster than an uncomfortable case of indigestion. The feeling of heartburn and indigestion have at one time or another happened to almost everyone and for some people, it can be a painful and unpleasant experience.

 

Having occasional feelings of indigestion and heartburn may be normal for some people depending on a variety of factors including certain food sensitivities. But when these painful episodes begin to happen to you regularly, it may mean that something more serious is happening such as gastroesophageal reflux disease.

 

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What is gastroesophageal reflux disease or GERD?

Gastroesophageal reflux disease, better known as GERD, happens when stomach acid and stomach contents splash back up into your lower esophagus, the tube through which food passes to get from your mouth to your stomach. Once acidified, the contents from your stomach cause discomfort and pain when they travel back up.

 

The main culprit is hydrochloric acid that is created by your stomach in order to digest food. There is a circular band of muscle (lower esophageal sphincter) at the end of the esophagus that relaxes to allow food to enter the stomach. The sphincter then closes again. If the sphincter is weak or does not function correctly, stomach acid can rise up into the lower esophagus. This constant backwash of acid causes irritation in the esophagus lining and causes a burning and uncomfortable feeling in your chest. 

 

Learn more about acid reflux and gastroesophageal reflux disease (GERD)

 

What are the symptoms of gastroesophageal reflux disease?

 

GERD has the following symptoms, but the most common ones include heartburn, indigestion or discomfort:

• Heartburn, caused by acid reflux, feels like burning in your chest, throat, or mouth. It gets worse when you lie down, bend or breathe deeply.
• Backwash or regurgitation of food or acidic liquid
• Upper abdominal or chest pain
• Trouble swallowing
• Sensation of a lump in your throat

 

Nighttime symptoms can cause you to experience cough, laryngitis or asthma.

 

Learn more about acid reflux and take a heartburn quiz

 

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What are the main complications of gastroesophageal reflux disease?

 

If left untreated, GERD can lead to other health conditions such as esophagitis, esophageal strictures, aspiration, gastrointestinal (GI) bleeding, a precancerous condition called Barrett's esophagus, and esophageal cancer.

• Esophagitis is when the esophagus gets red and swollen. This can make sores (ulcers) and bleeding occur. If it keeps happening for a long time, it might make your esophagus narrower because of inflammation (stricture) and raise the chance of other problems like Barrett's esophagus.
• Esophageal strictures happen when the swallowing tube becomes too narrow. Strictures can be caused by inflammation, scar tissue, or abnormal growths in the esophagus. The majority of esophageal strictures are believed to be the result of GERD.
• Aspiration happens when you accidentally inhale foreign objects such as food, liquids or stomach contents into your breathing tube and lungs. This can cause problems like trouble breathing, infection and possibly choking.
• GI bleeding is a sign of a bigger issue, often linked to certain other diseases. But GERD can lead to bleeding of the GI tract when severe esophagitis occurs.
• Barrett’s esophagus is a precancerous condition that can occur in people who regularly experience acid reflux. Barrett's esophagus sometimes happens as a result of GERD when stomach acid damages the tissue in the esophagus. If you have Barrett's esophagus, there's a higher chance, although small, that you might get esophageal cancer later on.
• Esophageal cancer occurs in the esophagus when unhealthy cell growth develops. The cancer begins on the inside lining of the esophagus and can move to the outer layers and even to other parts of your body. Learn more about esophagus cancer.

 

What are the risk factors for gastroesophageal reflux disease?

 

GERD develops over time when stomach acid splashes up through the lower esophageal sphincter. The weak seal between the stomach and the esophagus creates a path for stomach acid and partially digestive food to flow back up into your chest. However, there are certain factors that may increase GERD such as making too much stomach acid or having higher than normal intragastric pressure. 

• Hiatal hernia is a bulging of the stomach above the diaphragm that impacts the ability of the esophageal sphincter to keep acid and stomach contents from traveling back up into the esophagus. This leads to frequent heartburn, acid reflux and GERD.
• Producing more hydrochloric acid is a common cause of GERD and can occur when your body produces more stomach acid than it should. Other factors that play a role in high production of stomach acid are related to: pregnancy, obesity, consuming large meals and gastroparesis (poor stomach emptying).
• Using nonsteroidal anti-inflammatory drugs or NSAIDS. The constant use of pain and inflammation reducers such as NSAIDS like ibuprofen can increase the risk of GERD symptoms. Overuse of NSAIDS also increases chances for stomach bleeding and other stomach and GI-related problems.
• Lifestyle choices such as smoking and drinking alcohol reduces the pressure of the lower esophageal sphincter enabling more stomach acid to enter up into the esophagus. The more stomach acid enters the esophagus, the higher chance there is that your esophagus could become damaged.

 

How is gastroesophageal reflux disease treated?

 

If you have GERD symptoms, find a gastroenterologist near you for an assessment. At Nuvance Health, you will receive care from gastroenterologists who specialize in heartburn and upper GI diseases. Your gastroenterologist can detect and treat acid reflux and GERD in earlier stages, lowering the risk of complications.

 

Lifestyle changes that can help gastroesophageal reflux disease 

Nuvance Health doctors often suggest making dietary or other lifestyle changes to reduce reflux and damage caused by GERD. In fact, these changes are often the first step in reducing GERD because people with mild acid reflux symptoms often find that their discomfort is eliminated with lifestyle modifications.

These lifestyle changes can often improve GERD:

• Avoid lying down for at least two hours after a meal.  This can help prevent stomach contents from moving back into the esophagus.
• Keep your head elevated while sleeping. Using a wedge pillow can help prevent reflux.
• Eating smaller and more frequent meals instead of a few large meals will help with digestion and can prevent reflux
• Wear loose fitting clothing to help decrease the pressure on your abdomen which can worsen GERD
• Quit smoking. Smoking worsens reflux for several reasons. It can increase the production of stomach acid and reduce the function of the lower esophageal sphincter (the muscle that keeps acid from moving from the stomach into the esophagus). Smoking also decreases saliva which plays an important role in neutralizing acid produced in the stomach.
• Reduce any excess weight around the midsection. Like tight clothing, this increases pressure on the abdomen which can force stomach contents back up into the esophagus.

 

Dietary changes to improve GERD

Diet is a big lifestyle change that can help GERD. Many people can get some relief from their symptoms by eliminating trigger foods. These foods include chocolate, coffee, fried foods, peppermint, spicy foods and carbonated beverages.>

Related content: Heartburn trouble? Here are the worst and best foods for acid reflux

 

There are plenty of things you can eat to help prevent acid reflux. High fiber foods make you feel full so you’re less likely to overeat, which may contribute to heartburn. These types of foods include whole grains such as oatmeal and brown rice, root vegetables such as sweet potatoes, carrots and beets, and green vegetables such as asparagus, broccoli and green beans.

Alkaline foods can help counter the acid produced in the stomach. These types of foods include bananas, melons, cauliflower and nuts. Finally, foods that contain a lot of water can help dilute stomach acid. In this case choose foods such as celery, cucumber, lettuce, watermelon, and broth-based soups.

Medications that can help gastroesophageal reflux disease

Your doctor may suggest the use of antacids in order to provide relief from both GERD symptoms and to neutralize stomach acid. Medications may also be used to reduce the amount of stomach acid your body creates. These medications are called histamine blockers and they provide longer lasting relief from GERD symptoms. However, antacids and histamine blockers will not heal an esophagus that has been inflamed and damaged from stomach acid.

 

Medications that block stomach acid production may be used in order to heal the damaged and inflamed esophagus tissue. These medicines are available as proton pump inhibitors and provide up to 24-hour relief. However, if these medications do not work, your doctor may prescribe additional alternatives.

 

Surgery for gastroesophageal reflux disease

Surgery may be an option depending on the severity of your GERD. You and your doctor should discuss the best approach. Your doctor may suggest minimally invasive procedures to either strengthen or correct your esophageal sphincter valve in order to improve gastroesophageal reflux disease.

 

The bottom line: Gastroesophageal reflux disease happens when stomach acid and stomach contents splash back up into your lower esophagus. While there are many risk factors for GERD, if the lower esophageal sphincter does not relax as it should or it weakens, acid can flow back into the esophagus.  If occurring frequently over time, GERD can cause damage to your esophagus. Gastroesophageal reflux disease can be managed with medicine that reduces the amount of acid in the stomach, but your doctor may recommend surgery if your GERD is more severe.