Gastroesophageal reflux disease (GERD): causes and essence

The diagnosis of GERD sounds more serious than ordinary heartburn, although they share the same mechanism. We explain what happens at the border of the esophagus and stomach, where acid reflux comes from, and at what point you should no longer just put up with it.

What gastroesophageal reflux disease is

The backflow of stomach contents into the esophagus is called gastroesophageal reflux. Everyone has it from time to time: after a heavy dinner or if you lie down right after eating. Gastroesophageal reflux disease is no longer a one-off episode but a chronic condition in which the backflow recurs regularly and symptoms occur two or more times a week, or the esophageal mucosa is damaged.

The scale of the problem is visible in the numbers: weekly GERD symptoms are reported by an average of 14.5% of people in Russia (range 6.4–23.6%), in Europe — 18.9%, in North America — 20.8%, in Asia — 10.2%. In 45–80% of patients with GERD, examination reveals esophagitis, that is, inflammation of the esophagus.

How gastroesophageal reflux occurs and the role of the stomach valve

Between the esophagus and the stomach lies a muscular ring — the lower esophageal sphincter. This is that very "valve": it lets food pass down and closes so that stomach contents do not rise back up. Reflux begins when the sphincter weakens or relaxes at the wrong moment.

The development of the disease is also promoted by: reduced ability of the esophagus to clear itself, the damaging properties of the contents of the stomach and duodenum, the inability of the mucosa to resist them, impaired gastric emptying, and increased intra-abdominal pressure.

Causes and risk factors of GERD

There are several causes; here are the main risk factors:

• excess weight or obesity
• pregnancy
• smoking and passive smoking
• hiatal hernia
• certain foods, drinks and medications, as well as stress and hormonal fluctuations

Acid reflux is also provoked by certain medications, for example anti-inflammatory painkillers such as ibuprofen, gastric ulcer and bacterial infection in the stomach. A separate factor is work that involves frequently bending the torso.

Symptoms of GERD and how it differs from ordinary heartburn

The main sign is heartburn: a burning sensation in the middle of the chest. The second common symptom is an unpleasant sour taste in the mouth due to gastric juice. There may also be a recurring cough or hiccups, hoarseness, bad breath, bloating, nausea. Usually everything worsens after eating, in a lying position and when bending forward.

Extraesophageal manifestations include cough and shortness of breath in a lying position, dry throat, white coating on the tongue, early satiety, vomiting, as well as iron-deficiency anemia.

The frequency of symptoms helps distinguish an ordinary occurrence from a disease. Episodic reflux happens to many people: after a large portion of food or if you lie down too soon after eating. But if symptoms occur two or more times a week or the backflow damages the esophageal mucosa, that is already a reason to suspect GERD.

How GERD is diagnosed

The diagnosis is made by a doctor: they ask about symptoms and medical history, and then decide which examinations are needed. The arsenal includes upper endoscopy (gastroscopy), in which a thin tube with a camera is passed through the mouth into the esophagus and stomach, and a biopsy, that is, analysis of a piece of tissue.

Also used are X-ray of the upper digestive tract, esophageal pH-metry (shows how often acid is refluxed and how long it remains there), esophageal manometry (checks how the organ moves food during swallowing) and transnasal esophagoscopy.

Complications and when to see a doctor

If GERD is not treated, inflammation of the esophagus, scarring and changes in the tissue of its mucosa — Barrett's esophagus — are possible. Among patients with esophagitis, Barrett's esophagus is found in 5–30% of cases. Reflux can also worsen asthma and cause chronic cough or hoarseness.

You should see a doctor in clear situations: heartburn almost every day, lifestyle changes and over-the-counter remedies do not help, food gets stuck in the throat, frequent nausea or vomiting, unexplained weight loss.

By itself this is not a reason to call an ambulance; 103/112 — if chest pain is accompanied by shortness of breath or pain in the jaw or arm, because this may be a sign of a heart problem.

The text is for reference: it explains the mechanism of GERD but does not replace a doctor's consultation — examinations and management are selected by a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer