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Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms. Heartburn is a burning sensation in the lower chest. It is the main symptom of gastroesophageal reflux disease.

Causes

Heartburn occurs when gastric juices from the stomach flow up into the esophagus (tube connecting the mouth to the stomach).

Food travels down the esophagus to the stomach. The opening between the esophagus and stomach opens to let food enter the stomach. Normally it closes as soon as the food enters the stomach. With heartburn, the opening does not close tightly. Stomach acid flows into the esophagus (called acid reflux), causing the burning sensation. Other causes include diseases that interfere with food passing through the esophagus or cause excess acid production.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition and can include:

  • Obesity
  • Pregnancy
  • Hiatal hernia
  • Exercise immediately after eating (especially jogging or running)
  • Smoking
  • Alcohol use
  • Chocolate
  • Carbonated beverages, caffeinated beverages, and decaffeinated coffee
  • High-fat or high-carbohydrate foods and spicy foods
  • Certain medications, including:
    • Anticholinergics
    • Calcium channel blocking agents
    • Theophylline
    • NSAIDs
    • Quinidine
    • Tetracycline
    • Potassium and iron supplements
    • Anti-osteoporosis agent alendronate
  • Prior surgery for heartburn, including gastric reflux surgery and vagotomy
  • Asthma and the use of asthma medications
  • Peptic ulcer and its treatment
  • Certain diseases, including:
    • Diabetes
    • Cancer
    • Scoliosis
    • Cystic fibrosis
    • Nervous system diseases
  • Defects in the respiratory system or gastrointestinal system
  • Food allergies

Symptoms

Heartburn symptoms usually occur after overeating or lying down after a big meal. They may last for a few minutes or a few hours. The severity of symptoms depends on the reason the opening does not close, the amount of acid entering the esophagus, and how much the saliva is available to neutralize it.

Symptoms include:

  • Burning feeling that starts in the lower chest and may move up the throat
  • Feeling that food is coming back up
  • Sour or bitter taste in the throat
  • Pain that increases when bending over, lying down, exercising, or lifting heavy objects

If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:

  • Bleeding and ulcers in the esophagus
  • Difficulty swallowing
  • Vomiting blood
  • Black or tarry stools
  • Inflammation and scarring of the esophagus
  • Barrett's esophagus (precancerous condition of the esophagus that has no unique symptoms but can be diagnosed by periodic medical surveillance examinations involving endoscopy)
  • Dental problems (due to the effect of the stomach acid on the tooth's enamel)

Diagnosing GERD

Your doctor will ask about your symptoms and medical history, and perform a physical exam. He or she will usually make an initial diagnosis of GERD based on your symptoms. In some cases, other tests will be done to confirm the diagnosis or exclude other disorders.

These tests may include:

  • Upper GI Series – A series of x-rays of the upper digestive system are taken after drinking a barium solution.
  • 24-hour pH Monitoring – A probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus. This is done over a 24-hour period.
  • Manometry – This test measures muscle pressures in the lower esophagus.
  • Endoscopy – A thin, lighted tube with a tiny camera attached is passed down the throat to examine the esophagus and stomach.

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