Gastroesophageal Reflux Disease (GERD)

  • Basics

    Gastroesophageal reflux disease (GERD) is a chronic condition in which there is a backflow (reflux) of stomach acid into the food pipe (esophagus).

    GERD is a condition in which acid from the stomach repeatedly escapes upward into the esophagus, exposing the sensitive lining of the esophagus to stomach acid. The most common symptoms of GERD are heartburn (a burning sensation in the throat and chest) and regurgitation (a sensation of acid or stomach material “coming back up”).

    Almost everyone occasionally experiences a reflux of acid from their stomach into their esophagus. In most people, reflux symptoms (such as heartburn) are mild and do not last long. However, for millions of people the symptoms are chronic (recurring).

    GERD can cause frequent heartburn. People who suffer from GERD usually have heartburn two or more times a week, and the heartburn lasts for more than a couple of hours.

    GERD is a bothersome condition. It is usually not serious; however, it can sometimes lead to more serious conditions. The repeated backflow of acid from the stomach can irritate, inflame, and eventually erode the internal lining of the esophagus. This condition is referred to as esophagitis. A serious complication of GERD, called Barrett's esophagus, may later develop in a small percentage of cases. Barrett's esophagus can increase the risk of cancer of the esophagus. Esophageal bleeding and difficulty swallowing can occur as a result of chronic GERD.

  • Causes

    GERD can be caused by the malfunction of the lower esophageal sphincter (LES) and other problems Figure 01.

    The LES is responsible for closing and opening the lower end of the esophagus and is essential for keeping food and acid in the stomach. The LES can be weakened by certain foods and drugs or by injury. When the LES is weak, it does not close completely after food enters the stomach or it doesn't stay closed. This allows acid to back up from the stomach into the esophagus Figure 01.

    The diaphragm, a flat muscle that separates the lungs from the abdomen, also helps to keep contents in the stomach. When there are problems with the diaphragm, such as a hiatal hernia, GERD symptoms can occur.

    Other problems that can cause GERD include defects or injuries in the lining of the esophagus, problems with peristalsis (the wave-like muscle contractions of the esophagus that move food down into the stomach), or overly acidic stomach contents.

    Click to enlarge: The anatomy of GERD

    Figure 01. The anatomy of GERD

    Although researchers do not know why, about 50% of asthma patients also have GERD.

    Some scientists think that the coughing and sneezing that happens with asthma changes the pressure in the chest, which may allow abnormal acid backflow from the stomach into the esophagus. In addition, certain asthmatic drugs that open up the airways may also relax the LES, allowing reflux.

    Treatment for certain types of bacterial infection can trigger GERD.

    Approximately 20% to 30% of patients treated for Helicobacter pylori (or H. pylori), a type of bacterial infection associated with peptic ulcers, may develop GERD. Researchers believe that H. pylori protects against GERD by lowering stomach acid. Ridding the body of H. pylori removes this protection.

    Crohn's disease and other medical conditions can contribute to GERD.

    Crohn's disease causes inflammation in the small intestine. It usually occurs in the lower part of the small intestine, but it can affect any part of the digestive tract, from the mouth to the anus. Crohn's disease can cause inflammation of the esophagus and may contribute to the development of GERD.

    Other conditions that are associated with GERD include diabetes, scleroderma (a disease that causes the hardening of the skin), peptic ulcers (sores or inflamed areas that form in the lining of the esophagus, stomach, or small intestine), and certain forms of cancer. Pregnancy can also cause GERD.

    Heredity may influence the severity of GERD.

    Your genes may make you more vulnerable to Barrett's esophagus, a precancerous condition caused by severe GERD.

Recommended Reading

Meet the Pharmacists

I'm Kristen Dore, PharmD. Welcome to PDR Health!

Check out my latest blog post on heartburn medication

Gastroesophageal Reflux Disease (GERD) Related Drugs

Gastroesophageal Reflux Disease (GERD) Related Conditions