Gastroesophageal reflux disease (GERD) is a chronic condition that affects nearly 20 percent of American adults, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It costs the United States more than $9 billion each year with more than half of that cost being spent on medications. People with GERD spend billions on over-the-counter and prescription medications to combat their most common symptom: painful heartburn.
While most people experience occasional heartburn, GERD is a chronic condition with symptoms that can occur daily. GERD can cause serious complications over time if it’s left untreated.
When a person swallows, a complex set of muscles in the mouth and tongue close off the windpipe to protect the lungs and move the food into the esophagus (a narrow tube connecting the throat to the stomach).
At the bottom of the esophagus is a ring of muscles known as the lower esophageal sphincter (LES). A healthy LES encircles the food and pushes it into the stomach. In GERD patients however, the LES relaxes and allows stomach acid to enter the esophagus. This causes a painful burning sensation in the mid-abdomen.
While the stomach has a tough lining to resist the acid, the esophagus doesn’t. Therefore, sensitive esophageal tissue may be injured over time. The acid will often back up into the mouth, where it will damage other structures along the way.
Complications of GERD may include:
- Barrett's esophagus
- erosive esophagitis
- narrowing of the esophagus
- damage to the throat, teeth, and airways that lead to the lungs
Symptoms can be serious, especially in older people. They may include a severely inflamed esophagus and muscle abnormalities.
Barrett’s esophagus (BE) is a condition in which the lining of the esophagus becomes more like the lining of the stomach and intestines. It’s most often caused by irritation from GERD. Someone with BE is at risk for esophageal cancer due to abnormal changes in the cells of the esophagus. According to the NIDDK, only a small percentage of those with GERD will also have BE. The average age for diagnosis is age 55.
Obesity, smoking, and alcohol use have all been identified as risk factors for BE. However, their role remains unclear. Those with both BE and symptoms of GERD are at a higher risk of developing esophageal cancer.
Acid irritation and inflammation can injure the esophagus over time, creating a condition known as erosive esophagitis. Those who are obese (especially Caucasian males) are at the greatest risk for developing erosive esophagitis.
Some people with the condition also experience bleeding. This can be seen in dark-colored stools or bloody vomit. Ulcers in the esophagus can cause long-term bleeding, which may result in iron-deficiency anemia. This is a serious condition that requires immediate attention.
The esophagus may become severely injured over time. This can result in a narrowed band-like area known as a stricture. A stricture may result in dysphagia (impaired swallowing). Stricture may occasionally stop other symptoms of GERD by preventing acid from travelling up the esophagus.
Erosion of tooth enamel from acid backing up into the mouth is very common among those with GERD.
GERD and Asthma
There is an undeniable connection between GERD and asthma. The two conditions often appear together. Researchers believe that acid may back up into the esophagus, triggering changes to the immune system that lead to asthmatic conditions. Also, the airways and lungs can become irritated by acid reflux, increasing asthma symptoms.
Asthma may lead to GERD in some people as well, although the reasons why are still unclear. Also, those with GERD are at an increased risk for a host of other respiratory and throat conditions, including:
- chronic bronchitis
- chronic laryngitis
- chronic sinusitis
- chronic cough
- difficulty speaking
- granulomas (pink bumps on the vocal cords)
- hoarse voice
- pneumonia (often recurring and serious)
- pulmonary fibrosis (lung scarring)
- sleep apnea
- constant throat clearing
Most people with GERD have mild symptoms that can be treated successfully by lifestyle changes such as:
- quitting smoking
- losing weight
- eating smaller portions at meals
Also, avoiding certain foods that trigger GERD symptoms can provide relief. Foods to avoid include:
- citrus fruits
- colas and other carbonated beverages
- fried and fatty foods
- tomato sauce
Adopting lifestyle changes usually allows the body to heal itself in the majority of cases, and it means there won’t be long-term damage to the esophagus, throat, or teeth. However, sometimes lifestyle changes are not enough. More serious cases of GERD can often be treated with medications such as:
- a coating agent (Carafate, generically known as sucralfate)
- histamine H2-receptor antagonist or H2-blockers (Pepcid, known generically as famotidine; Zantac, known generically as ranitidine)
- a motility agent (Reglan, known generically as metoclopramide)
- proton pump inhibitors (Prevacid, known generically as lansoprazole; Prilosec, known generically as omeprazole)
Surgery can be a very effective treatment for GERD patients who don't respond to other treatments. Once GERD symptoms are under control, no further damage to the esophagus, throat, or teeth will occur.
While GERD can be a painful disturbance to your lifestyle, it doesn’t affect your lifespan. Those who are able to resolve their symptoms will resume a normal, healthy life.