A guide to identifying symptoms of gastroesophageal reflux disease (GERD).
An overview of Gastroesophageal Reflux Disease (GERD)
Do you often experience abdominal or chest discomfort after meals? Is heartburn a common occurrence after certain meals? Do you find it distressing on some evenings to retire for sleep after dinner?
Then, there is a chance you are suffering from gastroesophageal reflux disease (GERD). GERD is a chronic digestive disorder where your stomach’s contents (acidic juices, food, fluids) flow backwards up the oesophagus.
GERD affects people of all ages, from infants to seniors. If you suspect you might be suffering from GERD, it is wise to seek help:
You are likely to require a gastroscopy procedure to diagnose chronic GERD damage. If these are present, your physician will recommend preventive actions, such as lifestyle or diet changes.
Medications will alleviate most of these symptoms and damage. Let’s break down exactly what GERD is and what you can do about it so that this common condition does not negatively impact your quality of life.
What are the common symptoms of GERD?
Gastroesophageal reflux is a very common occurrence. Reflux sometimes occurs after an over-indulgence at a meal and when you belch. Because these occurrences are infrequent, they do not impact your well-being in a significant way.
If gastroesophageal reflux occurs frequently, even with regular food intake, it can be rather distressing, to say the least and may interfere with your social life. This may be a signal to visit your doctor for an assessment and evaluation.
Patients with GERD may report some of the following symptoms. Some of these symptoms are experienced immediately or not long after a meal, while some present as insidious chronic symptoms.
- Acid regurgitation or acid brash: a sour taste in the mouth, especially after a heavy meal, combined with plenty of fluid ingestion, such as alcohol.
- Excessive saliva in the mouth.
- Heartburn or a sharp burning pain in the mid-chest.
- Difficulty or pain when swallowing. Sometimes, it may feel like a “lump in the throat”, as if something is stuck mid-way in the oesophagus. Some sufferers feel the need to clear their throat all the time – “throat-clearers”.
- Chronic cough
- Laryngitis, which is an infection of the larynx. This may present as recurrent sore throat or hoarseness without an apparent reason.
- Inflammation of the gums, cavities and bad breath are consequences of excessive acid reflux from GERD.
Given that some of these symptoms may be mild, most sufferers tend to ignore them until they occur with a certain degree of frequency. If that should happen, it might be time to seek medical attention.
What are the causes and risk factors of GERD?
GERD is a disorder of the digestive tract. It occurs when the lower oesophageal sphincter muscle fails to maintain its function. To understand how GERD happens, we must first understand the normal digestive physiology.
The lower oesophageal sphincter (LES) is a muscle located between the oesophagus and the stomach. When food is being swallowed, the sphincter naturally relaxes to allow food to pass into the stomach. Once this is done, the LES receives a signal to tighten, thus sealing the oesophagus off so that gastric juices and the food being digested in the stomach do not flow back up.
Thus, it functions as a gatekeeper or a one-way valve. GERD occurs when this function fails, resulting in digested food and fluid flowing back up into the oesophagus unhindered.
There are many known food triggers for GERD. These include the consumption of unusually large meals or consuming certain food types (e.g high-fat content, chocolate, peppermint). Coffee, tea, and alcohol are very common offenders too.
Lifestyle factors can also lead to a higher risk of developing GERD. Being overweight or obese leads to increased pressure within the abdomen, which affects the proper functioning of the lower oesophageal sphincter. Smoking or inhaling second-hand smoke is also a trigger factor.
Pregnant women may also find themselves at higher risk of developing GERD, as there is increased pressure on the abdomen in the presence of hormonal changes. It is not uncommon for some pregnant women to experience heartburn on a regular basis.
A common anatomical reason for GERD is the presence of a diaphragmatic or hiatal hernia. In this setting, the LES sits above the diaphragm and is no longer optimised to perform its function.
Which diagnostic scope procedure is needed?
Common scope procedures to diagnose GERD include a gastroscopy (upper endoscopy) as well as nasendoscopy.
A gastroscope (tube-like contraption with fibreoptic function) is inserted under sedation through the mouth into the oesophagus, stomach and duodenum with air insufflation.
This enables the physician to evaluate for evidence of acid reflux and damage to the lining of the oesophagus.
For chronic GERD, it is important to survey for such changes that may indicate a change towards cancer. Usually, biopsies are taken during the scope procedure to determine if such changes have taken place or whether cancer or a pre-cancerous condition is present.
The frequency of a surveillance gastroscopy is determined by the severity of symptoms and the presence of established changes in the lining as seen in previous scopes.
A nasendoscope is a similar fibreoptic tube that is thinner and shorter. It is inserted through the nostril and into the back of the nose and throat. No air insufflation is needed, and it is performed in the specialist clinic without sedation.
Evidence of GERD is determined through changes seen in the lining of the back of the throat as well as around the larynx (voice box). When suspicious changes such as discolouration or loss of smooth lining or polyps are seen, a biopsy is also performed to determine if a pre-cancerous or cancerous change has taken place.
How to prevent and treat GERD?
While GERD has the potential to severely interfere with your daily life, there are actionable steps to prevent this from happening:
By observing some lifestyle changes together with the appropriate medical treatment, you can alleviate the symptoms of GERD.
Avoiding large meals or binge-eating can reduce the risk of GERD. As does weight reduction and regular physical exercise. Avoid alcohol, caffeinated or carbonated beverages at meal times avoiding certain unique trigger foods is also a good strategy to prevent GERD occurrence. Ultimately, it is important to have an awareness of what the unique triggers of GERD are for you and avoid them. You may keep a food diary to aid in this exercise.
If you are interested in discussing more about GERD or need a proper assessment, such as a gastroscopy or nasendoscopy, you may contact us to fix an appointment.