By Dr Ananya Mandal, MD
Gastro-Esophageal Reflux Disease (GERD) is one of the most common digestive disorders. The most frequent symptoms are heart burn and discomfort in the chest.
Although symptoms of the condition are varied they may be characterized by three cardinal features – heart burn, acid reflux or regurgitation in the mouth and difficulty swallowing.
Heartburn refers to a feeling of discomfort or burning pain that occurs beneath the breast bone. The pain is caused due to irritation of the inner lining of the esophagus by the acid that has seeped back.
The pain worsens after eating or when bending over or lying down. This causes back pressure over the lower esophageal sphincter that guards the entry of the stomach. This back pressure yields the sphincter and causes reflux of the acid.
Regurgitation of reflux
This leads to reflux of the acid from the stomach into the back of the mouth. This causes a sour or bitter taste at the back of the mouth or throat.
Around a third of individuals with GERD may suffer from swallowing problems or dysphagia. This happens when long term acid exposure leads to irritation and inflammation of the inner linings of the esophagus causing esophagitis.
This esophagitis may progress to open ulcers and sores. As the ulcers heal they may lead to narrowing of the esophagus and scarring. This causes difficulty in food to pass through and leads to dysphagia.
People with GERD-associated difficulty in swallowing feel like a piece of food has become stuck somewhere near their breastbone.
Other symptoms of GERD
Other symptoms of GERD include:
Some patients may experience nausea and some may even vomit due to persistent back pressure on the esophagus.
A persistent regurgitation of the acid into the throat and back of the mouth particularly at night may lead to a persistent dry cough. This occurs because the back of the throat is irritated. In 6 to 10% of patients with chronic cough, GERD is the underlying cause.
There may be repeated burping in some individuals.
Some patients experience water brash or excessive salivation.
Chest pain from GERD may mimic a heart attack or pain from angina.
Seepage of the acid into the wind pipe may lead to inflammation of the larynx or voice box. This leads to laryngitis and manifests as a hoarse and raspy voice.
If the acid seeps into the airways, it may lead to worsening of symptoms of asthma and cause wheezing. This occurs due to irritation of the linings of the airways.
Persistent effects of the acid in the mouth lead to decaying and erosion of the enamel of the teeth. This is outer hard, white layer of the tooth. Thus tooth decay may be seen in patients of GERD.
There may be pain over the abdomen and bloating in some individuals.
In some patients seepage of acid into the lungs may lead to pneumonia, lung abscess, and interstitial pulmonary fibrosis.
Most children under 12 years with GERD, and some adults, have GERD without heartburn or other common symptoms. Instead, they may experience a dry cough, asthma symptoms, or difficulty in swallowing. (1-7)
Symptoms may occur once or twice a month usually after a triggering factor like a high fat or spicy meal or after a particularly heavy meal. In these patients symptoms may be controlled by lifestyle measures and occasional over the counter medications.
However, when symptoms are more frequent prescription medication may be needed to control the condition and prevent complications.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Aug 12, 2012