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Gastroesophageal Reflux Disease, also known as GERD for short, is a condition in which gastric juices flows up the oesophagus (the gullet), causing irritation of the oesophageal lining. It is this irritation of the oesophageal lining that produces the troublesome symptoms and complications of GERD.
The lower oesophageal sphincter (LES) is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. When the LES fails to close properly, acid from the stomach is allowed to flow up the oesophagus.
Symptoms Of GERD
The main symptoms of GERD in adults are:
(i) Heartburn: the burning-type sensation or pain felt in the chest which may rise to the throat.
(ii) Acid reflux/regurgitation: in which there is a sour or bitter taste in the back of the throat or mouth.
Other less common symptoms of GERD include increased salivation, chest pain, a persistent dry cough, asthma-like symptoms, difficulty swallowing, a persistent sore throat or hoarseness of voice.
Causes of GERD
As mentioned earlier, GERD is caused by the failure of the lower oesophageal sphincter to prevent reflux of stomach acid into the oesophagus.
Factors that contribute to GERD include:
• Hiatal hernia: a hiatal hernia occurs when the upper part of the stomach and the LES move above the level of the diaphragm. Normally, the diaphragm helps the LES function properly, but when a hiatal hernia is present, mechanical and motility factors come into play in increasing the likelihood of GERD occurring.
• Obesity: obesity is associated with GERD.
• Pregnancy
• Smoking
• Zollinger-Ellison syndrome
• Scleroderma and systemic sclerosis: which can affect normal oesophageal motility.
• Hypercalcaemia: which can increase gastrin production, thus increasing gastric acid production.
• Use of certain medication
Complications of GERD
Chronic GERD, if undetected or left untreated, can result in several potential complications. These would include the following:
• Reflux Oesophagitis - chronic irritation by gastric acid leads to inflammation and possible ulceration at the lower end of the oeophagus.
• Oesophageal Stricture - chronic inflammation and fibrosis can lead to stricture formation.
• Barrett's Oesophagus - chronic irritation by gastric acid causes the normal lining of the oesophagus to be replaced by a lining more like that of the stomach or intestine (change of the epithelial cells from squamous to intestinal columnar epithelium). The risk of oesophageal cancer is increased significantly in patients with Barrett's oesophagus.
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