Health Matters

Acid reflux

It’s not unusual to feel a painful burning sensation in your chest after you eat. However, you may have gastroesophageal reflux disease (GERD) if your acid reflux occurs regularly. This disease affects millions of people across the world and yet many of them have never heard of the condition and don’t know much about the recommendation to reduce their risk factors.

  • 783.95m

    cases of GERD globally in 2019 (1)

  • 8-33%

    estimated global prevalence (2)

GERD is a common clinical problem with significant morbidity and potentially decreased quality of life. Early recognition of symptoms is integral to preventing complications of GERD. Behavioural changes and advances in acid suppression remain integral to its treatment (3).

Symptoms

GERD ‘s condition is often overlooked and its symptoms are often misinterpreted.

The classic and most common symptom of GERD is heartburn. Heartburn is a burning sensation in the chest, radiating toward the mouth, as a result of acid reflux into the esophagus. Notably, GERD is a common cause of non-cardiac chest pain (3).

Furthermore, acid reflux may trigger bronchospasm, which can exacerbate underlying asthma, thereby leading to cough, dyspnea, and wheezing.  Some GERD patients may also experience chronic nausea and vomiting (3).

 

Complications

Left untreated, GERD can result in several serious complications (3):

  • Chronic esophageal inflammation (esophagitis), which can cause ulcers and bleeding in the lining of the esophagus.
  • Damages to the lining of the esophagus (Barett’s esophagus), which increases the risk of cancer called esophageal adenocarcinoma.
  • Narrowing of the esophagus (esophageal stricture), which may lead to problems with swallowing.

People affected by GERD can also develop complications in the mouth, throat, and lungs, such as asthma and chronic cough.

Treatement

GERD is usually curable. Some people try to modify their lifestyle, while others find relief in over-the-counter medications and other take antacids.

The goals of treatment in reflux disease, independent of presenting symptom, are to relieve symptoms, heal esophagitis, and prevent recurrence of symptoms and future complications. Some options to achieve these goals include endoscopic antireflux procedures, and sometimes surgical interventions (5).

Successful treatment of GERD symptoms has been associated with significant improvement in quality of life, including decreased physical pain, increased vitality, physical and social function, and emotional well-being (3).

How to prevent health burden?

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Reduce your risk

Main risk factors for GERD (3):

  • Smoking or are regularly exposed to secondhand smoke
  • Eating habits (including the acidity of food, as well as size and timing of meals, particularly with respect to sleep)
  • Anxiety/depression
  • Less physical activity at work
  • Older age

Lifestyle modifications (5):

  • Reduce weight
  • Elevate head of bed
  • Reduce offending food items (alcohol, soda, caffeine, smoking, trigger foods)
  • Eat small meals
  • Avoid eating too close to going bed

Lifestyle modification measures including avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss have been proposed for management of GERD. Late evening meals have been shown to contribute to reflux. Head of bed elevation as well as left lateral decubitus position have been shown to improve nocturnal esophageal acid exposure (6)

When to see a doctor?

Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack (4)

Make an appointment with your doctor if you (4):

  • Experience severe or frequent GERD symptoms
  • Take over-the-counter medications for heartburn more than twice a week

GERD is usually diagnosed clinically with classic symptoms and response to acid suppression. The most utilized diagnostic test for the evaluation of GERD and its possible complications is the upper gastrointestinal endoscopy, or esophagogastroduodenoscopy (EGD). The primary benefit of endoscopy is direct visualization of the esophageal mucosa. Ambulatory pH monitoring is considered the gold standard in the diagnosis of acid reflux (1).

Last update: 15 May 2023

References
1. Global, regional and national burden of gastroesophageal reflux disease, 1990–2019: update from the GBD 2019 study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122392/#:~:text=Results,%2C%20and%2077.19%25%2C%20respectively accessed 15.05.2023
2. Sawyer, M. A., MD. (n.d.). Gastroesophageal Reflux Disease (GERD) Imaging: Practice Essentials, Radiography, Nuclear Imaging. https://emedicine.medscape.com/article/368861-overview  accessed 11.05.2023
3. Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167.
4. Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic. (2023, January 4). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940 accessed 11.05.2023
5. Vaezi MF, Katzka D, Zerbib F. Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now? Clin Gastroenterol Hepatol. 2018 Jul;16(7):1018-1029. doi: 10.1016/j.cgh.2018.02.001. Epub 2018 Feb 7. PMID: 29427733.
6. Chen JW, Vela MF, Peterson KA, Carlson DA. AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review. Clin Gastroenterol Hepatol. 2023 Apr 13:S1542-3565(23)00143-X. doi: 10.1016/j.cgh.2023.01.040. Epub ahead of print. PMID: 37061897.

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