GERD: Upper Digestive Tract Disorder
The contents of your stomach empty into the small intestine, but sometimes they flow backwards into your esophagus. This phenomenon, known as gastroesophageal reflux, happens to most everyone from time to time. It usually produces no symptoms other than occasional heartburn—a burning sensation behind the breastbone.
When gastroesophageal reflux occurs often, however, you may begin to experience significant discomfort related to the acid reflux—then, it is considered gastroesophageal reflux disease (GERD).
Many people in the United States have GERD: Heartburn affects about 7 to 10 percent of U.S. adults every day and up to 44 percent at least once a month. Symptoms of reflux are more common in individuals who are obese, smoke cigarettes, or drink alcohol.
GERD is a serious condition: The acid and digestive enzymes from the stomach can damage tissues in the esophagus as well as in adjacent organs such as the
- pharynx (throat)
- larynx (voice box)
- trachea (windpipe)
Causes of GERD
Coordinated contractions of the lower esophageal sphincter and the diaphragm produce an area of high pressure in the lower segment of the esophagus that prevents stomach contents from entering the esophagus.
This "antireflux barrier" does not always work properly. When it fails occasionally, the esophagus has several defenses to help it deal with the harsh stomach contents. First, the esophageal secretions and your saliva are alkaline, which helps to neutralize the acid and inactivate the enzymes from the stomach. Second, peristalsis and gravity work together to rapidly clear the esophagus of the acid and enzymes, minimizing the length of time the lining of the esophagus is exposed to the stomach contents. Third, the esophageal mucosa is able to regenerate quickly following injury from acid or enzymes.
However, frequent reflux of the acidic stomach contents can overwhelm these protective measures, resulting in damage to the tissues of the esophagus and adjacent organs.
A recent survey of 43,000 people found that smoking and excessive use of table salt can increase the risk of GERD by 70 percent. A 2005 study found that a diet high in calories and fat (especially saturated fat) is linked to GERD. Excess weight also can cause GERD.
Medications that relax the lower esophageal sphincter, such as
- the bronchodilator theophylline (Theo-24, Theo-Dur, Uniphyl, for asthma, emphysema, and chronic bronchitis)
- calcium channel blockers (for angina or high blood pressure)
- nonsteroidal anti-inflammatory drugs (NSAIDs, for arthritis and pain)
- bisphosphonate drugs (for osteoporosis)
- some medications to treat menopausal symptoms
- a class of antidepressant drugs called tricyclics
If you are at risk for GERD or develop it while taking any of these medications, discuss with your doctor the possibility of discontinuing or reducing the dosage of the medication.