By Tonya DeVaul, APRN-CNP
Certified Nurse Practitioner, Gastroenterology Associates of Northwest Ohio

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into the esophagus. When this type of backflow happens repeatedly over time, it can lead to esophageal irritation causing GERD. Frequent acid reflux or reflux of nonacidic content from the stomach into the esophagus is what causes GERD. When you swallow, a circular band of muscle around the lower part of your esophagus, called the lower esophageal sphincter, relaxes to allow food/liquid to flow into the stomach. After this occurs, the sphincter then closes; however, if the sphincter does not relax as it should and/or it weakens over a period of time, stomach acid then flows back into the esophagus causing irritation/inflammation to the lining of the esophagus. 

Some very common signs and symptoms of GERD include burning in the chest after eating (which may be more noticeable at night or when lying flat), regurgitation of food or liquid that may cause a sour taste in the mouth, difficulty swallowing (dysphagia), upper abdominal discomfort and the sensation of a lump in the throat (globus sensation).

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If you experience severe or frequent GERD symptoms or take over-the-counter medications for heartburn more than two to three times per week, it would be advisable to seek medical attention. Typically, healthcare providers can diagnose GERD based on the history collected during an office visit as well as a physical exam. If the primary care provider suspects persistent GERD the involvement of a gastroenterologist, (GI provider) may be necessary.  

There are many diagnostic procedures done to determine if there are any further complications associated with persistent GERD. These procedures can include upper endoscopy, ambulatory acid probe test, an X-ray of the upper gastrointestinal system, esophageal manometry and/or EGD with bravo. Each of these tests help providers to determine anatomical and/or motility dysfunction of the upper gastrointestinal tract, which helps to identify the culprit of GERD for the patient. 

Risk factors associated with GERD include bulging of the top of the stomach up above the diaphragm called a hiatal hernia, obesity, smoking, pregnancy, connective tissue disorders such as scleroderma and delayed stomach emptying known as gastroparesis. Factors that can aggravate GERD include vaping, eating large meals or eating meals late at night before bed, eating fried/fatty/greasy foods, alcohol, carbonated beverages, coffee and certain medications such as aspirin, ibuprofen, Aleve and Naprosyn.  

If you have persistent GERD and do not seek medical attention, the complications most often associated include esophagitis, esophageal stricture and/or Barrett’s esophagus. Esophagitis is an acute inflammation of the tissue lining in the esophagus. Esophageal narrowing occurs when uncontrolled acid reflux happens and this often requires dilation of the esophagus. Barrett’s esophagus by definition is precancerous changes to the esophagus from uncontrolled reflux that can lead to esophageal cancer if not treated. 

Most people are able to manage the discomfort of GERD with lifestyle modifications and medications, however, some people do require surgical intervention to ease the discomfort. If you think you may be struggling with GERD, do not hesitate to reach out to your medical provider for further evaluation and treatment.