GERD: Feel the Burn

What is GERD

GERD or gastroesophageal reflux disease is a combination of conditions involving acid exposure outside of the stomach. Your body produces two Liters of stomach acid daily, which is needed to breakdown your food. In healthy states, this acid will then exit the stomach into the small intestine, where it will become neutralized by your pancreas. This acid is integral to digestion and also is antibacterial, killing those harmful bugs that try to get in your body through your dirty dirty mouth.

The other structure attached to your stomach (other than the small bowel), is the esophagus (food pipe). This organ delivers your food from the mouth into the stomach for digestion. Between the food pipe and stomach is a doorway called the lower esophageal sphincter (LES), made of muscles in the food pipe, your belly wall, and diaphragm. The LES has a very tough job of sending that steak you just ate into your stomach, but not allowing a liquid (acid) or digested food back upward. 

The balance of the LES is thrown out of whack when you:

1) make too much acid or

2) weaken the doorway.

Too much acid is produced from dietary causes such as acidic foods (tomato, spicy foods, citrus), high-fat foods that take more acid to digest, alcohol, and cancer/non-cancerous states that cause your body to make more acid. 

The LES can weakness with anatomy issues like slipping of the stomach above the diaphragm (hiatal hernia), surgery, weakness of the esophagus muscles or diaphragm (via neurologic conditions like Parkinson’s disease, autoimmune conditions like scleroderma, muscle conditions like muscular dystrophy). 

Your doorway can also be opened by certain foods, such as caffeine, tobacco, peppermint, chocolate.

The results of these issues lead to GERD, which can make people feel awful and affect millions of people.

Types of GERD

There are two main buckets for describing GERD, typical and atypical. Typical can be broken down into feelings of burning in the chest, reflux of food back into the esophagus, chest pain. Atypical reflux can be the cause of dental problems, asthma, sore throat, bad-breath, and long-term cough.

People with atypical reflux disease usually do not respond as well to conventional treatments. Also, just because you may have these atypical symptoms, does not mean that they are from GERD. This can be from post-nasal drip, asthma, etc. Testing is required in this case (see below).  

Another category to be aware of are the “red flags.” These include symptoms that are very concerning to your doctor along with your GERD symptoms. Such symptoms include weight loss, food getting stuck in the esophagus, nausea and vomiting, abdominal pain, blood in the stool or vomit. If you smoke or have someone in your family with cancer of the esophagus or stomach this is also concerning. IF YOU HAVE THESE GO SEE A DOCTOR.

 There is also non-acid reflux…whaaattt??? Yes, that’s right, bile acids, pancreas juice, and other gut secretions can reflux into the food pipe and cause you discomfort. This is a separate problem and a lot of conventional medical treatments do not work for this condition. It is also difficult to diagnose in the absence of invasive pH testing.

How to diagnose GERD

Well, in the old days, GERD was diagnosed by actually giving people different amounts of acid, to see when symptoms were reproduced…barbaric, I know. Nowadays, response to anti-acid therapy is actually very helpful in diagnosing GERD. 

Another test is available including an endoscopy (or lighted tube into the food pipe to look at the esophagus for burning). An x-ray test called a barium esophagogram can also show dye coming back into the esophagus. You can also undergo testing to measure the acid levels in your esophagus by a catheter in your nose (impedance testing) or implanted pill (capsule telemetry) that falls off in 2 days. These tests are excellent are determining if you have acid reflux or not.