Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) occurs when there is abnormal passage of acidic stomach contents (or refluxate) in a retrograde fashion from the stomach back into the esophagus, causing symptoms or complications. GERD is one of the primary causes of heartburn, and is a common phenomenon. Estimates are that 15% to 20% of people in the United States have heartburn or regurgitation at least once a week.1

Symptoms of GERD result from the interplay of many factors, including the amount of time the esophagus is exposed to refluxate, its degree of causticity, and the susceptibility of the esophagus to damage.2 Three main factors prevent refluxate from entering the esophagus: the lower esophageal sphincter (LES), the diaphragm (which wraps surrounds the esophagus and acts as another sphincter), and the location of the transition of the esophagus to the stomach and its relation to the diaphragm.1,2 Dysfunction in any of these structures may lead to symptoms of GERD, although the major pathological mechanism is abnormal LES tone.

Decreased tone of the LES occurs with many substances, medications, and other factors.2 These factors include: alcohol, chocolate, coffee (caffeinated more than decaffeinated), cow’s milk, fat, orange juice, spicy foods, tea, tomato juice. Smoking and obesity are also believed to contribute to development of acid reflux.

In mild cases of GERD, lifestyle modifications are the first line of therapy and can lead to improvement or elimination of symptoms. For example, GERD symptoms may improve if smokers quit; if obese patients lose weight;3 or if patients avoid eating large meals or consuming large quantities of fluids with meals.1

If nighttime symptoms are present, patients should elevate the head of the bed by 4 to 6 inches using blocks under the bed posts rather than extra pillows. Use of extra pillows could compress the abdomen and increase intra-abdominal pressure, thereby exacerbating symptoms.1

Exercise may benefit GERD indirectly by promoting weight loss; however, it may also have direct effects, with studies independently demonstrating that individuals who are more active have better digestion and less GERD.3 Several types of botanical treatments are useful for GERD. These include chamomile and valerian root.

At RMRM, we’d be happy to have a more in-depth discussion of all the options available to you to decrease your chances of suffering chronically from this malady.

  1. P.J. Kahrilas: Gastroesophageal reflux disease. N Engl J Med. 359:1700-1707 2008
  2. D.J. Mikami, K.M. Murayama: Physiology and pathogenesis of gastroesophageal reflux disease. Surg Clin North Am. 95 (3):515-525 2015 Jun
  3. A. Eherer: Management of gastroesophageal reflux disease: lifestyle modification and alternative approaches. Dig Dis. 32 (1-2):149-151 2014