What are acid reflux and gastroesophageal reflux disease (GERD)?

Acid reflux is caused when acid from the stomach leaks back into the oesophagus. Gastroesophageal reflux disease (GERD) is a digestive disorder where acid reflux occurs regularly and causes irritation and discomfort.  

It usually occurs because of weakness in the lower oesophageal sphincter, the ring of muscle between the oesophagus and stomach. Normally, the valve between the stomach and oesophagus closes when food passes through, but if this valve doesn't close fully or opens too often, this can cause acid reflux.

What are the symptoms of gastroesophageal reflux?

Not everyone has the same symptoms if they have GERD. Heartburn is the most common symptom. It is a burning sensation in the chest caused by irritation to the oesophagus from stomach acid, that is often worse after eating. The name is misleading, as it has nothing to do with the heart. Other symptoms include: 

• Acid indigestion
• Acid regurgitation (sour, bitter taste of acid in the mouth)
• Bad breath
• Bloating
• Burping
• Chest pain
• Dry cough
• Dysphagia (food getting caught in the throat, choking sensation)
• Hiccups
• Hoarseness
• Sore throat
• Swallowing problems
• Vomiting and nausea
• Wheezing

What are the causes?

GERD is caused when there is a repeat occurrence of acid reflux. A circular band of muscle (sphincter) around the bottom of the oesophagus usually relaxes to allow food to pass into the stomach. If it becomes weak, the stomach acid can flow back up into the oesophagus. The backwash of acid irritates the lining of the oesophagus, which causes it to become inflamed. 

Who is at risk?

GERD is a common condition, affecting people of all ages. Risk factors that can increase the chance of developing chronic acid reflux include:  

• Ageing, people over the age of 40 are more likely to develop GERD 
• Being overweight/obese  
• Being pregnant
• Smoking  
• Taking certain medications 

How can it be prevented?

To prevent and manage GERD symptoms, it is advisable to:  

• Avoid eating three hours before going to bed
• Avoid trigger foods
• Eat small meals frequently
• Maintain a healthy weight
• Reduce saturated fats in the diet
• Sit upright when eating
• Sleep with blocks under your head when sleeping
• Stop smoking

What foods can cause GERD?

Trigger foods, those that make the symptoms worse, should be avoided. It is good to keep a record of what foods and drinks cause flare-ups, to have a better understanding of how to manage personal symptoms. Common foods and beverages that should be avoided include:

• Alcohol
• Chocolate
• Citrus fruits
• Coffee
• Fizzy drinks
• Foods high in saturated (animal) fats
• Fried foods
• Garlic
• Onions
• Spicy foods
• Tomato-based sauces

When should I see a doctor?

Most people will experience acid reflux at some point in their life. However, if symptoms persist, occurring more than twice a week over some time, potentially have developed GERD. This needs to be treated, to alleviate symptoms and also to prevent more serious problems from developing.  

How is it diagnosed?

Although relatively common, acid reflux and GERD can be confused with more serious conditions. Diagnosis is made by assessing symptoms and medical history. If acid reflux is not chronic, it can be controlled with diet and medication. 

If GERD is suspected, tests will be carried out, including 

• Endoscopy (camera imaging) and biopsy (tissue sample for analysis) of the upper GI tract  
• X-rays of the upper GI 
• Oesophageal manometry  
• pH monitoring  
• Impedance monitoring (measuring fluid as it flows down oesophagus)  

How is gastroesophageal reflux treated?

Heartburn can be treated with over-the-counter medication. Stronger medication can also be prescribed to manage heartburn when necessary. Other symptoms can be improved with lifestyle changes, especially eating healthier, quitting smoking, and maintaining a healthy weight. Additionally, improving posture, wearing loose-fitting clothes, and avoiding sit-up exercises can reduce the pressure on the abdomen.   

If symptoms do not improve with medication and lifestyle changes, surgery may be a solution. The most common surgical treatment is laparoscopic anti-reflux surgery which involves creating a new valve between the stomach and oesophagus to prevent stomach acid from entering the oesophagus.  

What complications can acid reflux cause?

GERD is not life-threatening, however, if left untreated, the tissue of the oesophagus becomes damaged, eating and sleeping habits can be affected, and quality of life is affected. Prolonged inflammation of the oesophagus can result in more serious conditions. These include: 

• Oesophagitis 
• Barrett's oesophagus 
• Cancer of the oesophagus 
• Strictures, or scaring due to damage
• Ulcers