The Center for Gerd Care - Acid Reflux Symptoms and Treatments

Pediatric GERD may go undiagnosed for months

GERD symptoms shown to intensify during pregnancy

Find out how pregnancy can affect GERD and Acid Reflux

IN THE NEWS

A recent study found that people who are overweight or obese may be up to six times more likely to have gastroesophageal reflux disease (GERD) than people who are of normal body weight. The association was strongest among heavy, pre-menopausal women and women who have used hormone therapy, suggesting that estrogen may play a role in the development of the medical condition.

Both obesity and GERD raise the risk of developing esophageal cancer, the incidence of which has also been rising in the last few years.

If traditional weight loss methods don't work and you've considered gastric bypass surgery or lap band surgery as an option for permanent weight loss, keep in mind that studies suggest that weight reduction may be an effective means of minimizing reflux symptoms.

Home

Symptoms

Risks

Treatment

Weight

Pregnancy

Risks of GERD and Acid Reflux

GERD isn't always a benign disease. Untreated, chronic GERD can result in damage to the esophagus due to acid. This damage can include inflammation, ulcers, bleeding, and scarring of the esophageal tissues. Advanced or serious conditions caused by GERD include the following:

Esophageal stricture: This is a narrowing of the esophagus that makes it hard to swallow foods or liquids.
Erosive esophagitis: This results in ulcer formation in your esophagus.
Vomiting blood or blood in your stools: In the presence of blood, your stools may look dark or tarry.
Barrett esophagus (BE) and ulcers: These are caused by prolonged exposure of the esophagus to stomach acid. BE sometimes precedes cancer of the esophagus, so your doctor will want to assess the state of your BE from time to time.
Esophageal cancer (adenocarcinoma): This has become more common in the past 20 years and is linked with GERD and BE.

Heartburn is the most common symptom of gastroesophageal reflux disease (GERD). Voice changes may occur, particularly upon wakening. Hoarseness is typical and results from stomach acid irritating the vocal cords. The following GERD -associated complications are serious and require immediate medical attention:

Esophagitis. This condition is severe inflammation of the lining of the esophagus. This is also known as erosive esophagitis. Approximately 50 percent of patients with weekly reflux symptoms have esophagitis at the time of endoscopy. An endoscope is a flexible tube that has a light on it, which allows physicians to view internal sections of the body during procedures referred to as "endoscopy" or "endoscopic procedures." The severity of reflux symptoms does not correlate with the degree of inflammation.
Esophageal ulcers. These are crater-like sores in the lining of the esophagus, which can bleed and cause anemia, or low red blood cell counts.
Esophageal strictures. A stricture is the narrowing of the esophagus caused by scar tissue, which can lead to difficulty swallowing and recurrent episodes of food being caught in the esophagus.
Barrett's esophagus. This is a condition where the normal lining of the esophagus is replaced by abnormal cells. Approximately 3.5 to seven percent of the patients with GERD will develop Barrett's esophagus. It is most commonly found in Caucasian men over the age of 50. Patients with Barrett's have been shown to have an increased risk of esophageal cancer.
Respiratory complications. Theoretically, these complications occur when stomach contents wash back up the esophagus and spill into the trachea and down into the lungs or when stomach contents traveling into the esophagus cause a bronchial reflex that may lead to wheezing or may mimic asthma or cause infections like pneumonia.
Reflux laryngitis. Inflammation of the voice box occurs when stomach acid spills into the trachea and irritates the vocal cords.
Dental erosions. Severe GERD can lead to an increased risk of tooth decay due to stomach acids wearing away the tooth enamel.
Reflux dyspareunia. This is a condition when heartburn symptoms occur during sexual intercourse while in the recumbent position.
Increased risk of cancer of the esophagus. People with severe and long-standing GERD
have an increased risk of esophageal cancer (i.e., adenocarcinoma of the esophagus), even when they don't develop Barrett's esophagus.

There are several diseases and conditions that present with similar symptoms and should be considered during an assessment. These include esophageal spasms, esophageal cancer, gall bladder attacks, peptic ulcer disease, gastritis, asthma and coronary artery disease.

Higher risk of esophageal cancer

An occasional bout of indigestion or heartburn is generally nothing to worry about. But there is growing concern about the dangers of frequent or chronic heartburn. Frequent heartburn, known in medical terms as gastroesophageal reflux disease or GERD, occurs when the stomach acid regularly flows into your esophagus, irritating and inflaming its lining. This happens when a muscle called the lower esophageal sphincter, which normally blocks acid flow between the stomach and esophagus, becomes weakened or relaxed.

If left untreated, over time, GERD can cause sleep problems, chronic cough and even asthma. Worse yet, years of chronic heartburn can cause permanent structural changes to the lining of your esophagus, putting you at a higher risk for esophageal adenocarcinoma—a very aggressive and deadly cancer.

The overall five-year survival rate for esophageal cancer is only 5% to 30%. However, someone diagnosed in the early stages of the disease has a better chance of survival.

Why Is Nighttime Heartburn More Dangerous?

Day or night, chronic reflux can gradually damage the esophagus. It may lead to inflammation and scar tissue that narrows the esophagus. In some people, chronic heartburn can lead to Barrett's esophagus, changes in the cells that increase the risk of esophageal cancer.

But nighttime heartburn tends to leave acid in the esophagus longer, and therefore may cause more damage than daytime heartburn.

"A good part of the explanation is gravity," says Lawrence J. Cheskin, MD, co-author of Healing Heartburn and associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore, Md. During the day, acids from the stomach may briefly force their way into your esophagus. But gravity quickly pulls them back down to the stomach.

When you're lying down, gravity isn't pulling in the right direction. Instead, the stomach contents are pressing on the sphincter muscle that connects the esophagus to the stomach. In people with GERD - which means nearly everyone with chronic heartburn - the sphincter is faulty. It doesn't fully close. So acids can reflux back up into the esophagus. And because you're lying down, once acids get into the esophagus, they can sit there for much longer than during the day. That can increase the damage.

Gravity isn't the only factor. When you're awake, you naturally swallow whenever acid begins to reflux. This pushes the acid back down into the stomach. Saliva also contains bicarbonate, which can neutralize stomach acid. But when you're asleep, the swallowing impulse is suppressed, Spechler says.

Nighttime Heartburn and Insomnia

The effects of nighttime heartburn aren't confined to esophagus. It can also result in chronic insomnia. Nighttime heartburn can wake you up and keep you up.

"The symptoms definitely aggravate insomnia," says Dave White, who has suffered from nighttime heartburn for years. "I'll wake up with cutting heartburn pain and then have to wait for the effects of [medicine] to kick in, which can take an hour or so. When that happens, I'll just get out of bed, since I know I'll be up anyway."

One recent study showed just how common nighttime heartburn can be. Researchers questioned nearly 15,300 average people and found that a whopping 25% reported having nighttime heartburn. The results were published in 2005 in the journal CHEST.

Another 2005 survey of 1,900 people with GERD in the U.S. and Europe found that about half had trouble sleeping at night. In these people, GERD symptoms caused a 22% impairment of leisure activities and a 15% impairment of their ability to work. The findings were presented during the 2005 Digestive Disease Week, an international conference for gastroenterologists. So the pain - and consequences - of nighttime heartburn go well beyond that burning in your chest.