Have you ever felt a burning sensation in your chest or throat after a meal? Perhaps you thought that curry was a bit too spicy and you may need to reconsider how many servings you take next time. Perhaps you thought you were having a heart attack. Or perhaps you knew exactly what was going on – you were experiencing heartburn.

Gastroesophageal Reflux Disease (GERD)

GERD is a digestive disorder. Although ENT surgeons don’t typically deal with stomach problems, one of the affected areas is your esophagus. The esophagus is the tube that brings food and drink from your mouth to your stomach.

GERD occurs when the sphincter ring of muscle between your esophagus and stomach starts to malfunction. A healthy sphincter (specifically known as the lower esophageal sphincter), opens to allow food to pass into the stomach, and then tightens again after. During GERD, the sphincter is weakened or opens at inappropriate moments. The result is that the contents of your stomach make a break for it, back up your esophagus. This reflux, as it’s known, may be comprised of stomach acid or other non-acid liquid from your half-digested food. Either way, your esophagus is not a fan of revisiting the food it thought it had sent into your stomach. This constant reflux or backwash of your stomach acid can irritate and inflame your esophageal tissue lining.

As a point of reference, GERD is not silent reflux, or Laryngopharyngeal Reflux (LPR). With Silent reflux, the reflux flows past the esophagus into the throat.

On occasion GERD may lead to some serious complications involving the esophagus.

• Esophageal ulcers may form from the constant acidic damage to the tissue lining. These open wounds cause pain and bleeding and can make swallowing difficult.
• Esophageal stricture results from scarring of the lower esophagus. The accumulation of scar tissue narrows the space through the esophageal tube, making swallowing food more difficult.
• Increased risk of esophageal cancer. The persistent wear and tear of stomach acid against your esophageal lining can change the appearance of cells. This condition, known as Barrett esophagus, is considered a precancerous state.

Common Symptoms of GERD

The most common symptom of GERD is heartburn, also often called indigestion or acid reflux. This feels like a painful, burning sensation in the middle of your chest, and is often worse when lying down. The discomfort can rise from your breastbone all the way up your throat (as the acid travels up your esophagus). This backwards journey of stomach acid can reach all the way to your mouth, where it can leave a sour, bitter, or acidic taste. Other typical symptoms of GERD include:

• Nausea with or without vomiting
• Difficulty or pain while swallowing
• Chronic coughing
• Laryngitis (inflammation of the voice box), leading to pain and hoarseness
• The sensation of a lump stuck in your throat
• Worsening or new onset of asthma

GERD can affect people of all ages – even infants and children can get it. In the US, over 15 million adults suffer from heartburn on a daily basis. Some risk factors are known to negatively affect the function of the lower esophageal sphincter, including being overweight or obese, being pregnant, or smoking (including passive smoking). There are also several known medications that may cause GERD or exacerbate its symptoms. These include certain sedatives, blood pressure medications, asthma medications, and antidepressants. Gastroparesis, which involves delayed emptying of the stomach, can increase your risk of GERD, as can certain connective tissue diseases, such as lupus or rheumatoid arthritis.

A condition known as a hiatal hernia may be associated with acid reflux and GERD. Hiatal hernias occur when the upper part of the stomach moves through the diaphragm into the chest area. Having a hiatal hernia doesn’t mean you will get GERD, but it does potentially make it easier for the contents of your stomach to reflux into your esophagus.

More recently, research has indicated that people with pre-existing anxiety may also be at a higher risk of GERD. This may be due to increased stomach acid production or abnormal muscle tension.
You may find that certain things can exacerbate your acid reflux. These include factors such as:

• Certain trigger foods
• Overly large food portions
• Eating too soon before lying down

GERD or Heart Attack?

If you’re experiencing heartburn for the first time, it can be difficult to tell the difference between GERD and a heart attack. Both GERD and a heart attack involve chest pain. If in doubt, we recommend going to the nearest emergency room. Heart attacks are typically associated with shortness of breath and pain in the arm or jaw. Chest pain from heart disease is also usually exacerbated by physical exercise, which is less likely with GERD. However, unless you’re an expert in cardiology and/or gastroenterology, it’s still best to be examine by a qualified doctor if you’re not sure.

Treatments for GERD

The pain associated with GERD can be highly unpleasant. Therefore, it’s no surprise that GERD can be a trigger for stress, anxiety, and depression. In fact, research has demonstrated that people with chest pain from GERD do suffer significantly higher levels of depression compared to people without chest pain.

The first-line treatments for GERD are lifestyle changes and non-prescription medications. Over-the-counter drugs may be ones that neutralize stomach acid, reduce acid production, or block acid production more completely, which gives your esophageal lining more time to recover.

Some lifestyle modifications your doctor may recommend can involve:

• Shedding some pounds to remove obesity or being overweight as a contributing factor
• Quitting smoking
• Avoiding trigger foods and drinks, which may be chocolate, fried or fatty foods, alcohol, and caffeine
• Avoid eating 2 to 3 hours before you go to bed
• Eat smaller servings and try to eat slowly
• Elevate yourself from the waist up when sleeping

To avoid further irritating your esophagus while it’s inflamed, you may also want to avoid certain foods, such as citrus fruits, tomatoes, and peppers.

If over-the-counter drugs and home remedies are unsuccessful in managing your GERD, your doctor may prescribe stronger medications to regulate your stomach acid. In most cases, medications are capable of alleviating GERD symptoms. However, if these fail, your doctor may recommend surgery.

There are a number of surgical options for treating GERD, most of which are minimally invasive or performed through keyhole surgery. Your doctor while advise you on which technique is the most suitable for you.

If you suspect you’re experiencing GERD, your ENT doctor will be able to perform a diagnosis and suggest appropriate treatments. To fully manage GERD, your ENT doctor may also refer you to a gastroenterologist.