You’ve just enjoyed a sumptuous meal. Suddenly, you feel a burning sensation at the middle of your chest, creeps upwards into your mouth. You feel nauseated, saliva pours out, you taste sour fluid and then you regurgitate food.  This had been happening more than twice weekly. Gastroenterologists term this as GERD or gastro-esophageal reflux disease.  

Causes of GERD

The culprit is a loose lower esophago-gastric sphincter (LES). Visualize your esophagus as a tube that ends in a sac, the stomach. When food enters the esophagus it passes through the upper esophageal sphincter that keeps food from going backwards to the mouth. Food is propelled towards the stomach and moves through the LES. The LES acts like a valve to keep the food tightly in the stomach. In GERD, the valve is loose and stomach contents – partly digested food, stomach acid and bile - flows backward into the esophagus.

Symptoms and Complications

Heartburn - that burning sensation at the middle of your chest – is the most common symptom. Other symptoms include:
•    Nausea
•    excessive salivation
•    food regurgitation
•    hoarseness
•    sore throat
•    frequent belching
•    chest pain
•    Backflow of stomach acid causes ulcers in the esophagus and bleeding occurs
•    dark stools
•    anemia   

Aspiration pneumonia is a fatal complication. The regurgitated food is aspirated into the lungs. You’ll be coughing and wheezing.  It may lead to widening and damage to air passages termed as bronchiectasis and cause asthma. GERD sufferers have sleep apnea - short spells when they can’t breathe automatically. It can cause restlessness, morning headaches and drowsiness.
Over time your esophagus narrows. The chronic inflammation causes strictures, sores may occur and bleed. You’ll experience painful and difficulty in swallowing. Precancerous changes may even occur.
Causes of GERD

GERD is traced to an abnormal functioning or a laxity of the LES. Hiatal hernia can cause GERD - when part of the stomach pushes into the esophagus and stomach contents flow back into the esophagus. The esophagus may not contract well or when the stomach empties slowly.
Fatty foods, sodas, alcohol, spicy food, caffeine, onions are implicated in GERD. Medications like anticholinergics, anti-inflammatory drugs, muscle relaxants, Vitamin C, alendronate, quinidine and hormonal changes are associated with GERD.
Obesity, diabetes, peptic ulcer, cigarette smoking, old age, asthma, connective tissue disorders and Zollinger-Ellison syndrome are risk factors.
Treatment of GERD
A gastroenterologist will prescribe antacids, H2 receptor blockers or proton pump inhibitors to relieve pain. Prokinetic drugs that strengthen the LES can help.
Surgery addresses the laxity of the LES. One surgical procedure creates a barrier between the stomach and esophagus while another forms scar tissue in the esophagus to strengthen it against stomach acid.
What you can do
Change your lifestyle if you’re at risk. Maintain an ideal weight, don’t lie down after eating, elevate your head when reclining, avoid foods that causes heartburn, don’t smoke and avoid tight fitting clothes.
If you haven’t consulted a gastroenterologist, it’s time to make that appointment.