When acid refluxes back into the esophagus in patients with GERD, nerve fibers in the esophagus are stimulated. This nerve stimulation results most commonly in heartburn, the pain that is characteristic of GERD. Heartburn usually is described as a burning pain in the middle of the chest. It may start high in the abdomen or may extend up into the neck. In some patients, however, the pain may be sharp or pressure-like, rather than burning. Such pain can mimic heart pain ( angina ). In other patients, the pain may extend to the back.
Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (esophagitis) although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. The first part of the small intestine attached to the stomach. Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.
Certain foods are triggers for acid reflux and can worsen symptoms. These foods include chocolate, dairy products containing whole milk, tomato-based foods, peppermint and other minty foods, citrus fruits and juices and fatty, oily or fried foods. Several types of beverages can also aggravate symptoms, including alcoholic, caffeinated and carbonated drinks and tea. These, too, should be avoided. You may notice that your symptoms worsen after you eat certain foods. When your symptoms flare, think about what you recently ate to see if there are other trigger foods that you need to avoid.
GERD is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun it will need to be continued indefinitely although. However, some patients with intermittent symptoms and no esophagitis can be treated only during symptomatic periods.
If complications of GERD, such as stricture or Barrett’s esophagus are found, treatment with PPIs also is more appropriate. However, the adequacy of the PPI treatment probably should be evaluated with a 24-hour pH study during treatment with the PPI. (With PPIs, although the amount of acid reflux may be reduced enough to control symptoms, it may still be abnormally full article high. Therefore, judging the adequacy of suppression of acid reflux by only the response of symptoms to treatment is not satisfactory.) Strictures may also need to be treated by endoscopic dilatation (widening) of the esophageal narrowing. With Barrett’s esophagus, periodic endoscopic examination should be done to identify pre- malignant changes in the esophagus.