Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backward from the stomach into the esophagus (the tube from the mouth to the stomach). When you eat, food passes from the throat to the stomach through the esophagus or food pipe. Once food is in the stomach, a ring of muscle prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter (LES). If this sphincter muscle doesn’t close well, food, liquid and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. This action can irritate the esophagus, causing heartburn, other symptoms and damage that can lead to cancer.
What Are the Symptoms?
There are two groups of symptoms that are produced with reflux. We refer to them as the “Two Faces of Gastroesophageal Reflux Disease.” There is the face that represents the most commonly noted symptoms and a more sinister face that represents what are called the “silent symptoms.” The common symptoms are:
- Burning breast plate (sternal) chest pain; increased by bending or lying down, worse at night, and relieved by antacids
- Food sticking after swallowing behind breast plate
- Acid in back of throat/sour taste upon awakening
- Upper abdominal pain
- Temporary relief obtained with OTC antacids
These are classic symptoms of reflux that many of us will have as part of our lives. When these symptoms are aggressive, there is no doubt that there is a problem. A more concerning presentation are those patients that do not have this symptom pattern. These symptoms are not the ones listed earlier and historically have not been associated with reflux.
Silent reflux is an often overlooked or misdiagnosed scourge that most patients do not know they have. Many physicians are not familiar with their significance and relationship to reflux. Silent reflux symptoms include:
- Postnasal drip
- Persistent cough
- Lump in throat
- Raspy or hoarse voice
- Non-cardiac chest pain
Frequently, the patient will present initially with these symptoms and none of the typical symptoms listed above. Classic reflux is absent in 60% of asthmatics, 43-75% of patients with chronic cough and 54%-94% of patients with ENT complaints such as hoarseness, post-nasal drip and chronic sinusitis. There are direct and indirect reasons for this association. Understandably, if acid refluxes all the way back up into the larynx and bronchus, there is a direct cause and effect that leads to laryngitis, chronic cough, or asthma. However, there is a little known indirect causation that can be explained by the fact that the esophagus and bronchial tree share a common embryologic and neural origin via the vagus nerve. When acid comes into the distal esophagus there is stimulation of the acid-sensitive receptors. This can cause non-cardiac chest pain, cough, or bronchoconstriction and asthma. This is a problem that has a strong footprint. Up to 38% of pulmonary referrals are for patients with a chronic cough of up to 3 weeks duration. Furthermore, there are 15 million people in the US with asthma, and 50-80% may have GERD.
How Common Is It?
It is absolutely shocking how many people this disease affects. Here are some startling facts about the widespread nature of GERD, and we often refer to this segment as “Gosh, I Didn’t Know That.”
- Upwards of 40 % (60-120 million) Americans have heartburn once a month
- 20% (60 million) Americans have heartburn once a week
- 3-7% (9-21 million) Americans have a more serious problem called GERD where they have reflux every day
- 1 in 33 people in the US have GERD
- The incidence is rising
- 22% of the primary care visits in this country involve GERD symptoms, and this is an increase of 46% over the last five years
- One theory is that the increase in obesity has also increased the incidence of GERD