• Introduction
    Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn, is a common problem caused by gastric acid gastric leakage back to the esophagus.
    The esophagus is a long muscular tube that connects the oral cavity to the stomach.
    The incidence of the disease
    Reflux is a common condition. It is estimated that one out of five people will experience at least one incident of acid reflux once a month, while one in 10 people will have GERD symptoms on a daily basis.
    The condition may develop at any age, even in children, but it usually starts at age 20-40.  According to observational studies it is more common in men than women.
    The anatomical basis
    The anatomical and physiological basis behind acid reflux is a muscle dysfunction of the lower esophageal sphincter. This sphincter functions as a valve that opens to allow passage of food and fluids to the stomach and after that, it closes to prevent the rise of gastric juices back to the esophagus. In the case of reflux, the lower esophageal sphincter does not close completely and allows digestive juices to flow out of the stomach toward the esophagus.
    Contributing Factors
    Overweight or obesity
    Pregnancy
    A fat-rich diet
    Excessive alcohol consumption
    Symptoms
    GERD has many different symptoms, some of them are not "straight forward" and thus it can take some time until the problem is being diagnosed and treated properly.
    Heartburn - Burning pain or chest discomfort that develops after a meal.
    Chest pain – very often the acid reflux causes chest pain that might be confused with angina pectoris (heart problems)
    An unpleasant metal taste in the mouth and/or throat pain - a condition caused by the rise of gastric acid back into the mouth.
    Prolonged coughing - a common condition caused by the rise of gastric acid back into the throat, usually at nighttime while the person lies down. The acid then irritates the upper airways, making the person affected to have a chronic irritating cough.
    Pain and difficulty in swallowing – feels like the food is "stuck" in the middle of the chest
    Many people experience occasional reflux attacks, especially after fatty meals. This can be treated with over-the-counter medications from time to time. However, it the symptoms recur frequently or persist over a long time, the condition should be treated as just like any other chronic disease.
    Treatment
    The treatment includes, in the first stage, changes in the patient's diet: eating small meals, avoiding certain foods such as – fried food, greasy food, sour or spicy products, alcohol.
    Furthermore, eating should be avoided 2-3 hours before bedtime or lying down.
     In mild non-frequent cases, treatment can start with with OTC antacids, such as Tums®, Maalox®, Rennie®, Alka-Seltzer®, which helps neutralize the effect of gastric acid. In advanced cases, preventive daily treatment that reduce the acid secretion from the stomach is recommended, such as Losec®, Nexium® etc.
    Very uncommonly, people with resistant severe acid reflux undergo surgery to treat the condition.
    Complications
    A common complication of reflux is irritation of the esophagus lining and the development of chronic inflammation in this area (Esophagitis). In severe cases ulcers might develop in the esophagus that cause pain during swallowing.
    A rare but severe complication of reflux is esophageal cancer.
    Prognosis
    Most people respond well to life style changes and medical treatment. However, in about half the patients the symptoms will return after one year. As a result, some will need ongoing medication to control their symptoms.