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The Ultimate Comprehensive Guide to GERD: Gastroesophageal Reflux Disease

GERD is gastroesophageal reflux disease, where the stomach content, including acid, comes up in the esophagus and causes burning pain in the chest behind the sternum, commonly called heartburn. Of course, the heart is not burning, but the pain’s location is where the heart is located, so people commonly call it heartburn. Other symptoms of GERD include non-burning chest pain, cough, bad taste in the mouth, difficulty swallowing, sore throat, and a feeling that a ball is stuck in the throat. Although heartburn is very common, one must be careful not to think that all heartburn is caused by reflux because a heart attack shares the same symptoms in some instances. Therefore, talk to your doctor to ensure your symptoms are not cardiac-related. One of the easiest ways to suspect cardiac-related heartburn or chest pain is if the pain occurs while one is exerting themselves. If you have a history of heart disease, even non-exertional chest pain should be evaluated by your doctor before thinking that you have GERD. For example, one of my patients told me that he has heartburn when he goes on bike rides or while he is out hiking. I sent him to a cardiologist and found out that he had severe coronary heart disease and he would have had a massive heart attack if I had attributed the pain to GERD. His cardiologist treated him, and his heartburn resolved. 

Dr. Angie Sadeghi, MD

December 11, 2023

Causes of GERD include obesity, pregnancy, hiatal hernia, and several lifestyle factors, including alcoholic beverages, tobacco smoking, oily or greasy meals, chocolate, peppermint, caffeine, and cow’s milk in individuals who are lactose intolerant. In specific individuals who have celiac disease, consumption of gluten can manifest as heartburn. H. pylori (a bacteria) is another cause that must be tested via a breath, stool test, or biopsy to confirm. 

I would like to highlight that obesity is a prevalent cause, and here at IOPBM, we have many successful stories of patients who eliminate their symptoms after we help them lose weight and achieve an average weight. We have hundreds of patients successfully removing their need for acid reflux medicines after successful weight loss, which we achieve with lifestyle modifications and through the use of FDA-approved medications for short-term weight loss. Ozempic and Mounjaro are for diabetic patients who are overweight or obese, and ZepBound, Wegovy, and Phentermine are for patients without diabetes who are overweight and obese. 

How does obesity cause severe acid reflux attacks? 

There are a few factors that contribute to this problem. One is the intra-abdominal pressure elevation, which pushes the stomach content up but is also possibly hormonal. The fat cells in the body are a sizeable endocrine system and produce inflammatory hormones that circulate in the body and cause dysfunction. These hormones cause relaxation of the LES and allow the stomach contents to come up into the chest. 

Why does stomach content come up?

Is acid reflux dangerous? A sphincter at the bottom of the esophagus anatomically separates the esophagus from the stomach, called the Lower Esophageal Sphincter (LES). The sphincter should stay toned to prevent the stomach content from moving into the chest. Although the stomach mucosa is well equipped to handle a low PH, the esophageal mucosa is easily damaged when exposed to acid. This damage can cause many problems, such as reflux esophagitis, Barrett’s esophagus, closure of the esophagus, and eosinophilic esophagitis. Although lifestyle habits cause the LES to relax, sometimes genetic causes contribute to LES relaxation. Also, suppose you have a hiatal hernia due to a structural and anatomical abnormality. In that case, the LES tone is lower than normal, which is why people with a hiatal hernia are at a higher risk for GERD. 

Frequently Asked Questions:

  • How to cure GERD permanently?

  • What food neutralize stomach acid immediately?

  • What to do if I have acid reflux at night?
  • What are some acid reflux foods I should avoid?

  • What are acid reflux treatments at home?

  • What are some GERD symptoms at night?

Cure your acid reflux today – Schedule a Telehealth appointment with us.

Your doctor diagnoses GERD in the clinic after a detailed history and physical exam. Sometimes, your doctor may decide to do a trial of acid reflux medicines as a diagnostic and therapeutic method. However, various diagnostic tests are available for individuals who need to improve, such as an upper endoscopy, a wireless PH/impedance study, esophageal manometry, and a barium esophagogram. 

The treatment of GERD is, first and foremost, lifestyle-related. IOPBM has a team of doctors, weight loss specialists, and dietitians to help with these dietary and lifestyle changes before initiating medicines. Of course, we are not opposed to pharmaceuticals, which are sometimes life-saving. Still, in many cases, we have successfully treated our patients with lifestyle changes, eliminating the need for medications. If lifestyle modifications fail, and medication therapy is not an option, there are new procedures for GERD, such as Transoral Incisionless fundoplication (TIF), Linx procedure, and Nissen fundoplication. 

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