Most of us are familiar with that burning sensation in the chest that’s associated with heartburn, but when should we be concerned that it’s something more serious? Lokesh Jha, MD, PPG – Gastroenterology helps explain what GERD in adults looks like, possible treatment options and complications that could arise if left untreated.
What is adult gastroesophageal reflux disease?
Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when stomach acid flows back into the esophagus, the tube that carries food from the mouth into the stomach.
What are the leading causes of adult GERD?
GERD occurs due to frequent acid reflux, but some conditions could increase someone’s risk of developing this digestive disorder. Risk factors that could play a role include:
- Hiatus hernia (bulging upper stomach that pushes into the diaphragm)
- Pregnancy
- Obesity
Additionally, certain lifestyle factors could exacerbate acid reflux and GERD. Those factors could include:
- Smoking
- Eating large meals
- Drinking certain beverages (alcohol and caffeine)
- Consuming certain foods (fatty/fried foods, chocolate, peppermint, tomato-based, citrus)
What are the most common signs and symptoms of GERD in adults?
Symptoms of GERD can be divided into two different categories, typical and atypical.
The typical symptoms could include:
- Heartburn
- Regurgitation (stomach contents flow back up into the mouth or throat)
The atypical symptoms could consist of the following:
- Stomach pain
- Chest pain
- Cough
- Sore throat
- Difficulty swallowing
- A hoarse voice
- Nausea or vomiting
- A lump like sensation in the throat
How is this digestive disorder diagnosed?
GERD in adults is clinically diagnosed. Based on a medical history and physical exam, your provider might be able to give you a diagnosis, but to confirm or check for complications; they will likely recommend one of the following testing options or procedures:
- Upper endoscopy: Patients must fast for this procedure and need someone to take them home afterward because of sedation during the endoscopy. This test will allow providers the chance to assess irritation, ulcers, or strictures caused by acid reflux.
- Esophageal pH study: This procedure doesn’t require sedation, but patients must still fast beforehand. A tube with a sensor is inserted through the nose and placed into the esophagus for 24 hours. It will assess the amount and severity of acid reflux. Patients will go home with a recording device and symptom diary that they must return after the study, at which time the pH catheter gets removed.
- Wireless bravo pH study: For this study, a wireless pH capsule is placed in the esophagus during an upper endoscopy and can measure acid reflux for 48-96 hours. Like an upper endoscopy, patients must fast and need someone to take them home after the procedure. Patients will leave with a recording device and symptom diary that they must return following the study. The capsule does not need removing; it will fall off on its own. Also, we recommend not getting an MRI for at least 30 days after the capsule placement.
- Esophageal manometry: This procedure doesn’t require sedation, but patients will still need to fast beforehand. This test measures the muscle contractions in the esophagus when swallowing, which can determine if the lower esophageal sphincter is functioning or not.
How are adults with GERD typically treated?
Depending on the severity of symptoms, a provider will first suggest making some lifestyle modifications like maintaining a healthy weight, stopping smoking, eating meals slowly, not lying down after a meal, elevating the head of your bed, and avoiding trigger foods and tight clothing. If those changes and over-the-counter medications do not relieve your symptoms, the next step might be a prescription medication to treat and manage your GERD. However, if these strategies remain ineffective or you want to avoid long-term medication use, your provider might recommend surgical options to treat the condition.
What are the complications that could arise if GERD is left untreated?
If GERD remains untreated or inadequately treated, the following complications could occur:
- Esophageal ulcers
- Damage to the esophageal lining
- Barrett’s esophagus and esophageal cancer
- Dental problems and acid erosion of tooth enamel
At what point should someone seek medical attention?
If you experience any of the following symptoms, please speak with your primary care provider or seek immediate medical attention:
- Difficulty or pain when swallowing
- Chest pain (if cardiac causes aren’t an issue)
- Weight loss
- Vomiting blood or black stools
- Persistent vomiting
- New stomach pain and 60 years of age or older
