Gastroesophageal reflux disease

The main symptoms of GERD vary from person to person and can sometimes cause significant discomfort in daily life. They often occur after meals or at night (when lying down).  
The most common symptoms are:

• heartburn rising up to the throat
• acid regurgitation: liquid or food rising up, sometimes into the mouth, sometimes causing an unpleasant sour or bitter taste in the mouth.

Other symptoms are less typical and therefore less easy to link directly to GERD:  

• nausea or burning in the stomach only 
• chronic cough: irritation of the throat and larynx by acids can cause a persistent cough, hoarseness, recurrent sore throat, or a feeling of a lump in the throat 
• asthma attacks: acid reflux can enter the respiratory tract and aggravate asthma symptoms, causing coughing and/or breathing difficulties. 

1. Overweight/obesity and pregnancy: these conditions promote or aggravate reflux by increasing pressure in the abdomen and therefore on the stomach, causing gastric contents to rise up into the esophagus. 
2. Hiatus hernia: this is when part of the stomach protrudes through the diaphragm into the chest, weakening the anti-reflux valve. 
3. Diet: Certain foods, particularly those that are too fatty, caffeine, alcohol, carbonated drinks, mint, citrus fruits, and chocolate, can promote reflux.   
4. Tobacco use 
5. Disorders affecting esophageal contraction or gastric emptying: Although rarer, these conditions can also cause gastroesophageal reflux.

The diagnosis of GERD is generally based on clinical symptoms and medical examination. However, in cases of uncertain diagnosis or when the response to treatment is insufficient, additional tests may be necessary to confirm the diagnosis or assess its severity: 

• Upper gastrointestinal endoscopy: this involves inserting a flexible tube equipped with a camera into the esophagus to examine the mucous membrane for signs of inflammation or lesions. 
• Esophageal pH monitoring: this involves a small probe with a tip that measures acidity in the esophagus, as well as the number and intensity of reflux episodes over a 24-hour period. Some centers, such as the Crohn's and Colitis Center at Hôpital de la Tour, now offer a probe-free alternative in the form of a capsule attached by endoscopy directly to the bottom of the esophagus, which allows for longer recording (up to 4 days). 
• Esophageal manometry: this also involves a probe equipped with sensors to assess esophageal contraction. 

Treatment for GERD aims to relieve symptoms, prevent complications, and improve quality of life. It includes:

Lifestyle changes

• Quitting smoking.
• Avoiding overeating or eating too quickly.
• Eating dinner at least 2 to 3 hours before bedtime and, more generally, avoiding lying down immediately after meals. 
• Avoiding triggers: reducing consumption of fatty, spicy foods and the main trigger foods mentioned above.
• Elevating the head of the bed when lying down.
• Losing weight.

Medication

• Antacids: these coat the stomach lining and provide immediate but temporary relief.
• Proton pump inhibitors (PPIs): these reduce acid production in the stomach and are the treatment of choice for persistent GERD symptoms.
• H2 receptor antagonists: these drugs also reduce acid production, but are generally less potent than PPIs.

Surgery

Fundoplication: in selected cases of severe GERD, surgery may be considered. Fundoplication involves tightening the lower esophageal sphincter to prevent reflux.
Endoscopy: less invasive but less studied endoscopic techniques may be used in some cases to strengthen the lower esophageal sphincter.

If GERD is left untreated or poorly controlled, it can lead to complications such as: 

• Esophagitis: inflammation of the esophageal lining caused by contact with acidic fluid, sometimes leading to ulcers. 
• Esophageal stricture: prolonged inflammation can cause scarring of the esophagus, narrowing its diameter and sometimes making swallowing more difficult. 
• Barrett's esophagus: this is a change in the lining of the esophagus that significantly increases the long-term risk of developing esophageal cancer. 

Gastroesophageal reflux disease (GERD) is a common condition that can affect quality of life due to its bothersome symptoms and potential impact on health. While most cases can be managed through lifestyle changes and medication, it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment, especially if symptoms persist or worsen. 

The Crohn's and Colitis Center at La Tour Hospital has the technical facilities necessary for the specialized management of this type of condition.

Are there any long-term risks associated with GERD?
Approximately 5 to 15% of patients with chronic GERD develop Barrett's esophagus, a precancerous lesion. This increases the risk of developing esophageal adenocarcinoma, although this remains rare.
PPIs, although very effective, are taken long-term by 30 to 50% of patients, sometimes without clear medical justification.

Does GERD affect women and men equally?
Several studies show a slightly higher prevalence in women, especially between the ages of 30 and 60. However, when it comes to serious complications, men are at greater risk. Overall, studies find no significant difference between the two sexes.

Is a woman who suffers from GERD during pregnancy more likely to suffer from it after giving birth?
For the majority of women, no. But it is possible, especially in cases where there are predisposing factors, significant weight gain, or an unbalanced diet.

Information sheet revised under the supervision of Dr. Ollo