Gastroesophageal reflux disease (GERD), commonly known as acid reflux, is a condition characterised by the backward flow of stomach acid into the oesophagus. Symptoms can also arise from the backward flow of non-acid substances (e.g. bile).


This reflux of acid can irritate the lining of the oesophagus and lead to a range of symptoms, including heartburn, regurgitation, and chest pain.


While occasional episodes of acid reflux are normal, frequent or persistent reflux can indicate gastroesophageal reflux disease (GERD), a more chronic and severe form of the condition.


Causes and Risk Factors

The primary cause of gastroesophageal reflux disease is a weakening or relaxation of the lower esophageal sphincter (LES), a ring of muscle that normally acts as a valve between the oesophagus and stomach.


When the LES fails to close properly, stomach acid or other liquids such as bile can flow back into the oesophagus, leading to symptoms of reflux. Certain factors may increase the risk of developing gastroesophageal reflux disease, including:

  1. Obesity:Excess body weight can put pressure on the stomach and LES, increasing the likelihood of acid reflux.
  2. Hiatal Hernia:A hiatal hernia, where a portion of the stomach protrudes through the diaphragm into the chest cavity, can weaken the LES and contribute to reflux.
  3. Pregnancy:Hormonal changes and increased abdominal pressure during pregnancy can predispose women to experience acid reflux.
  4. Dietary Factors:Certain foods and beverages, such as spicy, acidic, fatty, or fried foods, caffeine, alcohol, and carbonated drinks, can trigger or exacerbate symptoms of reflux.
  5. Smoking:Smoking can weaken the LES and impair the body’s ability to clear stomach acid from the oesophagus, increasing the risk of reflux.


The symptoms of gastroesophageal reflux disease can vary from person to person and may include:

  1. Heartburn: A burning sensation in the chest, often occurring after eating or when lying down.
  2. Regurgitation: Sour or bitter-tasting fluid that rises from the stomach into the throat or mouth.
  3. Chest Pain: Chest pain or discomfort, particularly when lying down or bending over.
  4. Chronic Cough: A persistent cough, especially at night, may be a symptom of reflux-related irritation of the throat and airways.


Diagnosing gastroesophageal reflux disease typically involves a combination of medical history assessment, physical examination, and diagnostic tests. Common diagnostic tests may include:

  1. Upper Endoscopy: A procedure in which a thin, flexible tube with a camera (endoscope) is passed through the mouth and into the oesophagus and stomach to visualize the lining of the digestive tract and assess for signs of inflammation or damage.
  2. Esophageal pH Monitoring: A test that measures the acidity levels in the oesophagus over a 24-hour period to evaluate the frequency and severity of reflux episodes.
  3. Esophageal Manometry: A procedure that measures the pressure and function of the muscles in the oesophagus to assess for abnormalities in swallowing and reflux.


Treatment for gastroesophageal reflux disease aims to alleviate symptoms, reduce the frequency and severity of reflux episodes, and prevent complications. Treatment options may include:

  1. Lifestyle Modifications: Making changes to diet and lifestyle habits, such as avoiding trigger foods, eating smaller meals, maintaining a healthy weight, and avoiding lying down or bending over after meals, can help reduce symptoms of reflux.
  2. Medications: Over-the-counter or prescription medications, such as antacids, H2-receptor antagonists, or proton pump inhibitors (PPIs), may be used to neutralize stomach acid, reduce acid production, or strengthen the LES.
  3. Surgical Intervention: In cases of severe or refractory gastroesophageal reflux disease , surgical procedures such as fundoplication may be considered to strengthen the LES and prevent reflux. This may be considered earlier in the treatment plan if symptoms are associated with significant anatomical problems such as a hiatus hernia.
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