The stomach makes hydrochloric acid that is
needed to digest food and help kill bacteria and other
foreign organisms that are accidentally consumed with
food. The cells lining the stomach secrete a thick layer
of mucus that protects them from damage by stomach
acid. The cells lining the esophagus do not secrete
mucus, so when the LES opens and the acid mixture
from the stomach come into contact with them, they
become first irritated, then later inflamed, and finally
eroded. The individual often feels this damage as
heartburn. Heartburn is a pain or burning behind the
breastbone. GERD is diagnosed when the stomach
acid comes in contact with the esophagus twice or
more in a week on a regular basis.
Demographics
Acid reflux or heartburn is extremely common.
About 7% of Americans, or more than 15 million
people, have heartburn every day. About 60 million
Americans have heartburn at least once a month,
although not everyone who has heartburn has
GERD, and not everyone who has GERD has heart-
burn. The exact number of people with GERD is
difficult to determine, as many people self-treat symp-
toms with over-the-counter medications.
People of any race or age can develop GERD,
including infants and children, but the disease is
most common among people over age 50, pregnant
women, and people who are overweight or obese. The
condition is often overlooked in infants and children
and is likely to be underdiagnosed in this group.Causes and symptoms
GERD is caused by stomach acid coming in con-
tact with cells of the esophagus. The most common
cause for this is weakening of the LES. Hiatal hernia
is thought to increase the likelihood of developing
GERD. The diaphragm is a sheet of muscle that divides
the chest cavity from the abdominal cavity. With a
hiatal hernia, a tear develops in the diaphragm and a
portion of the stomach protrudes through the hole and
up into the chest cavity. Hiatal hernias are very com-
mon, especially in people over age 50, and usually do
not cause health problems or need treatment. However,
the diaphragm gives support to the LES. When it is
torn, this support is weakened, and the LES closes less
tightly. The relationship between hiatal hernia and
GERD is somewhat controversial. Many people with
a hiatal hernia do not have heartburn, and some people
who do not have a hiatal hernia do have heartburn.
Certain lifestyle choices increase the likelihood of
developing GERD. These include:
smoking
alcohol consumption
obesity
pregnancy
poor posture
eating large meals shortly before bedtime
Certain foods also increase the likelihood of
developing GERD. These foods include:
greasy or fried foods
citrus fruits or juices (e.g. orange, grapefruit)
caffeinated beverages (e.g. coffee, colas)
garlic and onions
tomato-based foods (e.g. spaghetti sauce, chili)
chocolate
foods flavored with mint
garlic and onions
spicy foods
wine, beer, and distilled spiritsSymptoms
The most common symptom of GERD is heart-
burn. Heartburn is a sharp pain in the center of the
chest that can spread to the neck and last for up to 2
hours. The pain can be substantial enough to be con-
fused with angina or a heart attack. Note that if there
is any question about whether the pain is caused by aIllustration of acidic stomach contents moving up into the
esophagus.(Copyright Hector Aiza/Phototake. Reproduced by
permission.)
Gastroesophageal reflux disease