With the increase in occurrence of gastroesophageal reflux disease (also known as GERD), it’s essential to understand the disease itself, including the known risk factors. As a chronic digestive disease, GERD can be uncomfortable, disruptive, and even dangerous.
Gastroesophageal reflux disease occurs when either stomach acid or bile flows back to the esophagus, also referred to as “refluxing”. This refluxed acid can severely irritate the esophageal lining, causing the common symptoms of GERD. The most common signs and symptoms of GERD include heartburn and acid reflux. Although these symptoms are also associated with typical digestive issues, which the average person may experience throughout their lifetime, the frequency of occurrence (at least twice a week) or interference with daily life is considered confirmation of GERD. Many patients with average heartburn can find relief of symptoms with mild to moderate lifestyle changes, and the use of easily obtainable over-the-counter (or OTC) medications. However, for patients suffering with GERD, these options usually only provide temporary relief; more permanent solutions are typically surgery or much stronger (prescription) medications.
There are several risk factors, which are known to increase the chances of patient diagnosis of GERD: pregnancy, asthma, alcohol, diabetes, obesity, connective tissue disorders (i.e. scleroderma), and smoking, among others. A rather significant risk factor for increase in occurrence and long-term damage, is alcohol. As noted by Mohammed et al. (2005), “Excess alcohol consumption was also independently associated with longstanding GERD symptoms in the present study. It has been suggested that chronic excess alcohol may result in neuropathic damage resulting in impaired oesophageal motor function” (p. 825). Smoking is also a significant risk factor for GERD, as Stanghellini (1999) found the following:
The results of this study further suggest that smoking is a risk factor for GORD-like symptoms. A number of authors are of the opinion that the symptoms of heartburn and regurgitation are diagnostic of GORD (2, 44). These findings therefore suggest that smoking is a risk factor for GORD; and this conclusion supports the evidence from a number of previous studies. (p. 35)
These risk factors are subject to lifestyle choice. However, there is also risk in the use of nonsteroidal anti-inflammatory drugs (or NSAIDs), which may be necessary for some patients. As Stanghellini (1999) notes, “The relationship between NSAID use and the prevalence of relevant upper GI symptoms confirms the role of these agents in precipitating GI symptoms” (p. 35).
Steroid use was found to significantly increase the risk of GERD. Ruigomez et al. (2010) found that, “Children and adolescents with a GERD diagnosis were more likely than those with no GERD diagnosis to have used antiepileptic medications, oral/inhaled steroids, b-agonists, paracetamol or antibiotics in the 90 days prior to the index date” (p. 142) and although asthma was not a contributing factor, “we did find a clear association between GERD and prior use of oral/inhaled steroids or b-agonists, both of which can be used to treat asthma” (p. 145).
The treatment plan for GERD can include recommendations for modification of lifestyle choices (i.e. smoking cessation), medications, and even surgery. Although lifestyle choices are much safer than medication and surgery, many patients find change difficult. Some may be reluctant to quit smoking or drinking alcohol, but they may be willing to try ‘simple’ changes such as mild weight loss and elevating the head while sleeping.
Medications can include H2 receptor blockers (such as ranitidine), antacids (with or without alginic acid) and proton-pump inhibitors (such as ompeprazole, the most effective). The effectiveness of each type of medication in the treatment of GERD is ranked from best to least effective: Proton-pump inhibitors (PPIs), H2 receptor blockers, and antacids.
Surgery treatment is usually the Nissen fundoplication, wherein the upper stomach is wrapped around the lower esophagus to strengthen the sphincter and prevent reflux (as well as repairing hiatal hernias). However, the benefits of surgery are usually the same as medication, for those with chronic symptoms.
- Mohammed, I. I., Nightingale, P. P., & Trudgill, N. J. (2005). Risk factors for gastro-oesophageal reflux disease symptoms: a community study. Alimentary Pharmacology & Therapeutics, 21(7), 821-827.
- Ruigómez, A., Wallander, M., Lundborg, P., Johansson, S., & Rodriguez, L. (2010). Gastroesophageal reflux disease in children and adolescents in primary care. Scandinavian Journal Of Gastroenterology, 45(2), 139-146.
- Stanghellini, V. V. (1999). Relationship between Upper Gastrointestinal Symptoms and Lifestyle, Psychosocial Factors and Comorbidity in the General Population: Results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scandinavian Journal Of Gastroenterology. Supplement, 3429-37.