What Is GERD? What Causes GERD?

GERD or Gastroesophageal Reflux Disease occurs when gastric acid from the stomach goes up into the esophagus, often causing inflammation of the esophagus - esophagitis. Reflux refers to the upward or reverse movement from the stomach upwards to the esophagus.

If the GERD remains untreated the patient can experience great discomfort and inflammation of the esophagus. This is sometimes linked to serious complications, such as the narrowing (stricture) of the esophagus, Barrett's esophagus (severe esophagus damage which is linked to the development of cancer), ulceration, and bleeding.

Complications are more likely to happen as a result of nocturnal reflux, than daytime reflux. However, daytime reflux can also lead to complications.

What is erosive esophagitis?

This is when the esophagus lining has been damaged or eroded away by long-term exposure to gastric acid - a common problem with untreated acid reflux.

How common are GERD and erosive esophagitis?

In industrialized nations between 20% and 40% of adults experience regular heartburn. Heartburn is the primary symptom of GERD.

Hospitalized patients commonly have GERD as a concomitant condition. A concomitant condition is one that accompanies another.

It is estimated that over half of GERD sufferers may have erosive esophagitis.

What are the symptoms of GERD?

Heartburn is usually the main symptom; a burning sensation that rises from the stomach or lower chest towards the neck and throat.

A bitter or sour taste at the back of the throat is sometimes experienced.

Most of us experience occasional heartburn. When this happens two or more times per week, it is then more likely to be a symptom of GERD.

The correlation between symptom severity and the presence/grade of esophagitis is poor, and cannot be used as diagnostic guidance.

What causes GERD?

GERD occurs when the anti-reflux mechanisms at the junction between the esophagus and the stomach do not work properly. This may be due to a weakness in the lower esophageal sphincter that is supposed to close off the esophagus from the stomach and stop acid reflux from happening.

How is GERD diagnosed?

• If a patient experiences heartburn at least twice a week, GERD is usually suspected.


• The doctor will carry out a careful review of symptoms.


• History Endoscopy may be used to confirm suspected diagnosis. However, less than 50% of patients with GERD have diagnostic endoscopic abnormalities.

How are GERD and erosive esophagitis treated?

• For GERD management to be effective the patient's gastric acidity must be reduced, while his intragastric pH must be above 4 - keeping it above 4 reduces the damage caused to the esophagus by refluxed gastric contents.


• PPI (proton pump inhibitor) therapy is very effective in maintaining intragastric pH above 4, as it suppresses gastric acid secretion, and is the recommended first-line treatment for all GERD patients (Geneva Guidelines). PPIs inhibit the proton (acid) pumps of the cells that line the stomach wall - preventing the secretion of stomach acid.


• By commencing treatment with the most successful therapy, the higher initial cost of medication will probably be offset by rapid symptom control for the patient and the reduced need for repeated consultations.

How is the endoscopic severity of GERD classified?

The severity of esophagitis can be categorized by endoscopy using the Los Angeles classification of disease severity:

• Grade A
  Definition - At least one mucosal break no longer than 5 mm, none of which extends between the tops of the mucosal folds.


• Grade B
  Definition - At least one mucosal break more than 5 mm long, none of which extends between the tops of two mucosal folds.


• Grade C
  Definition - Mucosal breaks that extend between the tops of two or more mucosal folds, but which involve less than 75% of the mucosal circumference.


• Grade D
  Definition - Mucosal breaks which involve at least 75% of the mucosal circumference.