What are the Symptoms and Causes of Gastroesophageal Reflux? How it is Treated and Diagnosed?


Gastroesophageal reflux disease (GERD) appears when the lower oesophagal sphincter (LES), the valve that controls the passage of the contents of the oesophagus into the stomach, is altered or relaxes inadequately, allowing the contents to pass back into the oesophagus, thus irritating the mucosa caused characteristic symptoms and complications.

Gastroesophageal reflux differs from hiatal hernia, but both diseases make eating difficult, producing very annoying symptoms.

What are the symptoms of gastroesophageal reflux?

The most characteristic symptoms of GERD are the following:

  • Heartburn and acid regurgitation. Heartburn is a burning sensation, also known as heartburn, that is felt behind the sternum and appears when gastric content passes into the oesophagus, irritating the mucosa. Acid regurgitation in the chest occurs when gastric fluids rise, being able to reach the mouth.
  • Other less common symptoms may be related to this pathology, such as; chest pain, wheezing, sore throat, hoarseness due to irritation caused by the acid content in the larynx, cough, asthma or respiratory distress due to aspiration of acid through the respiratory tract, among others.

What are the causes of reflux?

It appears when there is an alteration between the oesophagus’s defence mechanisms and the stomach’s offensive mechanisms, such as acid and other digestive juices and enzymes. The passage of food from the oesophagus to the stomach is controlled by the lower oesophagal sphincter (LES) or valve. Those people who present this disease have an alteration in this valve. This is kept open for some time, thus allowing the passage of content from one area to another.

Some dietary aspects or lifestyles can contribute to or increase the risk of gastroesophageal reflux, such as:

  • High consumption of alcoholic beverages, smoking, increased consumption of irritating foods such as chocolate, pepper or spices, mint, coffee, and foods with high-fat content. All this favours the relaxation of the lower oesophagal sphincter allowing the passage of stomach contents into the oesophagus.
  • Many patients also have a hiatal hernia displaces part of the stomach towards the chest through the diaphragm, favouring gastroesophageal reflux. This is not its only cause since not all people with a hiatal hernia have reflux.
  • On the other hand, other situations that produce an increase in intra-abdominal pressure can favour said reflux; overweight or obesity, pregnancy etc.

How is GERD diagnosed?

The main symptoms that can lead to the diagnosis of gastroesophageal reflux disease are a burning sensation, heartburn and acid regurgitation. In most cases, no further testing is necessary before starting treatment.

If, despite the following treatment, the symptoms persist or new symptoms appear, such as weight loss, difficulty swallowing or internal bleeding, more specific tests should be considered.

The tests needed to diagnose GERD are:

  • Upper gastrointestinal x-rays: X-ray examination of the oesophagus, stomach and the first part of the small intestine allows to see the existence or not of reflux through the administration of an opaque oral liquid.
  • Endoscopy: Through a small tube with a light, the oesophagus, stomach and duodenum (the first portion of the small intestine) are examined to observe the mucosa of the oesophagus and detect any possible damage to it.
  • Oesophageal manometry or oesophagal pH: This test can measure how often stomach acid passes into the oesophagus and calculate how long the acid remains there.

Gastroesophageal Reflux Treatment

Treatment for GER will vary greatly depending on the person. In most cases, the symptoms disappear and improve a lot when those lifestyle or dietary factors causing their symptoms are reduced or eliminated.

Advice and recommendations aimed at establishing habits that facilitate and improve digestion, avoiding gases and irritating or exciting foods that can worsen the situation:

  • A varied and balanced diet, with a high content of fruit, vegetables and vegetable fibre from cereals and legumes.
  • To avoid snacking between meals, distribute the total intake of the day in 5 servings, better than 3. Eat slowly and chew food well.
  • Avoid caffeinated and decaffeinated coffee, as it increases stomach acidity and is an exciting food. Instead, infusions include chamomile, green anise, lemon balm, bitter orange or orange blossom, thyme, lemon verbena or hops.
  • Avoid foods and drinks that promote relaxation of the LES, such as fats (especially fried foods), pepper and spices, chocolate, alcohol, carbonated drinks, coffee, citrus fruits, tomatoes and menthol products.
  • Avoid the consumption of foods that irritate the surface of the oesophagus, such as certain condiments (vinegar, pepper, paprika, chilli ) and acidic foods ( tomatoes, fruits or citrus juices)
  • Avoid copious meals and foods rich in fat. They are difficult to digest and delay gastric emptying and increase.
  •          inflammation of the gastric mucosa such as sauces and   
  •           Stews.
  • Avoid the consumption of carminatives ( garlic, fennel, mint, basil, coriander, onion, carrot, nutmeg or sage ).
  • Increase the intake of ω-3 and ω-6 acids due to their anti-inflammatory action.

Other tips:

  • Eat dinner at least 2-3 hours before going to sleep. Raise the head of the bed about 10 cm to achieve a minimum inclination of the entire trunk to avoid increasing the risk of reflux.
  • Do not wear tight clothing, especially after meals.
  • Do not lie down just after eating.
  • No Smoking
  • If you identify that one of the causes may be stress due to nervousness, try to improve attitudes and thoughts or perform some relaxing therapy (yoga, meditation, relaxing plants).
  • Avoid cooking that irritates the mucosa of the digestive system, such as grills and fried foods. Choose cooking such as steamed, boiled, papillote, microwave or oven.
  • Avoid consuming foods with extreme temperatures, neither very cold nor boiling, due to their irritating effect on the mucosa of the oesophagus.
  • Consume liquids between meals and not during them to avoid increasing the stomach volume.
  • Lose weight if you are overweight or obese.