Esophageal Reflux: Symptoms, Causes, and Treatments

Q: Esophageal Reflux: Symptoms, Causes, and Treatments

Hello： The symptoms you described are consistent with gastroesophageal reflux disease (GERD), which is typically caused by abnormal relaxation of the lower esophageal sphincter, leading to the easy backflow of stomach acid. <br>However, most individuals undergoing endoscopy do no

Is this gastroesophageal reflux disease (GERD)?

Hello Dr.
Yang,
Recently, I have been experiencing frequent pain in the middle of my back for the past two to three weeks.
My consumption of tobacco and alcohol has increased, approximately one pack of cigarettes every three days and two to three times a week of liquor below 50cc at 40% alcohol content, often mixed with water and ice.
The pain feels like being poked with a stick and sometimes radiates to the area near my shoulder blade.
After meals, I often feel a burning sensation in my esophagus and stomach, which can even reach my throat.
I underwent an endoscopy yesterday, and the doctor said there were no signs of erosion in my cardia from gastric acid.
I was prescribed Topaal and Primperan and advised to quit smoking and drinking entirely, eat smaller meals more frequently, and avoid overeating.
If there is no improvement, I may need to undergo a nasogastric tube insertion for 24-hour monitoring of gastric acid.
These symptoms began about two years ago, and I had an endoscopy at that time, which also showed normal results.
I tend to be anxious and have difficulty relaxing, so the doctor prescribed me an acid reducer along with medication for anxiety.
What confuses me is that my cardia appears normal, yet I experience easy regurgitation of food back into my mouth after eating, a condition I have had since I was young.
How can I have gastroesophageal reflux disease (GERD) and also experience back pain? Could this be related to my heart? Is it connected to gastrointestinal motility? Thank you!

A Gui, 40~49 year old female. Ask Date: 2003/05/25

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello: The symptoms you described are consistent with gastroesophageal reflux disease (GERD), which is typically caused by abnormal relaxation of the lower esophageal sphincter, leading to the easy backflow of stomach acid.
However, most individuals undergoing endoscopy do not reach the severity of reflux esophagitis but still meet the diagnostic criteria for this condition.
The purpose of endoscopy is not only to assess the severity of reflux esophagitis but also to rule out other potential lesions.
A 24-hour pH monitoring or esophageal manometry can assist in diagnosing this condition.
Since the esophagus is located in the posterior thoracic cavity, pain may radiate to the upper back.
When gastric contents reflux into the larynx, it can cause laryngeal irritation, leading to frequent coughing or a sensation of a foreign body in the throat.
If there are gastric lesions (such as gastritis or gastric ulcers), they can sometimes cause delayed gastric emptying, indirectly contributing to the reflux of gastric contents into the esophagus.
Therefore, treatment for this condition primarily involves acid-reducing medications, and sometimes prokinetic agents (such as metoclopramide) may also be effective.
Most importantly, dietary control and avoiding excessive obesity are crucial.
Wishing you good health, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare, Dr.
Yang Pei-Chen.

Reply Date: 2003/05/25

More Info

Understanding esophageal reflux, commonly known as gastroesophageal reflux disease (GERD), involves recognizing its symptoms, causes, and treatment options. Your recent experiences with back pain, burning sensations in the esophagus, and the discomfort after meals are indicative of this condition. Let's break down the aspects of GERD and how they relate to your situation.

Symptoms of GERD
The symptoms you describe, such as burning sensations in the chest (often referred to as heartburn), regurgitation of food or sour liquid, and discomfort after eating, are classic signs of GERD. The back pain you experience, particularly in the middle of your back, can sometimes be associated with GERD, although it is less common. This pain can be due to referred pain from the esophagus or even muscular tension resulting from chronic discomfort.

Causes of GERD
GERD occurs when stomach acid frequently flows back into the esophagus, the tube connecting your mouth and stomach. This backflow (reflux) can irritate the lining of your esophagus. Factors contributing to GERD include:
1. Lifestyle Choices: Smoking and alcohol consumption, as you mentioned, can weaken the lower esophageal sphincter (LES), the muscle that prevents stomach acid from entering the esophagus. Your current habits of smoking and drinking alcohol may exacerbate your symptoms.

2. Dietary Habits: Overeating or consuming trigger foods (spicy, fatty, or acidic foods) can lead to increased acid production and reflux.

3. Obesity: Excess weight can put pressure on the abdomen, pushing stomach contents into the esophagus.

4. Hiatal Hernia: This condition occurs when part of the stomach pushes through the diaphragm into the chest cavity, which can contribute to reflux.

5. Stress and Anxiety: Emotional stress can affect digestion and exacerbate symptoms of GERD.

Treatment Options
Your doctor has prescribed Topaal (a proton pump inhibitor) and Primperan (metoclopramide), which are commonly used to manage GERD symptoms. Proton pump inhibitors reduce stomach acid production, helping to heal the esophagus and alleviate symptoms. Metoclopramide helps with gastric emptying and can reduce the likelihood of reflux.

Here are some additional treatment strategies:
1. Lifestyle Modifications: As advised, quitting smoking and reducing alcohol intake are crucial. Eating smaller, more frequent meals rather than large meals can help minimize symptoms. Avoiding food and drink that trigger your symptoms (like spicy or fatty foods) is also important.

2. Weight Management: If applicable, losing weight can significantly reduce GERD symptoms.

3. Elevating the Head of the Bed: Sleeping with your head elevated can help prevent nighttime reflux.

4. Avoiding Tight Clothing: Tight clothing can put pressure on your abdomen, exacerbating reflux symptoms.

5. Monitoring Symptoms: If your symptoms do not improve with medication and lifestyle changes, your doctor may recommend further testing, such as a 24-hour pH monitoring study, to assess acid levels in your esophagus.

When to Seek Further Evaluation
If your symptoms persist despite treatment, or if you experience severe pain, difficulty swallowing, or unintentional weight loss, it is essential to follow up with your healthcare provider. These could be signs of complications related to GERD or other underlying conditions.

Conclusion
In summary, GERD is a manageable condition, but it requires a comprehensive approach that includes medication, lifestyle changes, and possibly further evaluation if symptoms persist. Your current symptoms, including back pain and burning sensations, are likely related to your esophageal reflux, and addressing your lifestyle choices will be crucial in managing your condition effectively. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific needs.

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