What Causes Reflux/GERD?
Reflux is caused by a weakness in the EGJ, which is the barrier to ALL reflux (acid, weakly acid, non acid, bile, pepsin, etc). If the primary cause of that weakness is LES dysfunction (TLESR, hypotensive/low basal LES pressure) then the LES muscle itself needs to be strengthened to restore function.
Types of Reflux/GERD
Approximately 30 percent of the adult population suffers from some kind of GERD. This disease can be characterized by classic symptoms of GERD (heartburn) or other mysterious symptoms that may or may not be immediately identified as Reflux disease. The types of GERD fall into a few main classifications:
Gastroesophageal Reflux Disease (GERD)
GERD has been defined as a chronic condition that develops when gastric contents in the stomach reflux back into the esophagus in causing typical symptoms of heartburn and/or acid regurgitation. This reflux may appear with or without mucosal erosions and/or relevant complications.
Non-erosive Reflux Disease (NERD)
NERD is a subcategory of GERD characterized by reflux-related symptoms in the absence of esophageal erosions/breaks as seen on conventional endoscopy. NERD patients are often less responsive to PPI therapy.
Extra Esophageal Reflux
When GERD manifests itself atypically as respiratory, laryngopharyngeal (LPR), nasopharyngeal, cardiac or silent symptoms it is often referred to as EER – extra esophageal reflux. Some of these atypical symptoms may include:
- Laryngitis-Chronic Cough-Hoarseness or Voice Disturbances
- Bronchitis and/or Asthma
- Recurrent Pneumonia
- Sleep Apnea
- Acid erosion of teeth
- Chest pain
- Abnormal heart rate or rhythm
All forms of extra esophageal reflux are the result of the rapid transit of gastric contents to the esophagus, and up into the larynx, bronchi, lungs, or sinuses. This type of reflux may be in association with any of the other prior mentioned appearances of reflux disease in the esophagus, or the esophagus may be entirely normal appearing.
Barrett’s Esophagus (BE)
Barrett’s Esophagus is thought to be a result of chronic GERD and is a coexisting condition associated with reflux that may be found anywhere within the body of the esophagus, but is usually in the lower portion of the esophagus near the EG junction. BE usually develops as a result of mucosal destruction and tissue transformation associated with acid or bile damage to the esophageal tissue. Left untreated, or if unrecognized, Barrett’s can be associated with the development of esophageal cancer.