Symptoms
Common symptoms of NERD include:
Heartburn (a burning sensation in the chest)
Regurgitation (the backflow of stomach contents into the mouth or esophagus)
Dyspepsia (indigestion, upper abdominal discomfort)
Difficulty swallowing (dysphagia)
Nausea
Bloating
Excessive belching
Chronic cough
Sore throat
Hoarseness
Causes
The exact causes of NERD are not fully understood, but several factors contribute:
Increased Sensitivity to Acid: The esophagus may be overly sensitive to normal levels of stomach acid.
Abnormal Esophageal Motility: Problems with the muscles of the esophagus not properly moving food down.
Visceral Hypersensitivity: Increased pain perception in the esophagus.
Psychological Factors: Stress, anxiety, and depression can exacerbate symptoms.
Dietary Factors: Certain foods and beverages can trigger symptoms in susceptible individuals.
Hiatal Hernia: While not always present, it can contribute to reflux.
Medicine Used
Medications used to manage NERD symptoms include:
Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, lansoprazole, esomeprazole, pantoprazole).
H2 Receptor Antagonists (H2RAs): Also reduce stomach acid production, but typically less potent than PPIs (e.g., ranitidine, famotidine, cimetidine).
Antacids: Neutralize stomach acid for quick, temporary relief (e.g., Tums, Rolaids, Maalox).
Prokinetics: Help to empty the stomach faster and improve esophageal motility (e.g., metoclopramide, domperidone - less commonly used due to side effects).
Mucosal Protectants: Forms a protective layer over the esophageal lining (e.g., sucralfate).
Precautions
Lifestyle and dietary modifications can help manage NERD symptoms:
Dietary Changes: Avoid trigger foods (e.g., fatty foods, spicy foods, chocolate, caffeine, alcohol, citrus fruits, tomatoes). Eat smaller, more frequent meals.
Eating Habits: Don't lie down immediately after eating. Avoid eating 2-3 hours before bedtime.
Weight Management: If overweight or obese, losing weight can reduce symptoms.
Elevate Head of Bed: Sleeping with the head of the bed elevated 6-8 inches can help prevent nighttime reflux.
Avoid Tight Clothing: Tight clothing can increase abdominal pressure.
Quit Smoking: Smoking weakens the lower esophageal sphincter (LES).
Stress Management: Practice relaxation techniques to reduce stress and anxiety.
How long does an outbreak last?
NERD is a chronic condition. There aren't "outbreaks" in the traditional sense. Symptom duration varies greatly. Some individuals experience symptoms frequently, while others have periods of remission. Symptoms can last for days, weeks, or months if untreated or poorly managed.
How is it diagnosed?
Diagnosis of NERD typically involves:
Medical History and Physical Exam: Discussion of symptoms and examination by a doctor.
Upper Endoscopy: A procedure where a thin, flexible tube with a camera is inserted into the esophagus to visualize the lining. In NERD, the endoscopy shows no visible erosions or damage.
Esophageal pH Monitoring: Measures the amount of acid in the esophagus over a 24-hour period.
Esophageal Manometry: Measures the pressure and function of the esophageal muscles.
Timeline of Symptoms
The timeline of NERD symptoms is highly variable:
Acute onset: Symptoms may appear suddenly after a trigger.
Intermittent: Symptoms may come and go, with periods of remission.
Chronic: Symptoms may persist for months or years.
Progression: Symptoms may worsen over time if not managed. The individual's experience defines the symptom timeline
Important Considerations
NERD significantly impacts quality of life.
Proper diagnosis is crucial to rule out other conditions.
Treatment is aimed at symptom control and improving quality of life.
Lifestyle modifications are essential for long-term management.
Long-term use of PPIs can have potential side effects and should be discussed with a doctor.
Psychological factors should be addressed as they can influence symptom perception.