Protective mechanisms in GER include
(1), gravity,
upright posture allows gravity to augment esophageal
acid emptying;
(2), peristalsis, acid clearance begins
with peristalsis that empties the refluxed content from
the esophagus; and
(3), saliva, the final phase of esophageal
acid clearance depends on the swallowed saliva,
which has a neutralizing pH around 6.0.
The LES is closed at rest, with an average pressure of
about 20 mmHg, which prevents gastric content from
refluxing into the esophagus
Acid reflux occurs when the basal LES pressure is within
1–4 mmHg of the intragastric pressure
Transient lower esophageal sphincter relaxation
(relaxation without swallowing) is the main mechanism
of acidic and nonacidic reflux – gastric distention
high-fat diet (delayed gastric emptying),
foods that lower LES pressure (alcohol, chocolate,
peppermint,
caffeine, and onion), and acidic foods (citrus,
tomato products, and carbonated beverages)
Obesity may lead to GERD through
chronically increased intra-abdominal pressure and
increased frequency of TLESRs (
Clinical Manifestations:
 Heartburn is a burning, tight sensation felt intermittently
o beneath the lower sternum and spreading upward to the
throat or jaw.
o may occur after ingestion of food or drugs that decrease
the LES pressure
o occurs more than twice a week, is rated as severe,
occurs at night and wakes a person from sleep, or is
associated with dysphagia.
 Dyspepsia
o Pain or discomfort centered in the upper abdomen
 Regurgitation – hot bitter sour liquid coming into the throat
or mouth
 Hypersalivation (water brash)
 Respiratory symptoms (wheezing, coughing, dyspnea)
 Nocturnal discomfort & coughing –
 Otolaryngologic symptoms (hoarseness, sore throat, a
globus sensation, choking)
 GERD-related chest pain can mimic angina – burning ,
squeezing , radiating to the back neck jaw or arms. It is
relieved with antacids
Irritation and inflammation by gastric secretions
Long-term use of PPIs has been associated with decreased
bone density,14 chronic hypochlorhydria, and increased risk of
Clostridium difficile in hospitalized patients.15 Long-term PPI
use has also been associated with pneumonia.
Heartburn vs Heart Attack
 Heart burn is associated with food and
hence gets worst in terms of causing pain
after the intake of food. However, a heart
attack can be caused even at the resting
state.
 For connecting pain of Heart and stomach,
it is best to take antacid first and check for
effectiveness. The best natural antacid to be
taken at home is lemon water with a half
teaspoon of black pepper. Note: Refer to a
chemist or your Doctor
 Heartburn does not cause symptoms like
shortness of breath, while a heart attack
does affect the breathing.
 Heartburn usually causes bloating while
heart attack does not cause any.