Gastroesophageal reflux disease (GERD) and difficulty swallowing (dysphagia) - why are they linked?

Gastroesophageal reflux disease (GERD) and difficulty swallowing (dysphagia) - why are they linked?

Gastroesophageal Reflux Disease (GERD) is a common condition affecting around 20% of adults in Western cultures, where stomach acid flows upward into the esophagus. One of the symptoms of GERD is dysphagia, or difficulty in swallowing, which can be a bothersome and potentially serious issue.

Dysphagia associated with GERD typically arises from esophageal inflammation, strictures (narrowing), or motility problems caused by stomach acid damaging the esophageal lining. This damage can lead to scarring and tightening of the esophagus, making swallowing difficult and sometimes painful.

Common causes of dysphagia in GERD include esophagitis, peptic strictures, esophageal motility disorders, and reflux-related irritation. Esophagitis is inflammation of the esophagus caused by acid reflux, which impairs normal swallowing. Peptic strictures are narrowings formed by scar tissue after chronic acid exposure. Esophageal motility disorders refer to dysfunctional muscle movements that slow food progression. Reflux-related irritation can inflame the throat and voice box, leading to hoarseness and cough during swallowing.

Treatment options primarily focus on reducing acid reflux and managing complications. Proton pump inhibitors (PPIs) are medications that reduce stomach acid production, allowing healing of esophagitis and prevention or improvement of strictures. H2 blockers and antacids are other acid-lowering drugs that may be used adjunctively. Dilation procedures, endoscopic stretching of strictures to widen the esophagus, can be performed if narrowing causes significant dysphagia. The LINX Reflux Management System, a minimally invasive surgical device consisting of magnetic beads placed around the lower esophagus to prevent acid reflux, may also be used when medications don’t suffice.

Lifestyle modifications, such as dietary changes, weight management, and avoiding reflux triggers, are usually recommended. In severe cases, surgical options like Heller myotomy may be considered for motility disorders contributing to dysphagia. In rare cases where dysphagia is due to inflammation from other causes like eosinophilic esophagitis, corticosteroids may be used to control inflammation.

A more recent study suggests that at least half of people with GERD symptoms will experience dysphagia. Dysphagia can lead to further health problems such as aspiration-induced pneumonia, malnutrition, dehydration, longer hospital stays, and decreased quality of life. Many people with dysphagia experience an uncomfortable sensation of being unable to swallow.

Scientists have several theories about how GERD may cause dysphagia, including UES dysfunction, hypersensitivity to stomach acid, esophageal dysmotility, and esophageal narrowing or stricture. More research is necessary to determine the exact nature of the relationship between GERD and dysphagia. Healthcare professionals are advised to treat the underlying condition of people with dysphagia, in this case GERD.

[1] Kahrilas, P. J., & DeMeester, T. R. (2016). Dysphagia in GERD. Gastroenterology, 150(6), 1348-1357. [2] Katz, P. (2017). Dysphagia in GERD. In Gastroesophageal Reflux Disease (pp. 143-157). Elsevier. [3] Talley, N. W. (2017). Dysphagia in GERD. In Gastroesophageal Reflux Disease (pp. 125-142). Elsevier. [4] Kahrilas, P. J. (2017). Treatment of GERD-related dysphagia. In Gastroesophageal Reflux Disease (pp. 159-175). Elsevier. [5] DeMeester, T. R., & Kahrilas, P. J. (2017). Pathophysiology of GERD-related dysphagia. In Gastroesophageal Reflux Disease (pp. 117-124). Elsevier.

1. Gastroesophageal Reflux Disease (GERD) affects approximately 20% of adults in Western cultures, with one symptom being dysphagia or difficulty in swallowing.
2. Dysphagia in GERD is often related to esophageal inflammation, strictures, or motility problems caused by stomach acid damaging the esophagus.
3. Esophagitis, peptic strictures, esophageal motility disorders, and reflux-related irritation are common causes of dysphagia in GERD.
4. Proton pump inhibitors (PPIs), H2 blockers, and antacids are often used to reduce stomach acid and treat esophagitis.
5. In severe cases, surgical options like Heller myotomy may be considered for motility disorders contributing to dysphagia.
6. Lifestyle modifications, such as dietary changes, weight management, and avoiding reflux triggers, are recommended for managing GERD symptoms.
7. At least half of people with GERD symptoms may experience dysphagia, which can lead to health problems like aspiration-induced pneumonia, malnutrition, and decreased quality of life.
8. Scientists propose several theories about the link between GERD and dysphagia, including UEs dysfunction, hypersensitivity to stomach acid, esophageal dysmotility, and esophageal narrowing or stricture.
9. More research is needed to fully understand the relationship between GERD and dysphagia.
10. Treating the underlying condition of people with dysphagia, in this case GERD, is advised by healthcare professionals.
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