Gastroesophageal Reflux Disease

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Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.

Symptoms

GERD signs and symptoms include:

  • A burning sensation in your chest (heartburn), sometimes spreading to your throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in your throat

When to see a doctor

Seek immediate medical attention if you experience chest pain, especially if you have other signs and symptoms, such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you experience severe or frequent GERD symptoms. If you take over-the-counter medications for heartburn more than twice a week, see your doctor.

Causes

GERD is caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus.

When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.

However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn. Sometimes this can disrupt your daily life.

This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can wear away the esophageal lining, causing complications such as bleeding, esophageal narrowing or Barrett’s esophagus (a precancerous condition).

Risk factors

 

Conditions that can increase your risk of GERD include:

  • Obesity
  • Bulging of top of stomach up into the diaphragm (hiatal hernia)
  • Pregnancy
  • Smoking
  • Dry mouth
  • Asthma
  • Diabetes
  • Delayed stomach emptying
  • Connective tissue disorders, such as scleroderma

Complications

Over time, chronic inflammation in your esophagus can lead to complications, including:

  • Narrowing of the esophagus (esophageal stricture)
  • An open sore in the esophagus (esophageal ulcer)
  • Precancerous changes to the esophagus (Barrett’s esophagus)

Tests and diagnosis

Diagnosis of GERD is based on:

  • Your symptoms. Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms.
  • A test to monitor the amount of acid in your esophagus. Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours.
  • An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine (duodenum).
  • A flexible tube to look inside your esophagus. Endoscopy is a way to visually examine the inside of your esophagus and stomach. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat.
  • Your doctor may also use endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett’s esophagus.
  • A test to measure the movement of the esophagus. Esophageal motility testing (manometry) measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.

Treatments and drugs

Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. If you don’t experience relief within a few weeks, your doctor may recommend other treatments, including medications and surgery.

Initial treatments to control heartburn

Over-the-counter treatments that may help control heartburn include:

  • Antacids that neutralize stomach acid. Antacids may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
  • Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine, famotidine, nizatidine or ranitidine. H-2-receptor blockers don’t act as quickly as antacids do, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form.
  • Medications that block acid production and heal the esophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole and omeprazole.

Contact your doctor if you need to take these medications for longer than two to three weeks or your symptoms are not relieved.

Prescription-strength medications

If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:

  • Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine, famotidine, nizatidine and ranitidine.
  • Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole and dexlansoprazole.

These medications are generally well-tolerated, but long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency.

  • Medications to strengthen the lower esophageal sphincter. Baclofen may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than do proton pump inhibitors, but it might be used in severe reflux disease. Baclofen can be associated with significant side effects, most commonly fatigue or confusion.

GERD medications are sometimes combined to increase effectiveness.

Surgery and other procedures used if medications don’t help

Most GERD can be controlled through medications. In situations where medications aren’t helpful or you wish to avoid long-term medication use, your doctor may recommend more-invasive procedures, such as:

  • Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication).
  • Surgery to strengthen the lower esophageal sphincter (Linx).

Lifestyle and home remedies

Lifestyle changes may help reduce the frequency of heartburn. Consider trying to:

  • Maintain a healthy weight.
  • Avoid tight-fitting clothing.
  • Avoid foods and drinks that trigger heartburn. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn.
  • Eat smaller meals. Avoid overeating by eating smaller meals.
  • Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  • Elevate the head of your bed.
  • Don’t smoke.

 

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