Gastroesophageal reflux disease (GERD) is a more
serious form of gastroesophageal reflux (GER), which
is common. GER occurs when the lower esophageal
sphincter opens spontaneously, for varying periods
of time, or does not close properly and stomach
contents rise up into the esophagus. GER is also
called acid reflux or acid regurgitation,
because digestive juices—called acids—rise up with
the food. The esophagus is the tube that carries
food from the mouth to the stomach. The LES is a
ring of muscle at the bottom of the esophagus that
acts like a valve between the esophagus and stomach.
When acid reflux occurs, food or fluid can be
tasted in the back of the mouth. When refluxed
stomach acid touches the lining of the esophagus it
may cause a burning sensation in the chest or throat
called heartburn or acid indigestion. Occasional GER
is common and does not necessarily mean one has GERD.
Persistent reflux that occurs more than twice a week
is considered GERD, and it can eventually lead to
more serious health problems. People of all ages can
have GERD.
What are the symptoms of
GERD?
The main symptom of GERD in adults is frequent
heartburn, also called acid indigestion—burning-type
pain in the lower part of the mid-chest, behind the
breast bone, and in the mid-abdomen. Most children
under 12 years with GERD, and some adults, have GERD
without heartburn. Instead, they may experience a
dry cough, asthma symptoms, or trouble swallowing.
What causes GERD?
The reason some people develop GERD is still
unclear. However, research shows that in people with
GERD, the LES relaxes while the rest of the
esophagus is working. Anatomical abnormalities such
as a hiatal hernia may also contribute to GERD. A
hiatal hernia occurs when the upper part of the
stomach and the LES move above the diaphragm, the
muscle wall that separates the stomach from the
chest. Normally, the diaphragm helps the LES keep
acid from rising up into the esophagus. When a
hiatal hernia is present, acid reflux can occur more
easily. A hiatal hernia can occur in people of any
age and is most often a normal finding in otherwise
healthy people over age 50. Most of the time, a
hiatal hernia produces no symptoms.
Other factors that may contribute to GERD include
-
obesity
-
pregnancy
-
smoking
Common foods that can worsen reflux symptoms
include
-
citrus fruits
-
chocolate
-
drinks with caffeine or alcohol
-
fatty and fried foods
-
garlic and onions
-
mint flavorings
-
spicy foods
-
tomato-based foods, like spaghetti sauce,
salsa, chili, and pizza
How is GERD treated?
See your health care provider if you have had
symptoms of GERD and have been using antacids or
other over-the-counter reflux medications for more
than 2 weeks. Your health care provider may refer
you to a gastroenterologist, a doctor who treats
diseases of the stomach and intestines. Depending on
the severity of your GERD, treatment may involve one
or more of the following lifestyle changes,
medications, or surgery.
Lifestyle Changes
-
If you smoke, stop.
-
Avoid foods and beverages that worsen
symptoms.
-
Lose weight if needed.
-
Eat small, frequent meals.
-
Wear loose-fitting clothes.
-
Avoid lying down for 3 hours after a meal.
-
Raise the head of your bed 6 to 8 inches by
securing wood blocks under the bedposts. Just
using extra pillows will not help.
Medications
Your health care provider may recommend
over-the-counter antacids or medications that stop
acid production or help the muscles that empty your
stomach. You can buy many of these medications
without a prescription. However, see your health
care provider before starting or adding a
medication.
Antacids, such as Alka-Seltzer,
Maalox, Mylanta, Rolaids, and Riopan, are usually
the first drugs recommended to relieve heartburn and
other mild GERD symptoms. Many brands on the market
use different combinations of three basic
salts—magnesium, calcium, and aluminum—with
hydroxide or bicarbonate ions to neutralize the acid
in your stomach. Antacids, however, can have side
effects. Magnesium salt can lead to diarrhea, and
aluminum salt may cause constipation. Aluminum and
magnesium salts are often combined in a single
product to balance these effects.
Calcium carbonate antacids, such as Tums,
Titralac, and Alka-2, can also be a supplemental
source of calcium. They can cause constipation as
well.
Foaming agents, such as Gaviscon,
work by covering your stomach contents with foam to
prevent reflux.
H2 blockers, such as cimetidine
(Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid
AR), and ranitidine (Zantac 75), decrease acid
production. They are available in prescription
strength and over-the-counter strength. These drugs
provide short-term relief and are effective for
about half of those who have GERD symptoms.
Proton pump inhibitors include
omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid),
pantoprazole (Protonix), rabeprazole (Aciphex), and
esomeprazole (Nexium), which are available by
prescription. Prilosec is also available in
over-the-counter strength. Proton pump inhibitors
are more effective than H2 blockers and can relieve
symptoms and heal the esophageal lining in almost
everyone who has GERD.
Prokinetics help strengthen the
LES and make the stomach empty faster. This group
includes bethanechol (Urecholine) and metoclopramide
(Reglan). Metoclopramide also improves muscle action
in the digestive tract. Prokinetics have frequent
side effects that limit their usefulness—fatigue,
sleepiness, depression, anxiety, and problems with
physical movement.
Because drugs work in different ways,
combinations of medications may help control
symptoms. People who get heartburn after eating may
take both antacids and H2 blockers. The antacids
work first to neutralize the acid in the stomach,
and then the H2 blockers act on acid production. By
the time the antacid stops working, the H2 blocker
will have stopped acid production. Your health care
provider is the best source of information about how
to use medications for GERD.
What if GERD symptoms
persist?
If your symptoms do not improve with lifestyle
changes or medications, you may need additional
tests.
-
Barium swallow radiograph
uses x rays to help spot abnormalities such as a
hiatal hernia and other structural or anatomical
problems of the esophagus. With this test, you
drink a solution and then x rays are taken. The
test will not detect mild irritation, although
strictures—narrowing of the esophagus—and ulcers
can be observed.
-
-
Upper endoscopy is more
accurate than a barium swallow radiograph and may
be performed in a hospital or a doctor’s office.
The doctor may spray your throat to numb it and
then, after lightly sedating you, will slide a
thin, flexible plastic tube with a light and lens
on the end called an endoscope down your throat.
Acting as a tiny camera, the endoscope allows the
doctor to see the surface of the esophagus and
search for abnormalities. If you have had moderate
to severe symptoms and this procedure reveals
injury to the esophagus, usually no other tests
are needed to confirm GERD.
The doctor also may
perform a biopsy. Tiny tweezers, called forceps,
are passed through the endoscope and allow the
doctor to remove small pieces of tissue from your
esophagus. The tissue is then viewed with a
microscope to look for damage caused by acid
reflux and to rule out other problems if infection
or abnormal growths are not found.
-
pH monitoring examination
involves the doctor either inserting a small tube
into the esophagus or clipping a tiny device to
the esophagus that will stay there for 24 to 48
hours. While you go about your normal activities,
the device measures when and how much acid comes
up into your esophagus. This test can be useful if
combined with a carefully completed
diary—recording when, what, and amounts the person
eats—which allows the doctor to see correlations
between symptoms and reflux episodes. The
procedure is sometimes helpful in detecting
whether respiratory symptoms, including wheezing
and coughing, are triggered by reflux.
A completely accurate diagnostic test for GERD
does not exist, and tests have not consistently
shown that acid exposure to the lower esophagus
directly correlates with damage to the lining.
Surgery
Surgery is an option when medicine and lifestyle
changes do not help to manage GERD symptoms. Surgery
may also be a reasonable alternative to a lifetime
of drugs and discomfort.
For More Information
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet:
www.acg.gi.org
American Gastroenterological Association
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email:
member@gastro.org
Internet:
www.gastro.org
International Foundation for Functional
Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email:
iffgd@iffgd.org
Internet:
www.aboutgerd.org
North American Society for Pediatric
Gastroenterology, Hepatology, and Nutrition
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3918
Email:
naspghan@naspghan.org
Internet:
www.naspghan.org
Pediatric/Adolescent Gastroesophageal
Reflux Association, Inc.
P.O. Box 486
Buckeystown, MD 21717–0486
Phone: 301–601–9541
Email:
gergroup@aol.com
Internet:
www.reflux.org
The National Digestive Diseases Information
Clearinghouse collects resource information about
digestive diseases for the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK)
Reference Collection. This database provides titles,
abstracts, and availability information for health
information and health education resources. The
NIDDK Reference Collection is a service of the
National Institutes of Health.
National Digestive
Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
Fax: 703–738–4929
Email:
nddic@info.niddk.nih.gov
Internet:
www.digestive.niddk.nih.gov