Gastroesophageal Reflux (GERD)
Gastroesophageal reflux disease (GERD) is an irritation in the lining of the esophagus. It occurs when stomach acid or bile (a digestive fluid) backs up into the lining of your esophagus.
If you have GERD, you might notice a burning feeling in your throat or stomach (heartburn) a couple times a week or more.
At the bottom of the esophagus is a muscle (sphincter). It relaxes to let food and liquid pass through to your stomach and then it closes. When this muscle doesn't work right, acid can come up into your esophagus from your stomach. The stomach acid in your throat causes heartburn. Over time, it can bother and inflame your esophagus. Over a prolonged period of time, it can wear away the lining of your esophagus and cause problems including:
- Narrowing of your esophagus from scar tissue
- Sores (ulcers) in your esophagus
- Precancerous changes to your esophagus (Barrett's esophagus)
Heartburn that only happens from time to time isn't a reason to see your doctor. If you have symptoms that don't get better with over-the-counter medications or that happen often, see your doctor. You might need another medication or treatment.
You Are at Risk for Gastroesophageal Reflux (GERD) if You:
- Are obese
- Have diabetes
- Are pregnant
- Take certain medications
- Have a hiatal hernia
- Have frequent dry mouth
- Have asthma
- Have a connective tissue disorder like scleroderma
- Have a condition that delays your stomach emptying
- Have a condition called Zollinger-Ellison
Symptoms of GERD include:
- Heartburn, or burning in your chest or throat
- A sour taste
- Trouble swallowing
- Feeling like you have a lump in your throat
- A dry cough
- Sore throat or hoarseness
- Acid reflux, or backing up of food or sour fluid
- Recurrent pneumonia
- Dental erosion and bad breath
- Chest pain
Chest pain can be a sign of something more severe than GERD. If you have chest pain or another symptom that concerns you, get medical help right away.
Sometimes your doctor can diagnose GERD without tests. When tests are needed, they may include:
- X-ray – You drink a chalky liquid that coats the lining of your digestive tract and then have X-rays of your upper GI system. The chalky substance makes your insides show up better on X-rays.
- Endoscopy – Your doctor inserts an endoscope (flexible tube equipped with a light and tiny camera) down your throat to see inside your esophagus and stomach. If needed, your doctor can get tissue samples (biopsy) during endoscopy. These samples are examined in a lab to check for problems.
- Ph monitoring – This test checks for stomach acid in your esophagus. In some types of Ph monitoring, a thin tube is threaded through your nose and into your esophagus to take the measurement. This tube remains in place, and you wear a small computer around your waist to check for acid in your esophagus over time. Other times, a tiny monitoring device is placed in your esophagus during endoscopy (tube down your throat). You wear a small computer around your waist for a couple of days, and the monitoring device sends signals to the computer about acid in your esophagus. The monitoring device comes off of your esophagus and passes through your bowels.
- Motility testing – This procedure measures if the esophagus is working properly. Your doctor puts a thin, flexible tube (catheter) through your nose, down your esophagus and into your stomach. The tube has sensors on it to take measurements.
The first step in treating GERD symptoms is usually over-the-counter medicines. If those don't work, your doctor might suggest prescription medication and, sometimes, surgery.
Over-the counter medications include:
- Antacids – These neutralize acid. They may make your symptoms better for the short term, but they can't fix damage that has occurred to your esophagus. Using antacids too much can cause problems like diarrhea and constipation.
- H-2 receptor blockers – These reduce the amount of acid your body makes. They do not act as quickly as antacids but help relieve your symptoms longer.
- Proton pump inhibitors – These block the acid your body makes, which can let your esophagus heal.
Your doctor may recommend prescription medication to treat your GERD symptoms. These include:
- H-2 receptor blockers (prescription strength) – These reduce the amount of acid your body produces. They do not act as quickly as antacids but help your symptoms for longer.
- Proton pump inhibitors (prescription strength) – These block the acid your body makes, which can let your esophagus heal.
- Prokinetic agents – These medications tighten the valve between the stomach and esophagus (esophageal sphincter) and help the stomach empty faster.
- Antibiotics – Some antibiotics can help improve stomach emptying.
Medications have side effects and should be taken only as needed.
Surgery for GERD:
- Nissen fundoplication – This tightens the sphincter (muscle) in the lower esophagus to stop reflux (backwash of acid). Your doctor wraps the top of your stomach around the outside of your lower esophagus. Sometimes this can be done in a minimally invasive way, with several small incisions in your abdomen. Other times, your doctor needs to make a larger incision.
How to Prevent Gastroesophageal Reflux (GERD)
You may be able to prevent GERD in these ways:
- Maintain your healthy weight – Extra weight pushes your abdomen upward and causes acid to back up into your esophagus
- Eat smaller meals
- Avoid food and drink that cause heartburn – These can include fatty foods, fried foods, alcohol, chocolate, garlic, onions, tomato sauce and caffeine
- Don't smoke
- Don't lie down for three hours after eating
- Raise the head of your bed 6 to 9 inches. You can buy wedges at medical supply stores to raise your mattress, or put blocks under your bed to raise the frame.
- Don't wear clothes that are tight around your waist