Gastroesophageal reflux disease (GERD) is a long-term condition where acid from the stomach comes up into the esophagus.
Many people occasionally experience gastroesophageal reflux (GER).
However, if an individual experiences persistent acid reflux that occurs more than twice a week, they may be diagnosed with GERD. In other words, GERD is the long-term, regular occurrence of GER.
Fast facts on GERD
Here are some key points about GERD. More detail and supporting information is in the main article.
Stomach acid that washes up into the esophagus can cause dangerous tissue damage.
GERD may result from a dysfunctional valve at the top of the stomach and bottom of the esophagus.
Maintaining a healthy weight, quitting smoking, and reducing stress can help reduce the risk of GERD.
Treating GERD may involve the use of protein pump inhibitors, antacids, and other medications, as well as lifestyle changes.
What is GERD?
If the sphincter at the top of the stomach does not close properly, stomach contents can flow upward.
Gastroesophageal reflux disease is a condition where stomach acid persistently and regularly flows up into the esophagus.
The esophagus may also be referred to as the food pipe or gullet and is the tube that transports food from the mouth to the stomach.
The acid in the esophagus causes heartburn and other symptoms, as well as possible tissue damage.
The American College of Gastroenterology says that at least 15 million Americans, or 20 percent of the American population, experience heartburn every day.
Occasional acid reflux is quite common, often occurring as a result of overeating, lying down after eating, or eating particular foods.
However, recurrent acid reflux, diagnosed as GERD, typically has other causes and risk factors and can have more serious complications.
Gastroesophageal reflux disease occurs in people of all ages, and sometimes for unknown reasons.
In short, GERD occurs when the sphincter at the bottom of the esophagus becomes weak, or opens when it should not.
GERD occurs more commonly in people who are:
overweight or obese because of increased pressure on the abdomen
pregnant, due to the same increased pressure
taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants
smoking, and being exposed to second-hand smoke
Hiatal hernia is a condition where an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the esophageal sphincter and raises the risk of GERD.
Woman with GERD being examined
The main symptom of GERD is heartburn.
The main symptom of GERD is heartburn.
Heartburn is discomfort felt behind the breastbone as a burning sensation. It tends to get worse if the person lies down or bends over, and also after eating food.
However, not all people with GERD experience heartburn, and there are other possible symptoms:
nausea or vomiting
difficulty or pain when swallowing
GERD can worsen and turn into other conditions if left untreated.
Esophagitis: This is an inflammation of the esophagus.
Esophageal stricture: In this condition, the esophagus becomes narrow, making it difficult to swallow.
Barrett's esophagus: The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into cancer.
Respiratory problems: It is possible to breathe stomach acid into the lungs, which can cause a range of problems including chest congestion, hoarseness, asthma, laryngitis, and pneumonia.
Anyone who is experiencing frequent acid reflux symptoms should talk to their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.
There are several possible tests to diagnose GERD, including:
Esophageal pH and impedance monitoring: This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.
Upper gastrointestinal (GI) endoscope: This is a tube with a camera attached, which is used to inspect the esophagus. A small sample of tissue may also be taken at the same time in a biopsy.
Upper GI series: This is a type of X-ray that shows up certain physical abnormalities that might cause GERD.
Esophageal manometry: This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.
Bravo wireless esophageal pH monitoring: In this test, a small temporary capsule is attached to the esophagus. This measures the acidity continuously for around 48 hours.
GERD will often be treated with medications before attempting other lines of treatment.
Proton pump inhibitors are one of the main pharmaceutical treatment options for people with GERD. They decrease the amount of acid produced by the stomach.
Other options include:
H2 blockers: These are another option to help decrease acid production.
Antacids: These counteract the acid in the stomach with alkaline chemicals. Side effects can include diarrhea and constipation. Antacids are available to purchase online.
Prokinetics: These help the stomach empty faster. Side effects include diarrhea, nausea, and anxiety.
Erythromycin: Ths is a type of antibiotic that also helps empty the stomach.
If lifestyle changes do not significantly improve the symptoms of GERD, or medications do not have the desired effect, a gastroenterologist may recommend surgery.
Surgical treatments include:
Fundoplication: The surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus and is generally successful at reducing reflux.
Endoscopic procedures: This is a range of procedures include endoscopic sewing, which uses stitches to tighten the sphincter muscle, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle.
Other lifestyle and behavior changes can help relieve GERD include:
Eat moderate amounts of food and avoid overeating.
Stop eating 2 to 3 hours before sleeping.
Quit or avoid smoking.
If a person is overweight, losing weight can help prevent symptoms.
Do not wear clothing that is tight around the abdomen.
Sleep at a slight angle with the head slightly elevated.
Certain foods may trigger GERD symptoms in some people.
What Is Acid Reflux Disease?
At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).
What Causes Acid Reflux Disease?
One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.
These are other common risk factors for acid reflux disease:
Eating large meals or lying down right after a meal.
Being overweight or obese.
Eating a heavy meal and lying on your back or bending over at the waist.
Snacking close to bedtime.
Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods.
Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications.
What Are the Symptoms of Acid Reflux Disease?
Common symptoms of acid reflux are:
Heartburn: A burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
Regurgitation: A sour or bitter-tasting acid backing up into your throat or mouth
Other symptoms of acid reflux disease include:
Bloody or black stools or bloody vomiting
Dysphagia -- the sensation of food being stuck in your throat
Hiccups that don't let up
Weight loss for no known reason
Wheezing, dry cough, hoarseness, or chronic sore throat
How Is Acid Reflux Disease Diagnosed?
It's time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don't bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms. If these steps don't help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:
Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
Esophageal manometry can check the function and movement of the esophagus and lower esophageal sphincter.
pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus.
Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube with a camera down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.
A biopsymay be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.
Can Acid Reflux Disease Be Treated With Diet and Lifestyle Changes?
One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms. Here are other steps you can take:
Eat smaller meals more frequently throughout the day and modify the types of foods you are eating..
Put blocks under the head of your bed to raise it at least 4 inches to 6 inches.
Eat at least 2 to 3 hours before lying down.
Try sleeping in a chair for daytime naps.
Don't wear tight clothes or tight belts.
If you're overweight or obese, take steps to lose weight with exercise and diet changes.
Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease.
Can Acid Reflux Disease Be Treated With Medications?
In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease. Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, or Riopan, can neutralize the acid from your stomach. But they may cause diarrhea or constipation, especially if you overuse them. It's best to use antacids that contain both magnesium hydroxide and aluminum hydroxide. When combined, they may help counteract these gastrointestinal side effects. If antacids don't help, your doctor may try other medications. They require prescription. Your doctor may suggest more than one type or suggest you try a combination of medications such as these:
Foaming agents (Gaviscon) coat your stomach to prevent reflux.
H2 blockers (Pepcid, Tagamet, Zantac) decrease acid production.
Proton pump inhibitors (Aciphex, Nexium, Prilosec, Prevacid, Protonix) also reduce the amount of acid your stomach makes.
Prokinetics (Reglan, Urecholine) can help strengthen the LES, empty your stomach faster, and reduce acid reflux.
Don't combine more than one type of antacid or other medications without your doctor's guidance.
Is Acid Reflux Disease Ever Treated With Surgery?
If medications don't completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn't effective.
The most recently approved procedure involves surgically placing a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps reflux by preventing stomach contents from backing up into the esophagus. In one study, patients were able to stop taking medicine or cut down the amount they took. You shouldn't get the LINX device if you're allergic to certain metals, and once you have a LINX device you shouldn't get any type of MRI test.
Another surgical procedure called a fundoplication can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open incision in the abdomen or chest or with a lighted tube inserted through a tiny incision in the abdomen.