Description

Gastroesophageal reflux disease occurs when the stomach acid backs up into the esophagus and causes heartburn. It is often referred to as GERD for short. This haven is known as acid reflux, and it can irritate the lining of the esophagus.

Many people suffer from acid reflux right now and then. However, when acid reflux occurs repeatedly over time, can cause GERD.

Most people can manage the discomfort of GERD with lifestyle changes and medicines. And although it is rare, some may need surgery to help with the symptoms.

Symptoms

Common symptoms of GERD include:

  • A burning sensation in the chest, often called heartburn. Heartburn usually occurs after eating and may be worse at night or while lying down.
  • Against the grain of food or sour liquid at the throat.
  • Upper part of the abdomen or pain in the chest.
  • Difficulty swallowing, called dysphagia.
  • The sensation of a lump in the throat.

If you have nighttime acid reflux, you may also experience:

  • A continuous cough.
  • The inflammation of the vocal cords, also known as laryngitis.
  • New or worsening of asthma.

When to see a doctor

Seek immediate medical help if you have chest pain, especially if you also have shortness of breath or jaw or arm pain. These may be symptoms of a heart attack.

Make an appointment with a health professional if:

  • Has severe or frequent symptoms of GERD.
  • Take an over-the-counter for heartburn more than twice a week.

Causes

GERD is caused by frequent acid reflux or reflux of nonacidic contents of the stomach.

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

If the sphincter does not relax as is typical, or weakens, stomach acid can flow back up into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed.

Risk factors

Conditions that may increase the risk of GERD include:

  • Obesity.
  • The bulging of the upper part of the stomach above the diaphragm, it is known as a hiatal hernia.
  • Pregnancy.
  • Connective tissue disorders such as scleroderma.
  • The delay of gastric emptying.

Factors that can exacerbate acid reflux include:

  • The habit of smoking.
  • Eating large amounts of food or eating late at night.
  • Eating certain foods, such as fatty or fried foods.
  • Drinking certain beverages, like alcohol or coffee.
  • Taking certain medications, such as aspirin.

Complications

Over time, long-term inflammation of the esophagus can cause:

  • The inflammation of the tissues in the esophagus, known as esophagitis. The stomach acid can break down the tissue of the esophagus. This can cause swelling, bleeding, and, sometimes, an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult.
  • Narrowing of the esophagus called esophageal stenosis. The damage to the lower part of the esophagus from the stomach acid causes the formation of scar tissue. The scar tissue narrows the food pathway, which leads to problems with swallowing.
  • Precancerous changes in the esophagus, known as Barrett's esophagus. The damage of acid can cause changes in the tissue that lines the lower part of the esophagus. These changes are associated with an increased risk of cancer of the esophagus.

Diagnosis

A health care professional may be able to diagnose GERD based on a history of symptoms and a physical examination.

To confirm a diagnosis of GERD, or to check for complications, a care professional might recommend:

  • The upper gastrointestinal endoscopy.An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine your upper digestive system. The camera helps to provide a view of the inside of the esophagus and the stomach. The results of the test may not show when reflux is present, but an endoscopy may find inflammation of the esophagus or other complications. Endoscopy can also be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett's esophagus. In some cases, if the narrowing is seen in the esophagus, it can be stretched or dilated during this procedure. This is done to improve difficulty swallowing.
  • Ambulatory acid (pH) probe test.A monitor is placed in the esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that is worn around the waist or with a strap over the shoulder. The monitor can be a thin, flexible tube, called a catheter, which is inserted through the nose into the esophagus. Or it could be a clip that is placed in the esophagus during an endoscopy. The clip is excreted in the feces after about two days.
  • X-ray of the upper part of the digestive system.X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows a health professional to see a silhouette of the esophagus and the stomach. This is particularly useful for people who have difficulty swallowing. Sometimes, a chest x-ray performed after the barium swallow of the pill. This can help to diagnose a narrowing of the esophagus that interfere with swallowing.
  • The esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measured the coordination and force exerted by the muscles of the esophagus. Typically, this is done in people who have difficulty swallowing.
  • Transnasal esophagoscopy. This test is done to detect any damage in the esophagus. A thin, flexible tube with a video camera through the nose and moved down the throat into the esophagus. The camera sends images to a video screen.

The upper gastrointestinal endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine your upper digestive system. The camera helps to provide a view of the inside of the esophagus and the stomach. The results of the test may not show when reflux is present, but an endoscopy may find inflammation of the esophagus or other complications.

Endoscopy can also be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett's esophagus. In some cases, if the narrowing is seen in the esophagus, it can be stretched or dilated during this procedure. This is done to improve difficulty swallowing.

Ambulatory acid (pH) probe test. A monitor is placed in the esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that is worn around the waist or with a strap over the shoulder.

The monitor can be a thin, flexible tube, called a catheter, which is inserted through the nose into the esophagus. Or it could be a clip that is placed in the esophagus during an endoscopy. The clip is excreted in the feces after about two days.

X-ray of the upper part of the digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows a health professional to see a silhouette of the esophagus and the stomach. This is particularly useful for people who have difficulty swallowing.

Sometimes, a chest x-ray performed after the barium swallow of the pill. This can help to diagnose a narrowing of the esophagus that interfere with swallowing.

Treatment

A health professional will likely recommend trying lifestyle changes and otc medicines as a first line of treatment. If you don't experience relief within a few weeks, the prescription of medication and additional testing may be recommended.

- The-counter medications

The options include:

  • Antacids neutralize the acid of the stomach. Antacids that contain calcium carbonate, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone does not cure the inflammation of the esophagus damaged by stomach acid. The overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney complications.
  • Medications to reduce acid production. These medicines known as histamine (H-2) blockers include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid). H-2 blockers do not act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
  • Medications that block acid production and heal the esophagus. These drugs known as inhibitors of the proton pump — are stronger acid blockers than H-2 blockers and allow time for damaged esophageal tissue to heal. - Counter proton pump inhibitors include lansoprazole (Prevacid), omeprazole (Prilosec OTC), and esomeprazole (Nexium).

If you start taking an otc medicine for GERD, be sure to inform your care provider.

Prescription medications

Prescription-strength treatments for GERD include:

  • Prescription-strength proton pump inhibitors.These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well-tolerated, these medications might cause diarrhea, headache, nausea, or, in rare cases, low levels of vitamin B-12 or magnesium levels.
  • Prescription-strength H-2 blockers. These include prescription-strength famotidine, and nizatidine. The side effects of these medications are generally mild and well tolerated.
  • Potassium-competitive acid blockers (P-Cabs). This new class of drugs can be recommended for someone with severe acid reflux if other medications have not worked. They include vonoprazan (Voquezna) and tegoprazan (K-Cab).

Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).

Although generally well-tolerated, these medications might cause diarrhea, headache, nausea, or, in rare cases, low levels of vitamin B-12 or magnesium levels.

Deep breathing training

A technique known as diaphragmatic breathing can help to improve the symptoms of GERD for some people. This exercise is done after eating. It involves deep breathing in the diaphragm, more than superficially in the chest. The diaphragmatic breathing techniques should ideally be delivered by a trained medical professional.

Surgery and other procedures

GERD can usually be controlled with medications. But if the medications do not help, or you want to avoid long-term use of medications, a healthcare provider may recommend:

  • The fundoplication. The surgeon wraps the upper part of the stomach around the lower esophageal sphincter to tighten the muscles and prevent reflux. Fundoplication is usually done with a minimally invasive procedure, called laparoscopic procedure. The wrap the upper part of the stomach may be complete or partial, known as the Nissen fundoplication. The most common of the partial procedure is the Toupet fundoplication. Your surgeon will usually recommend the type that is best for you.
  • LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and the esophagus. The magnetic attraction between the beads is strong enough to keep the union closed of acid reflux, but weak enough to allow the food to pass through. The LINX device can be implanted using minimally invasive surgery. The magnetic beads do not affect the security of the airport or magnetic resonance imaging.
  • Transoral incisionless fundoplication (TIF).This new procedure is to tighten the lower esophageal sphincter for the creation of a partial wrap around the lower part of the esophagus with polypropylene fasteners. TIF is performed through the mouth using an endoscope and does not require any surgical incision. Its advantages include the rapid recovery time and high tolerance. If you have a hiatal hernia, TIF alone is not an option. However, TIF can be possible if it combines with the laparoscopic repair of hiatal hernia.

Transoral incisionless fundoplication (TIF). This new procedure is to tighten the lower esophageal sphincter for the creation of a partial wrap around the lower part of the esophagus with polypropylene fasteners. TIF is performed through the mouth using an endoscope and does not require any surgical incision. Its advantages include the rapid recovery time and high tolerance.

If you have a hiatal hernia, TIF alone is not an option. However, TIF can be possible if it combines with the laparoscopic repair of hiatal hernia.

Because obesity may be a risk factor for GERD, a health professional may suggest weight-loss surgery as an option for treatment. Talk with your health care team to find out if you are a candidate for this type of surgery.

Emerging therapies

Lifestyle and home remedies

Lifestyle changes can help reduce the frequency of acid reflux. Try:

  • Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into the esophagus.
  • Stop smoking. Smoking decreases the lower esophageal sphincter is the ability to function properly.
  • Elevate the head of your bed. If you regularly experience heartburn, while trying to sleep, place wood or cement blocks under the feet on the head of your bed. Elevate the head of 6 to 9 inches. If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows is not effective.
  • Start on the left side. When you go to bed, start by lying on your left side to help make it less likely to have reflux.
  • Do not lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  • Eat food slowly and chew very well. Put down your fork after each bite and pick it up again once you have chewed and swallowed that bite.
  • Do not consume food and drinks that trigger reflux. Common triggers include alcohol, chocolate, caffeine, fatty foods, or mint.
  • Do not wear tight clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

Alternative medicine

Some complementary and alternative therapies, such as ginger, chamomile and slippery elm, can be recommended for the treatment of GERD. However, none have been proved to treat GERD or reverse damage to the esophagus. Talk with a health care professional if you are considering alternative therapies for the treatment of GERD.

Preparing for your appointment

You may be referred to a doctor who specializes in the digestive system, called a gastroenterologist.

What you can do

  • Be aware of any pre-appointment restrictions, such as restricting your diet before your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down any triggers of the symptoms, such as specific foods.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, together with the recent changes or stressors in your life.
  • Write questions to ask their doctor.
  • Ask a relative or friend to go with you, to help you remember what was talked about.

Questions to ask your doctor

  • What is the most likely cause of my symptoms?
  • What tests do I need? Is there any special preparation for them?
  • Is my condition likely temporary or chronic?
  • What treatments are available?
  • Are there any restrictions I need to follow?
  • I have other health problems. How can I best manage these conditions?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

It is likely to be asked a couple of questions. Be prepared to answer them you can let go the more points you want to spend more time. You may ask:

  • When did you begin experiencing symptoms? How serious are they?
  • The symptoms been continuous or occasional?
  • What, if anything, seems to improve or worsen your symptoms?
  • Make your symptoms you awake at night?
  • Are your symptoms get worse after meals or lying down?
  • Does food or the cream of material to reach an agreement in the back of your throat?
  • Do you have problems with swallowing food, or had to change your diet to avoid the difficulty swallowing?
  • Have you gained or lost weight?
Symptoms and treatment of Gastroesophageal reflux disease (GERD)