Gastroesophageal reflux disease (GERD)

Overview

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

Causes

GERD is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. The lower esophageal sphincter (LES), a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.

Other lifestyle contributors to GERD may include the following:

  • Being overweight
  • Overeating
  • Consuming certain foods, such as citrus, chocolate and fatty or spicy foods
  • Caffeine
  • Alcohol
  • Smoking
  • Use of nonsteroidal anti-inflammatory (NSAID) drugs such as aspirin and ibuprofen

Other conditions associated with heartburn may include the following:

  • Gastritis (inflammation of the stomach lining)
  • Ulcer

Symptoms

Each individual may experience symptoms differently. Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn. Most children younger than 12 years of age, and some adults diagnosed with GERD will experience a dry cough, asthma symptoms or trouble swallowing, instead of heartburn. Heartburn pain is less likely to be associated with physical activity.

The symptoms of GERD may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

 

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for GERD may include the following:

  • Upper GI (gastrointestinal) series (also called barium swallow)
    This is a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

  • Esophagogastroduodenoscopy (EGD or upper endoscopy)
    This test allows the doctor to examine the inside of the esophagus, stomach and duodenum. A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach and duodenum. The endoscope allows the doctor to view the inside of this area of the body and to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

  • Bernstein test
    This test helps to confirm that symptoms are a result of acid in the esophagus. The test is performed by dripping a mild acid through a tube placed in the esophagus.

  • Esophageal manometry
    This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.

  • pH monitoring
    This measures the acidity inside the esophagus and is helpful in evaluating GERD. A thin plastic tube is placed into a nostril, guided down the throat and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24-to-48-hour period. Normal activity is encouraged during the study, and the patient will keep a diary of symptoms or activity, such as gagging or coughing, that might be suspicious for reflux. It also is recommended to keep a record of the time, type and amount of food eaten. The pH readings are evaluated and compared to the patient's activity for that time period.

 

Treatments

Specific treatment for GERD will be determined by your doctor based on:

  • Your age, overall health and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your doctor. Some ways to manage heartburn include the following:

  • Take an antacid, as directed by your doctor.
  • Ask your doctor about use of over-the-counter medicines called "H2 blockers" and "proton pump inhibitors." Formerly available only by prescription, these drugs can be taken before eating to prevent heartburn from occurring. Your doctor also may prescribe promotility medications, which help to empty food from the stomach.
  • Occasionally, a surgical procedure called fundoplication may be performed to help keep the esophagus in proper position and prevent reflux.

Prevention

  • Monitor the medications you are taking; some may irritate the lining of the stomach or esophagus.
  • Quit smoking.
  • Limit fried and fatty foods, peppermint, chocolate, alcohol, citrus fruit and juices, tomato products and caffeinated drinks, such as coffee, soda and energy drinks.
  • Avoid overeating.
  • Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.
  • Lose weight, if necessary.
  • Elevate the head of your bed six inches by placing bricks or cinderblocks under its legs.

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