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.
This page covers information about the symptoms, causes, diagnosis, and treatment of 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.
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.
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
- bad breath
- respiratory problems
- 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.
- 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.
- greasy foods
- spicy foods
- foods containing tomato products
- alcoholic drinks
If you are avoiding these types of food and still experience regular heartburn, it is important to visit a doctor as there may be other underlying issues causing the symptoms.