Gastroesophageal reflux disease

  • Definition
    • Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This can irritate the esophagus and cause heartburn and other symptoms.

      Test Your GERD Knowledge

      1. In gastroesophageal reflux disease (GERD), acid leaks out of your stomach into your food pipe.

        1. A. True
        2. B. False

        The correct answer is true. When you eat, food passes from your mouth through a tube (or food pipe) and into the stomach. Once food is in the stomach, a ring of muscle prevents food from moving backward. If this muscle doesn't close well, food and stomach acid can leak up into the food pipe.

      2. Which is not a common symptom of GERD?

        1. A. Heartburn
        2. B. Nausea
        3. C. Diarrhea
        4. D. Hoarseness

        The correct answer is diarrhea. GERD mainly affects the upper part of your digestive tract. This is the part of your body that food moves through. The most common symptoms are a burning pain in the chest or the feeling that food is stuck behind the breastbone. Talk with your doctor if you think you have signs of GERD.

      3. Which medicines can make GERD worse?

        1. A. Some medicines for blood pressure
        2. B. Some medicines for asthma
        3. C. Medicines for motion sickness
        4. D. Some medicines for depression
        5. E. All of the above

        The correct answer is all of the above. If you suspect that one of your medicines may be causing heartburn, talk to your doctor. Never change or stop a medicine you take regularly without talking to your doctor.

      4. GERD rarely occurs in children.

        1. A. True
        2. B. False

        The correct answer is false. GERD can occur at any age. In fact, more than half of babies will have some reflux during their first three months. Contact your infant's health care provider if your baby isn't gaining weight or has trouble breathing after spitting up.

      5. If your GERD is mild, you may not need testing.

        1. A. True
        2. B. False

        The correct answer is true. Your doctor can use tests to check your esophagus (the tube that leads from your mouth to your stomach) for damage, but they may not be needed. If your symptoms are mild, your doctor may suggest diet changes and/or antacids.

      6. Antacids are the only over-the-counter (OTC) medicines that help with GERD.

        1. A. True
        2. B. False

        The correct answer is false. Several OTC medicines can relieve GERD symptoms. H2 blockers (Pepcid, Zantac) lower the amount of acid released into the stomach. Proton-pump inhibitors (Prilosec, Prevacid) reduce how much acid the stomach makes. These medicines don't work as quickly as antacids, but the benefits last longer.

      7. To prevent GERD symptoms at night:

        1. A. Raise the head of your bed.
        2. B. Eat a large dinner.
        3. C. Eat a bedtime snack.
        4. D. Lie down right after eating.
        5. E. All of the above.

        The correct answer is raise the head of your bed. Put blocks under the head of your bed or a wedge under your mattress to raise the head 4-6 inches. It also helps to avoid large evening meals and light-night snacks. Have dinner at least 2-3 hours before bedtime.

      8. GERD symptoms may improve if you avoid:

        1. A. Alcohol
        2. B. Caffeine
        3. C. Citrus fruits
        4. D. Tomato sauce
        5. E. All of the above

        The correct answer is all of the above. These foods can trigger heartburn, but not everyone has the same reaction. Try to pinpoint and avoid the foods that cause problems for you.

      9. You can prevent heartburn by exercising right after meals.

        1. A. True
        2. B. False

        The correct answer is false. People with GERD should exercise, but not right after eating. Physical activity, particularly bending or stooping, can trigger heartburn. Find another time to exercise -- it may help you lose weight and reduce stress, both of which can lead to fewer GERD symptoms.

      10. You should call your doctor if you notice which if the following symptoms?

        1. A. Choking (coughing, shortness of breath)
        2. B. Feeling filled up quickly when eating
        3. C. Frequent vomiting
        4. D. Hoarseness
        5. E. Loss of appetite or weight loss
        6. F. Trouble swallowing or pain with swallowing
        7. G. All of the above

        The correct answer is all of the above. These are warning signs that GERD symptoms may be caused by something more serious. Call your doctor right away if you notice any of these symptoms.

      11. Surgery can repair the leak between the stomach and esophagus.

        1. A. True
        2. B. False

        The correct answer is true. Some surgeries can tighten the connection between the stomach and the food pipe (esophagus). This helps keep food or acid from coming back up. Your doctor may suggest surgery if GERD causes serious problems, or if you want to stop taking medicine for GERD. Even with surgery, you may still need GERD medicines.

  • Alternative Names
    • Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD

  • Causes
    • When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter (LES).

      When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus.

      Gastroesophageal reflux disease

      The risk factors for reflux include:

      • Use of alcohol (possibly)
      • Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
      • Obesity
      • Pregnancy
      • Scleroderma
      • Smoking

      Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:

      • Anticholinergics (for example, seasickness medicine)
      • Bronchodilators for asthma
      • Calcium channel blockers for high blood pressure
      • Dopamine-active drugs for Parkinson disease
      • Progestin for abnormal menstrual bleeding or birth control
      • Sedatives for insomnia or anxiety
      • Tricyclic antidepressants

      Talk to your health care provider if you think one of your medicines may be causing heartburn. Never change or stop taking a medicine without first talking to your provider.

  • Symptoms
    • Common symptoms of GERD include:

      • Feeling that food is stuck behind the breastbone
      • Heartburn or a burning pain in the chest
      • Nausea after eating

      Less common symptoms are:

      • Bringing food back up (regurgitation)
      • Cough or wheezing
      • Difficulty swallowing
      • Hiccups
      • Hoarseness or change in voice
      • Sore throat

      Symptoms may get worse when you bend over or lie down, or after you eat. Symptoms may also be worse at night.

  • Exams and Tests
    • You may not need any tests if your symptoms are mild.

      If your symptoms are severe or they come back after you have been treated, your doctor may perform a test called an upper endoscopy (EGD).

      • This is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine.
      • It is done with a small camera (flexible endoscope) that is inserted down the throat.

      You may also need 1 or more of the following tests:

      • A test that measures how often stomach acid enters the tube that leads from the mouth to the stomach (called the esophagus)
      • A test to measure the pressure inside the lower part of the esophagus (esophageal manometry)

      A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.

  • Treatment
    • You can make many lifestyle changes to help treat your symptoms.

      Other tips include:

      • If you are overweight or obese, in many cases, losing weight can help.
      • Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.
      • Take all of your medicines with plenty of water. When your doctor gives you a new medicine, ask whether it will make your heartburn worse.

      You may use over-the-counter antacids after meals and at bedtime, although the relief may not last very long. Common side effects of antacids include diarrhea or constipation.

      Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.

      • Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
      • H2 blockers also lower the amount of acid released in the stomach

      Anti-reflux surgery may be an option for people whose symptoms do not go away with lifestyle changes and medicines. Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn.

      There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).

  • Outlook (Prognosis)
    • Most people respond to lifestyle changes and medicines. However, many people need to continue taking medicines to control their symptoms.

  • Possible Complications
    • Complications may include:

      • Worsening of asthma
      • A change in the lining of the esophagus that can increase the risk of cancer (Barrett esophagus)
      • Bronchospasm (irritation and spasm of the airways due to acid)
      • Chronic cough or hoarseness
      • Dental problems
      • Ulcer in the esophagus
      • Stricture (a narrowing of the esophagus due to scarring)
  • When to Contact a Medical Professional
    • Call your health care provider if symptoms do not improve with lifestyle changes or medicine.

      Also call if you have:

      • Bleeding
      • Choking (coughing, shortness of breath)
      • Feeling filled up quickly when eating
      • Frequent vomiting
      • Hoarseness
      • Loss of appetite
      • Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
      • Weight loss
  • Prevention
    • Following heartburn prevention techniques may help prevent symptoms. Obesity is linked to GERD, so maintaining a healthy body weight may help prevent the condition.

  • References
    • ASGE Standards of Practice Committee, Muthusamy VR, Lightdale JR, et al. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81(6):1305-1310. PMID: 25863867

      Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.

      Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial. JAMA. 2011;305:1969-1977. PMID: 21586712

      Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308-28. PMID: 23419381

      Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

      Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-797. PMID: 18341497