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GERD (Reflux)
Introduction
GERD is a common condition. The main symptom of GERD is heartburn. GERD can be prevented. It is treated with lifestyle changes and medications. Surgery is rarely needed. Untreated GERD can result in serious medical complications.
Anatomy
A ring of muscles is located at the bottom of the esophagus. It is called the lower esophageal sphincter (LES). The LES opens to allow food to enter the stomach. The LES closes tightly after the food enters. This prevents stomach contents and acids from entering the esophagus.
The stomach produces acids to break down food for digestion. The stomach secretes mucus to protect the lining of the stomach from the acids. The esophagus does not secrete mucus and is not protected from stomach acids.
Causes
Symptoms
GERD can cause chest pain with heartburn. The pain may feel dull and heavy in your chest.
Heartburn does not involve your heart in any way. The condition was named “heartburn” because the area of discomfort is located near the heart. However, the chest pain with heartburn can be confused with the chest pain associated with a heart attack. You should call emergency services if you suspect you are having a heart attack. Symptoms of a heart attack include chest pain that is crushing or squeezing, or a feeling like a heavy weight is on your chest. These symptoms may occur with sweating, shortness of breath, nausea or vomiting, dizziness, lightheadedness, and pain that spreads from the chest to the neck or jaw.
GERD can cause you to have a sour or bitter taste in your mouth. This occurs because of the back flow of stomach acid. You may have bad breath. You may also produce an excessive amount of saliva.
Your voice may be hoarse in the morning. You may have trouble swallowing. It may feel like there is something stuck in your throat. You may have laryngitis, a sore throat, and a frequent need to clear your throat.
Certain lung problems may occur with GERD. You may experience difficulty with breathing. You may cough or wheeze. GERD can contribute to asthma and worsen the symptoms of asthma in people who already have it.
Diagnosis
You may be referred for a test called an Upper Gastrointestinal (GI) Endoscopy. An endoscope is a thin tube with a tiny light and camera at the very end. After you are lightly sedated, the thin endoscope will be placed in your mouth and down your esophagus. Your doctor will be able to see the condition of your esophagus by viewing the images sent from the camera to a video monitor. The Upper GI Endoscopy allows your doctor to identify inflammation, bleeding, cancer, ulcers, other conditions, or narrowing of your esophagus. Your doctor will also be able to rule out other conditions such as Barrett’s esophagus, a complication of GERD, or peptic ulcers, by taking a tissue sample.
An Esophageal Manometry measures the muscle function in the esophagus and the LES. A thin tube will be placed in your esophagus through your nose or mouth. During the test you will be asked to swallow your saliva and to swallow liquids. The tube has sensors that detect the pressure in various parts of the esophagus. As the esophagus muscles contract and squeeze the tube, the pressures are transmitted and recorded in a computer.
pH Monitoring determines how much stomach acid backs up into the esophagus and how long it stays there. It also measures the strength of your stomach acid. This test may take place over a period of time, such as 24 hours. Your doctor will place a very thin tube through your nose and into your esophagus. This device will measure your stomach acid levels as you go about your regular activities. A newer version of pH Monitoring uses a tiny capsule that is placed in the esophagus. The capsule measures pH levels and transmits the results by radio wave to a receiver that you wear on a belt. After about 48 hours the capsule passes harmlessly through your digestive tract.
Treatment
Simple lifestyle changes may help relieve the symptoms of mild GERD. These include not smoking, not drinking alcohol, and not consuming foods that irritate the esophagus. It is helpful to eat small meals throughout the day instead of large meals. You should avoid eating before bedtime or lying down after you eat. It can be helpful to raise the head of your bed six inches. Additionally, you should maintain a healthy weight and good posture.
If lifestyle changes do not work, it can be helpful to use an over-the-counter antacid. Antacids work by neutralizing the stomach acid and coating the stomach. Antacids relieve symptoms rapidly, but only temporarily. If you need antacids for over two weeks, you should contact your doctor and discuss other appropriate treatments.
Your doctor may prescribe a stronger medication, usually acid blockers or histamine-2 (H2) blockers. These drugs block acid creation in the stomach. They prevent GERD because there is less acid to back up into the esophagus. If the acid blockers fail, your doctor may prescribe medications that are proton pump inhibitors. Proton pump inhibitors stop all acid production in the stomach. Another medication option is promotility drugs. Promotility drugs speed up the rate that the stomach empties food and acid. They also help to tighten the LES. This helps to prevent stomach acid from backing up into the esophagus.
You may need surgery if prescription medications fail and you are experiencing serious complications. The operation for GERD is called a fundoplication. It involves tightening the LES and tying the stomach to prevent stomach acid from entering the esophagus. Fundoplication surgery is successful for most people.
Prevention
To prevent GERD, you should not smoke, drink alcohol, or consume foods that irritate the esophagus. Do not overeat, eat large meals, or eat before bedtime or lying down.
Avoid foods that are especially irritating. These include fatty and fried foods; chocolate; garlic and onions; beverages or food containing caffeine; spicy foods; foods high in acid, such as tomatoes and citrus fruits; and candy or food containing mint flavorings. It is also helpful to maintain a healthy weight and good posture.
Am I at Risk
Risk factors may increase your likelihood of developing GERD. People with all of the risk factors may never develop the condition; however, the chance of developing GERD increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.
Risk factors for GERD:
_____ Being overweight or obese can increase abdominal pressure, causing food to back up into the esophagus.
_____ If you are pregnant, the hormones produce during pregnancy can relax the LES. The hormones can also relax the muscles in the esophagus and cause food to move more slowly. Additionally, abdominal pressure during pregnancy can cause food to back up into the esophagus.
_____ Cigarette smoking is an irritant. The nicotine from tobacco relaxes the LES. Cigarette smoking can also reduce the amount of saliva that you produce. A lack of saliva can make the esophagus lining more sensitive to the stomach acids. It can also cause your heartburn to be more severe.
_____ Drinking alcohol increases the likelihood that stomach acids will back up into the esophagus.
_____ Eating certain foods can relax the LES. Such foods include chocolate, caffeine products, fatty foods, greasy foods, spicy foods, citrus products, tomato-based foods, mints, or mint flavored foods.
_____ Certain medications can aggravate reflux in some people. Over-the-counter medications include aspirin and ibuprofen. This also includes certain prescription medications for asthma, emphysema, and osteoporosis.
_____ Older adults have an increased risk because the esophagus muscles can weaken with age. The esophagus may lose its wave pattern or have weak inconsistent contractions.
_____ Scleroderma increases the risk of developing GERD. Scleroderma is a rare autoimmune disease in which a person’s immune system destroys healthy tissues.
_____ A hiatal hernia increases the risk of developing GERD. A hiatal hernia occurs when a part of the stomach protrudes through the muscles and into the chest wall. A major symptom of a hiatal hernia is the back flow of stomach acid into the esophagus.
Complications
Advancements
Research trials are focusing on new surgery methods. The research trials will determine if the new surgery methods are safe and effective treatments for GERD. These include the Stretta Radiofrequency Procedure, EndoCinch Procedure, and Enteryx Injections. The Stretta Radiofrequency Procedure involves using radiofrequency delivered through the endoscope to tighten the LES. The EndoCinch Procedure uses an endoscopic sewing device to place sutures to correct the LES. Enteryx Injections are delivered by the endoscope. Enteryx is a medication that forms a spongy mass in the esophagus and reinforces the LES to prevent the back flow of stomach acid.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.
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