Gastroesophageal Reflux Disease - GERD
 Everyone gets heartburn once in a while. But if you get heartburn two or more times a week, it could be gastroesophageal reflux disease (GERD). In GERD, stomach acid splashes up into the esophagus due to a weak Lower Esophageal Sphincter (LES)—a ring of muscle that normally contains stomach acid. GERD is no joke. Chronic, prolonged acid reflux can damage the esophagus, causing a precancerous condition called Barrett's esophagus , or even esophageal cancer. However, you can get GERD under control with lifestyle changes, prescription medicines, over-the-counter drugs , and even surgery, if necessary.
What is gastroesophageal reflux disease (GERD)?
 Reflux means that stomach acid and juices flow from the stomach back up into the tube that leads from the throat to the stomach (esophagus). This causes heartburn . When you have heartburn at least 2 times a week, it is called gastroesophageal reflux disease, or GERD.
Eating too much or bending forward after eating sometimes causes heartburn and a sour taste in the mouth. But having heartburn from time to time doesn't mean you have GERD. With GERD, the reflux—and heartburn—last longer and come more often. If this happens to you, it is important to treat it, because GERD can cause ulcers and damage to the esophagus.
What causes GERD? Normally when you swallow your food, it travels down the food pipe (esophagus) to a valve that opens to let the food pass into the stomach and then closes. With GERD, the valve doesn't close tightly enough. Stomach acid and juices flow from the stomach and back up (reflux) into the esophagus. |
The esophagus is the tube that connects the throat to the stomach. When you eat or drink, food and liquids travel from your mouth through the throat and esophagus into your stomach.
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What are the symptoms?
The main symptom of GERD is heartburn. It may feel like a burning, warmth, or pain just behind the breastbone. It is common to have symptoms at night when you are trying to sleep
If you have pain behind your breastbone, it is important to make sure it is not caused by a problem with your heart. The burning sensation caused by GERD usually occurs after you eat. Pain from the heart usually feels like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull ache. It occurs most often after you are active. How is GERD diagnosed?
First, your doctor will do a physical exam and ask you questions about your health. You may or may not need further tests. Your doctor may just treat your symptoms by prescribing medicines that reduce or block stomach acid. These include H2 blockers (for example, Pepcid) or proton pump inhibitors (for example, Prilosec). If your heartburn goes away after you take the medicine, your doctor will likely diagnose GERD.
How is it treated?
For mild symptoms of GERD, you can try over-the-counter medicines. These include antacids (for example, Tums), H2 blockers (for example, Pepcid), or proton pump inhibitors (for example, Prilosec OTC). Changing your diet, losing weight if needed, and making other lifestyle changes can also help. If you still have symptoms after trying lifestyle changes and over-the-counter medicines, talk to your doctor.
Your doctor may recommend surgery if medicine doesn't work or if you can't take medicine because of the side effects. For example, fundoplication surgery strengthens the valve between the esophagus and stomach. But many people continue to need some medicine even after surgery.
GERD is common in pregnant women. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. Most of the time, symptoms get better after the baby is born.
How can you manage GERD?
Many people with GERD have it for the rest of their lives. You may need to take medicine for many years to help control the symptoms. But you can make changes to your lifestyle to help relieve your symptoms of GERD, too. Here are some things to try:
- Change your eating habits.
- It's best to eat several small meals instead of two or three large meals.
- After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
- Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
- Do not smoke or chew tobacco.
- If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
- Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 5 to 10 pounds can help.
Heartburn
Heartburn is an uncomfortable feeling or burning pain behind the breastbone. It may occur after eating, soon after lying down, or when bending forward. Heartburn may also occur after taking certain medications.
Heartburn occurs when stomach acid backs up (refluxes) into the tube that leads from the mouth to the stomach (esophagus), causing pain or discomfort behind the breastbone, in the center of the chest, and occasionally in the back of the throat. Sometimes there may be a sour or bitter taste in the mouth.
Antacids or other nonprescription medications (such as acid reducers or acid blockers) may relieve heartburn.
Heartburn can be a symptom of gastroesophageal reflux disease (GERD).
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Ulcer An ulcer is a sore that develops on the skin or a mucous membrane (such as inside the mouth, stomach, or intestines). Ulcers can be shallow or deep and can destroy the skin or the membrane where they develop.
Ulcers can be caused by some types of infection, injury, or cancer.
Stomach acid and juices
Stomach (gastric) juice is the term used to describe the chemicals that break down food in the stomach. These include hydrochloric acid and an enzyme called pepsin.
Gastric juice is sometimes referred to as stomach acid, although not all of the substances it contains are acidic.
Acid reflux Acid reflux is the backup of stomach acid into the esophagus, the muscular tube that connects the throat to the stomach. It may cause burning pain in the esophagus.
Acid reflux may occur because of weakness in the ring of muscle (lower esophageal sphincter, or LES) that controls the flow of food from the esophagus into the stomach. Frequent acid reflux can lead to irritation of the esophagus (esophagitis), narrowing of the esophagus, or development of sores (ulcers) in the esophagus. Long-term exposure of the esophagus to stomach acid causes the cells that line the inside of the esophagus to be replaced by cells similar to those that line the inside of the stomach (Barrett's esophagus).
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Barrett's esophagus In Barrett's esophagus, also called Barrett's syndrome, the cells that line the inside of the esophagus are replaced by cells like those that line the inside of the stomach. This change in the type of cell may occur with long-term exposure of the esophagus to stomach juices, such as from chronic gastroesophageal reflux.
The new cells are more resistant to stomach acid, but inflammation, sores (ulcers), and bleeding can still occur in that part of the esophagus.
There is no specific treatment for Barrett's esophagus. Having Barrett's esophagus slightly raises the risk for developing esophageal cancer. If Barrett's esophagus is suspected, a health professional may want to test the lining of the esophagus periodically to check for cells that may develop into cancer. These tests may include endoscopy and doing a biopsy of any cells that do not look normal.
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