What Is Gastroesophageal Reflux Disease?
Gastroesophageal reflux, or acid reflux, is a backward flow (reflux) of stomach contents into the esophagus. Everybody has some reflux. More than 20% of adults in the U.S. are affected by acid reflux. The two most common symptoms of acid reflux are heartburn and regurgitation.
- Heartburn feels like a burning pain that may move from your stomach to your abdomen, chest or throat.
- Regurgitation is a sour or bitter-taste from stomach acid that backs up into your throat or mouth.
Abnormal amounts of gastroesophageal reflux can cause gastroesophageal reflux disease (GERD). This occurs when the sphincter of smooth muscle between the esophagus and the stomach does not function properly. This muscle band is called the lower esophageal sphincter (LES).
Causes
Each time you eat, stomach acids are released. Normally the lower esophageal sphincter acts as a guard to prevent stomach acids from backing up into the esophagus. An increase of the pressure in the stomach and/or relaxation of the muscle tone of the sphincter may cause reflux to occur.
and/or relaxation of the muscle tone of the sphincter may cause reflux to occur.
Factors that cause an increase in pressure are:
- Bending forward
- Full stomach
- Lying down
- Obesity
- Pregnancy
- Tight clothing.
Factors that loosen the muscle tone of the valve can be caused by:
- Alcohol, coffee, tea
- Chocolate
- Fatty foods
- Mint
- Nicotine
- Pregnancy
Signs & Symptoms
Symptoms of GERD include:
- Chronic cough
- Choking sensation
- Chronic sinusitis
- Heartburn
- Increased trouble breathing while asleep
- Pain occurring in the middle of the chest or stomach
- Recurrent pneumonia
- Sore throat
- Sour taste in the mouth
- Swallowing problems
Diagnosis
A gastroenterologist will diagnose GERD. Your doctor will conduct a complete physical exam and ask you questions about your lifestyle, including your family history, your job, your habits, your hobbies, your current medications and your symptoms. When GERD is suspected, your gastroenterologist may have you do a number of tests.
Imaging Tests
Barium Swallow (Esophagram)
A barium swallow test, also called an esophagram (or esophagography) involves an X-ray examination of your esophagus. This type of X-ray exam uses live video so that gastroenterologists can watch the actions of your esophagus in real time as you swallow and diagnose reflux issues.
Diagnostic Procedures
Endoscopy (EGD)
An endoscopy or esophagogastroduodenoscopy (EGD) allows the doctor to look inside the esophagus, stomach and a portion of the small intestine. An endoscope is a thin, flexible tube inserted through the mouth into the esophagus, stomach and duodenum. A light and camera attached to the tube allow a specialist to view the lining of these organs and diagnose GERD.
pH Impedance Probe
An impedance and pH study measures the amount of acid and non-acid gastroesophageal reflux you have. Using a thin catheter with sensors, specialists are able to see how daily activities and exercise affect your reflux levels. Everyone has some reflux. An impedance and pH study will help identify if you have increased amounts of reflux and if it is causing trouble breathing or other symptoms.
Treatment
Managing GERD includes partnering with your gastroenterologist to create a comprehensive treatment plan.
Medications
Medications that may be prescribed to help this condition include:
Antagonists
Acid suppressing medicines that are used to treat mild GERD
- Tagamet® (cimetadine)
- Zantac® (ranitidine)
- Pepcid® (famotidine)
- Axid® (nizatidine)
Promotility Agent
Medicine that moves the food through the stomach more quickly
- Reglan® (metoclopramide)
- Baclofen
- Bethanechol
Proton Pump Inhibitors (PPIs)
Acid suppressing medicines that are used most commonly for patients with symptomatic GERD.
- Prilosec® (omeprazole)
- Nexium® (esomeprazole)
- Prevacid® (lansoprazole)
- Protonix® (pantoprazole)
- Aciphex® (rabeprazole)
- Dexilant® (lansoprazole)
Procedures
Occasionally, surgery may be recommended to help eliminate GERD when lifestyle changes and medications don’t lead to a response.
Nissen Fundoplication
A Nissen fundoplication is a surgery commonly used to treat GERD. By creating a sphincter (tightening muscle) at the bottom of the esophagus, doctors can help prevent acid reflux.
Lifestyle Management
Your doctor may suggest certain lifestyle, dietary or physical changes to help with GERD symptoms.
- Lose weight. If you are overweight, talk with your doctor about losing weight. Being overweight increases abdominal pressure. Extra weight can push stomach contents up into the esophagus. According to some statistics, approximately 35% of people who are overweight experience heartburn. Exercise can help you trim down.
- Quit smoking. Smoking increases your risk of acid reflux because it stimulates the production of stomach acid and nicotine relaxes the lower esophageal sphincter (LES). The LES keeps acid in the stomach and out of your esophagus. When LES pressure is reduced, the acid can more easily creep up and cause heartburn. Your health care provider will have suggestions to help you quit smoking.
- Relax. While stress hasn't been linked directly to heartburn, it is known that stress can lead to behaviors that can trigger heartburn such as smoking and overeating.
- Limit certain foods and beverages. Citrus and tomato products, strong spices, caffeinated and decaffeinated coffee and tea, carbonated drinks, fatty foods, chocolate, peppermint, spearmint and alcohol can all contribute to acid reflux.
- Eat smaller, more frequent meals. A full stomach from a large meal can put extra pressure on the LES. This increases the chance that some of this food will reflux into the esophagus.
- Avoid food or liquids for 2–3 hours before bedtime. Lying down with a full stomach can cause stomach contents to press harder against the LES. This increases the chances reflux.
- Elevate the head of your bed 6-8 inches. Lying flat will press the stomach's contents against the LES and can lead to reflux. Having your head higher than your stomach allows gravity to help reduce this pressure. Place bricks, blocks or anything that's sturdy securely under the legs at the head of your bed. You can also use a wedge-shaped pillow to elevate your head.
- Avoid bending forward at the waist. This will squeeze the stomach, forcing food up against the LES and increase the chance of GERD.
- Avoid wearing tight-fitting clothing. Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES and causing food to reflux into the esophagus. Clothing that can cause problems includes tight-fitting belts and slenderizing undergarments.
Clinical Trials
Clinical trials help determine new treatment options for diseases and conditions. Patients with GERD have access to clinical trials and should speak with their physician to determine what trials might work best for them.
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