Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). Food travels from your mouth to the stomach through your esophagus. GERD can irritate the food pipe and cause heartburn and other symptoms.
Gastroesophageal reflux disease - Animation
Do you feel a burning in your chest not long after you eat or lie down? If so, you may have Gastroesophageal reflux disease, or GERD. When we swallow food, it travels down our esophagus into the stomach, where it's greeted by a rush of Hydrochloric acid in the stomach to begin digestion. This acid is so powerful, it could eat the paint right off your car! Fortunately, there's a band of muscle between the stomach and the esophagus - called the Lower Esophageal Sphincter or L-E-S, that clamps down to prevent the stomach contents from moving or refluxing upward and burning the lining of the esophagus. If that band of muscle does not adequately clamp down, this backwash causes the irritation and burning that's known as heartburn or GERD. Maintaining good tight L-E-S muscle tone is the key to preventing this condition. Causes of GERD include being overweight, smoking, and drinking too much alcohol. Certain foods, like chocolate and peppermint and if you're a woman, pregnancy can bring on GERD. To determine if you have GERD, your doctor may request an upper endoscopy exam to look into your esophagus and stomach to diagnose reflux. Other tests can measure the acid and amount of pressure in your esophagus, or if you have blood in your stool. If you do have GERD, lifestyle changes can help. First, avoid foods that cause problems for you and avoid eating large meals. If you're a little on the heavy side, try to lose some weight. Since most GERD symptoms are experienced lying down in bed, let gravity help. Elevating the head of your bed 4 to 6 inches using blocks of wood may help. If symptoms continue, see your doctor or a Gastroenterologist for evaluation and an upper endoscopy exam. Your doctor may suggest you take over-the-counter antacids or may prescribe stronger medications. Call your doctor if you are bleeding, feel like you are choking, have trouble-swallowing, or experience sudden weight loss. The good news is most people who have GERD do not need surgery. For the worst cases, surgeons may perform a laparoscopic procedure to tighten a weak L-E-S muscle. If you have occasional heartburn, antacid tablets can be used as needed. However! If you're having heartburn more than 3 to 4 times a week, see your doctor & take the prescribed medication to prevent this condition.
Test Your GERD Knowledge
In gastroesophageal reflux disease (GERD), acid leaks out of your stomach into your food pipe.Correct AnswerThe correct answer is true. When you eat, food passes from your mouth through a tube (or esophagus) 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.
Which is not a common symptom of GERD?Correct AnswerThe 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.
Which medicines can make GERD worse?Correct AnswerThe 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.
GERD rarely occurs in children.Correct AnswerThe 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.
If your GERD is mild, you may not need testing.Correct AnswerThe 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.
Antacids are the only over-the-counter (OTC) medicines that help with GERD.Correct AnswerThe 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.
To prevent GERD symptoms at night:Correct AnswerThe 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 late-night snacks. Have dinner at least 2-3 hours before bedtime.
GERD symptoms may improve if you avoid:Correct AnswerThe 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.
You can prevent heartburn by exercising right after meals.Correct AnswerThe 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.
You should call your doctor if you notice which of the following symptoms?Correct AnswerThe 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.
Surgery can repair the leak between the stomach and esophagus.Correct AnswerThe 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.
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
A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.
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)
- Smoking or tobacco use
- Lying down within 3 hours after eating
Heartburn and gastroesophageal reflux can be caused by or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:
- Anticholinergics (for example, sea sickness medicine)
- Beta-blockers for high blood pressure or heart disease
- Bronchodilators for asthma or other lung diseases
- 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
- Theophylline (for asthma or other lung diseases)
- 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.
Heartburn - Animation
Eating spicy foods, such as pizza, may cause a person to feel heartburn. Although the name may imply the heart, heartburn has nothing to do with the heart itself. Heartburn is pain felt in the chest by a burning sensation in the esophagus. Here, you can see the pizza passing from the mouth to the esophagus and on to the stomach. At the junction between the stomach and esophagus is the lower esophageal sphincter. This muscular sphincter acts as a valve that normally keeps food and stomach acid in the stomach, and prevents the stomach’s contents from regurgitating back into the esophagus. However, certain foods may affect the lower esophageal sphincter, making it less effective. That’s how heartburn begins. The stomach produces hydrochloric acid to digest food. The stomach has a mucous lining that protects it from hydrochloric acid, but the esophagus does not. So, when food and stomach acid regurgitate back into the esophagus, a burning feeling is felt near the heart. This feeling is known as heartburn. Antacids may be used to relieve heartburn by making stomach juices less acidic, thereby reducing the burning feeling felt in the esophagus. If heartburn becomes frequent or prolonged, medical intervention may be necessary to correct the problem.
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
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...Read Article Now Book Mark Article
- Difficulty swallowing
- 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 provider may recommend a test called an upper endoscopy (EGD).
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum)....Read Article Now Book Mark Article
- This is a test to examine the lining of the esophagus, 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 be recommended to have one or more of the following tests:
- A test that measures how often stomach acid enters 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.
You can make many lifestyle changes to help treat your symptoms.
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from...Read Article Now Book Mark Article
Other tips include:
- If you are overweight or obese, in many cases, losing weight can help.
- Raise the head of the bed if your symptoms get worse at night.
- Have your dinner 2 to 3 hours before going to sleep.
- 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 provider 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.
Antacids help to treat heartburn (indigestion). They work by neutralizing the stomach acid that causes heartburn. You can buy many antacids without ...Read Article Now Book Mark Article
Other over-the-counter and prescription medicines 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 medicines.
- 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 medicines 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).
Most people respond to lifestyle changes and medicines. However, many people need to continue taking medicines to control their symptoms.
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)
- Long-term (chronic) cough or hoarseness
- Dental problems
- Ulcer in the esophagus
- Stricture (a narrowing of the esophagus due to scarring from chronic irritation)
When to Contact a Medical Professional
Contact your provider if symptoms do not improve with lifestyle changes or medicine.
Also call if you have:
- Choking (coughing, shortness of breath)
- Feeling filled up quickly when eating
- Frequent vomiting
- Loss of appetite
- Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
- Weight loss
- Feeling like food or pills are sticking behind the breast bone
Avoiding factors that cause heartburn may help prevent symptoms. Obesity is linked to GERD. Maintaining a healthy body weight may help prevent the condition.
Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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 pubmed.ncbi.nlm.nih.gov/25863867/.
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 129.
National Institute of Diabetes and Digestive and Kidney Diseases website. Acid reflux (GER & GERD) in adults. www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults. Updated July 2020. Accessed February 6, 2023.
Richter JE, Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 46.