DISEASE

Reflux/ Heartburn/ GERD

OVERVIEW | CAUSES | RISK FACTORS | SYMPTOMS | COMPLICATION | DIAGNOSIS | TREATMENT | PREVENTION | REFERENCES

Reflux/ Heartburn

OVERVIEW

Gastroesophageal reflux disease (GERD)/ Reflux/ Heartburn occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.

Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.

CAUSES

GERD is caused by frequent acid reflux.

When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

RISK FACTORS

Conditions that can increase your risk of GERD include:

Obesity
Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
Pregnancy
Connective tissue disorders, such as scleroderma
Delayed stomach emptying

Factors that can aggravate acid reflux include:

Smoking
Eating large meals or eating late at night
Eating certain foods (triggers) such as fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Taking certain medications, such as aspirin

SYMPTOMS

Common signs and symptoms of GERD include:

A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
Chest pain
Difficulty swallowing
Regurgitation of food or sour liquid
Sensation of a lump in your throat

If you have nighttime acid reflux, you might also experience:

Chronic cough
Laryngitis
New or worsening asthma
Disrupted sleep

When to see a doctor

Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you:

Experience severe or frequent GERD symptoms
Take over-the-counter medications for heartburn more than twice a week

COMPLICATIONS

Over time, chronic inflammation in your esophagus can cause:

Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult.
Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.

DIAGNOSIS

Your doctor might be able to diagnose GERD based on a physical examination and history of your signs and symptoms.

To confirm a diagnosis of GERD, or to check for complications, your doctor might recommend:

Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett's esophagus.
Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor might be a thin, flexible tube (catheter) that's threaded through your nose into your esophagus, or a clip that's placed in your esophagus during an endoscopy and that gets passed into your stool after about two days.
Esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus.
X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.

TREATMENT

To prevent and relieve symptoms of GERD, your doctor might encourage you to make changes to your eating habits or other behaviors.

They might also suggest taking over-the-counter medications, like:

Antacids
H2 receptor blockers
Proton pump inhibitors (PPIs)

In some cases, they might prescribe stronger H2 receptor blockers or PPIs. If GERD is severe and not responding to other treatments, surgery might be recommended.

Some over-the-counter and prescription medications can cause side effects.

Surgery for GERD

In most cases, lifestyle changes and medications are enough to prevent and relieve symptoms of GERD. But sometimes, surgery is needed.

For example, your doctor might recommend surgery if lifestyle changes and medications alone haven’t stopped your symptoms. They might also suggest surgery if you’ve developed complications of GERD.

There are multiple types of surgery available to treat GERD.

PREVENTION

Lifestyle changes can help ease heartburn:

Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
Avoid tightfitting clothing, which puts pressure on your abdomen and the lower esophageal sphincter.
Avoid foods that trigger your heartburn.
Avoid lying down after a meal. Wait at least three hours.
Avoid late meals.
Elevate the head of your bed if you regularly experience heartburn at night or while trying to sleep. If that's not possible, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows usually isn't effective.
Avoid smoking and alcohol. Both smoking and drinking alcohol decrease the lower esophageal sphincter's ability to function properly.
Avoid large meals. Instead eat many small meals throughout the day.