Gastroesophageal Reflux Disease

Gastroesophageal reflux disease, or GERD, is also called chronic acid reflux. GERD is a common gastrointestinal disorder that affects about 20% of Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

What Is GERD?

The lower esophageal sphincter (LES) is a strong ring of muscle where the esophagus connects to the stomach. Normally, the LES relaxes to allow food to pass, then closes to prevent digestive fluids from leaking, or refluxing, back into the throat. A weakened or damaged LES leads to reflux, which irritates and erodes esophageal tissue, resulting in frequent heartburn, the key feature of GERD.

Causes of GERD

The exact causes of GERD are not known. Several factors increase the risk of developing GERD, including:

  • abnormal LES function such as transient LES relaxations, in which the LES spontaneously relaxes when not triggered by swallowing
  • eating certain foods known to trigger GERD symptoms
  • hiatal hernia, in which a portion of the stomach bulges through an opening in the diaphragm, the muscle that divides the chest and abdomen
  • obesity
  • physical inactivity
  • smoking
  • taking certain medications such as nonsteroidal anti-inflammatory drugs or calcium channel blockers used in high blood pressure medicines

Signs and Symptoms of GERD

Occasional heartburn is normal, but frequent heartburn that happens more than twice a week may be a sign of GERD. Additional symptoms may include:

  • chest pain
  • chronic cough
  • difficulty swallowing
  • hoarseness or raspy voice
  • nausea or vomiting
  • problems sleeping
  • red, inflamed gums and bad breath
  • regurgitating sour or bitter-tasting fluid
  • sore throat
  • trouble swallowing
  • wearing of tooth enamel

How Is GERD Diagnosed?

GERD is diagnosed based on a physical examination and review of symptoms. To confirm a diagnosis of GERD and evaluate any complications, additional tests may be performed, including:

  • endoscopy — in which a flexible, lighted tube is used to examine the esophagus and upper stomach for abnormalities
  • esophageal impedance test — evaluates the movement of acidic and non-acidic fluids in the esophagus
  • esophageal pH (acid) monitoring — a test that tracks how often acid reflux enters the esophagus
  • esophageal X-ray — also called a barium swallow test or esophagogram, an imaging study to check the esophagus for GERD-related damage

Treatments for GERD

Early diagnosis and prompt treatment for GERD can help prevent a variety of serious complications such as Barrett’s esophagus, a condition in which the lower esophagus becomes damaged by acid reflux.  Complications also include esophagitis — an inflammation of the esophagus, esophageal stricture — a narrowing of the esophagus, gastrointestinal bleeding and an increased risk of cancer of the esophagus, a condition called esophageal adenocarcinoma.

Treatment for GERD focuses on managing symptoms and minimizing complications. Options depend on the severity of symptoms and extent of any esophageal damage. Initial treatment for GERD typically involves changing behaviors and habits that may be making symptoms worse.

Lifestyle changes

  • Eat more than two hours before bedtime.
  • Get more physical activity.
  • Limit portion sizes.
  • Maintain a healthy weight.
  • Quit smoking if applicable.
  • Raise the head of the bed by 6 to 10 inches to prevent reflux
  • Wear looser-fitting clothing.

Dietary changes

Avoid GERD food triggers, including:

  • coffee, citrus fruits and tomatoes
  • carbonated drinks
  • chocolate, garlic and peppermint
  • fatty or fried foods
  • spicy foods

If lifestyle changes are not effective at managing GERD symptoms, additional treatment options may include:

  • Medications. Over-the-counter antacids help relieve heartburn. Prescription medications including H2 blockers or proton pump inhibitors reduce the production of stomach acid.
  • Surgery. Fundoplication is the most common surgical procedure for GERD. Several types of fundoplication are available to prevent acid reflux, reinforce the LES and repair related problems such as hiatal hernia.