GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal Reflux Disease (GERD) is a digestive
disorder that occurs when acidic stomach juices, or food
and fluids back up from the stomach into the esophagus.
GERD affects people of all ages—from infants to older
adults.
People with asthma are at higher risk of developing GERD.
Asthma flare-ups can cause the lower esophageal sphincter
to relax, allowing stomach contents to flow back, or reflux,
into the esophagus. Some asthma medications (especially
theophylline) may worsen reflux symptoms.
On the other hand, acid reflux can make asthma symptoms
worse by irritating the airways and lungs. This, in turn, can
lead to progressively more serious asthma. Also, this
irritation can trigger allergic reactions and make the
airways more sensitive to environmental conditions such as
smoke or cold air.
SYMPTOMS
Symptoms
Everyone has experienced gastroesophageal reflux. It
happens when you burp, have an acid taste in your mouth or
have heartburn. However, if these symptoms interfere with
your daily life it is time to see your physician.
Other symptoms that occur less frequently but can indicate
that you could have GERD are:
• Acid regurgitation (retasting your food after eating)
• Difficulty or pain when swallowing
• Sudden excess of saliva
• Chronic sore throat
• Laryngitis or hoarseness
• Inflammation of the gums
• Cavities
• Bad breath
• Chest pain (seek immediate medical help)
Causes
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.
Occasional acid reflux is quite common, often occurring as a
result of overeating, lying down after eating, or eating particular
foods.
However, recurrent acid reflux, diagnosed as GERD, typically has
other causes and risk factors and can have more serious
complications.
Gastroesophageal reflux disease occurs in people of all ages,
and sometimes for unknown reasons.
In short, GERD occurs when the sphincter at the bottom of the
esophagus becomes weak, or opens when it should not.
GERD occurs more commonly in people who are:
overweight or obese because of increased pressure on the
abdomen
pregnant, due to the same increased pressure
taking certain medications, including
some asthma medications, calcium channel blockers,
antihistamines, sedatives, and antidepressants
smoking, and being exposed to second-hand smoke
Hiatal hernia is a condition where an opening in the diaphragm
lets the top of the stomach move up into the chest. This lowers
the pressure in the esophageal sphincter and raises the risk of
GERD.
DIAGNOSIS
Several tests may be used to diagnose GERD including:
• X-ray of the upper digestive system
• Endoscopy (examines the inside of the esophagus)
• Ambulatory acid (pH) test (monitors the amount of acid
in the esophagus)
• Esophageal impedance test (measures the movement
of substances in the esophagus)
barium swallow: after drinking a barium solution, X-ray
imaging is used to examine your upper digestive tract
upper endoscopy: a flexible tube with a tiny camera is
threaded into your esophagus to examine it and collect a
sample of tissue (biopsy) if needed
esophageal manometry: a flexible tube is threaded into your
esophagus to measure the strength of your esophageal
muscles
esophageal pH monitoring: a monitor is inserted into your
esophagus to learn if and when stomach acid enters it
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
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.
TREATMENT
Lifestyle changes to treat GERD include:
• Elevate the head of the bed 6-8 inches
• Lose weight
• Stop smoking
• Decrease alcohol intake
• Limit meal size and avoid heavy evening meals
• Do not lie down within two to three hours of eating
• Decrease caffeine intake
• Avoid theophylline (if possible)
Treatment
GERD surgery
Substitute for esophageal sphincter
Your doctor is likely to recommend that you first try lifestyle
modifications and over-the-counter medications. If you don't
experience relief within a few weeks, your doctor might
recommend prescription medication or surgery.
Over-the-counter medications
The options include:
Antacids that neutralize stomach acid. Antacids, such
as Mylanta, Rolaids and Tums, may provide quick relief.
But antacids alone won't heal an inflamed esophagus
damaged by stomach acid. Overuse of some antacids
can cause side effects, such as diarrhea or sometimes
kidney problems.
Medications to reduce acid production. These
medications — known as H-2-receptor blockers —
include cimetidine (Tagamet HB), famotidine (Pepcid
AC), nizatidine (Axid AR) and ranitidine. H-2-receptor
blockers don't act as quickly as antacids, but they
provide longer relief and may decrease acid production
from the stomach for up to 12 hours. Stronger versions
are available by prescription.
Medications that block acid production and heal the
esophagus. These medications — known as proton
pump inhibitors — are stronger acid blockers than H-2-
receptor blockers and allow time for damaged
esophageal tissue to heal. Over-the-counter proton pump
inhibitors include lansoprazole (Prevacid 24 HR) and
omeprazole (Prilosec OTC, Zegerid OTC).
Prescription medications
Prescription-strength treatments for GERD include:
Prescription-strength H-2-receptor blockers. These
include prescription-strength famotidine (Pepcid),
nizatidine and ranitidine. These medications are
generally well-tolerated but long-term use may be
associated with a slight increase in risk of vitamin B-12
deficiency and bone fractures.
Prescription-strength proton pump inhibitors. These
include esomeprazole (Nexium), lansoprazole (Prevacid),
omeprazole (Prilosec, Zegerid), pantoprazole (Protonix),
rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
Although generally well-tolerated, these medications
might cause diarrhea, headache, nausea and vitamin B-
12 deficiency. Chronic use might increase the risk of hip
fracture.
Medication to strengthen the lower esophageal
sphincter. Baclofen may ease GERD by decreasing the
frequency of relaxations of the lower esophageal
sphincter. Side effects might include fatigue or nausea.
Surgery and other procedures
GERD can usually be controlled with medication. But if
medications don't help or you wish to avoid long-term
medication use, your doctor might recommend:
Fundoplication. The surgeon wraps the top of your
stomach around the lower esophageal sphincter, to
tighten the muscle and prevent reflux. Fundoplication is
usually done with a minimally invasive (laparoscopic)
procedure. The wrapping of the top part of the stomach
can be partial or complete.
LINX device. A ring of tiny magnetic beads is wrapped
around the junction of the stomach and esophagus. The
magnetic attraction between the beads is strong enough
to keep the junction closed to refluxing acid, but weak
enough to allow food to pass through. The Linx device
can be implanted using minimally invasive surgery
Alternative medicine
No alternative medicine therapies have been proved to treat
GERD or reverse damage to the esophagus. Some
complementary and alternative therapies may provide some
relief, when combined with your doctor's care.
Talk to your doctor about what alternative GERD treatments
may be safe for you. The options might include:
Herbal remedies. Licorice and chamomile are
sometimes used to ease GERD. Herbal remedies can
have serious side effects and might interfere with
medications. Ask your doctor about a safe dosage
before beginning any herbal remedy.
Relaxation therapies. Techniques to calm stress and
anxiety may reduce signs and symptoms of GERD. Ask
your doctor about relaxation techniques, such as
progressive muscle relaxation or guided imagery.
