- Gastroesophageal Reflux Disease (GERD)
- Symptoms of GERD
- Upper Endoscopy
- Reflux Testing
- Wireless pH Testing
- 24-Hour pH Impedance
- Esophageal Manometry
- Barium Esophagram
- GERD Treatment at Johns Hopkins
- What Is GERD?
- What Causes GERD?
- How Do People Know They Have GERD?
- How Doctors Diagnose GERD
- How Is GERD Treated?
- Living With GERD
- Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy
- GERD: Acid Reflux Symptoms, Treatment & Heartburn Relief
- Antacids for GERD
- Histamine antagonists
- Proton pump inhibitors
- Pro-motility drugs
- Foam barriers
- Get the Facts About Gastroesophageal Reflux Disease (GERD)
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
Symptoms of GERD
The main symptom of GERD is heartburn, often described as a fiery feeling in one's chest, and regurgitating sour or bitter liquid to the throat or mouth. The combination of heartburn and regurgitation is such a common characteristic of GERD that formal testing may be unnecessary.
Other symptoms of GERD include:
- Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back
- Difficulty swallowing (dysphagia)
- Atypical reflux symptoms relating to the throat, larynx or lungs:
- Sore throat
- Increased salivation
- Shortness of breath
Gastroenterologists at Johns Hopkins are the leading experts in the nation, pioneering new diagnostic procedures and treatments for GERD and other reflux conditions. Our doctors treat a high volume of cases every year, giving them the necessary experience to diagnose and treat even the most complex cases of GERD.
At Johns Hopkins, we understand that more than one specialty may be involved in obtaining an accurate diagnosis. Our multidisciplinary approach gathers doctors from many different fields to analyze each case and discuss the best approach.
A diagnosis of GERD starts with a thorough physical examination, during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.
However, tests may be performed if:
- Your symptoms are atypical
- The severity of the reflux raises concerns about esophageal damage
- Symptoms do not respond to initial treatment
- Your doctor is considering anti-reflux surgery
Diagnostic procedures for GERD include:
- Upper endoscopy
- Reflux testing (wireless pH/pH impedance)
- Esophageal manometry
- Barium esophagram
Upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and first part of the small intestine. It is the best test for evaluating reflux-induced esophageal injury and diagnosing esophagitis and Barrett's esophagus. It can also help diagnose an esophageal stricture (narrowing).
Although only 10 percent to 20 percent of people with reflux will have abnormal findings during an endoscopy, the procedure is necessary to evaluate the potential for complications. Your doctor also will want to rule out other, more serious conditions that mimic GERD.
During an upper endoscopy:
- You receive an anesthetic to help relax your gag reflex. You may also receive pain medication and a sedative.
- You lie on your left side, referred to as the left lateral position.
- Your doctor inserts the endoscope through your mouth and pharynx into the esophagus.
- The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.
Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing.
The two methods are:
Wireless pH Testing
Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing:
- Your doctor performs an endoscopy and places a small chip in your lower esophagus
- The chip records the acid level in your esophagus for 48 hours.
- The chip transmits your acid level to a wireless recording device that you wear around your belt.
- The data from the recording device can gauge your reflux severity.
24-Hour pH Impedance
Your doctor may order this procedure to evaluate your reflux. This procedure monitors your pH level (level of acidity) for a prolonged period. During pH impedance:
- Your doctor places a thin, flexible catheter with an acid-sensitive tip through your nose into your esophagus. The catheter is placed in separate recording spots to evaluate the flow of liquid from your stomach into your esophagus.
- The catheter stays in your nose for a period of 24 hours.
Your doctor is able to evaluate whether you have GERD, the severity of your reflux, the presence of non-acid reflux and the correlation between your reflux and symptoms. This procedure helps in the design of a course of treatment for you.
Esophageal manometry — or esophageal motility (movement) studies — cannot diagnose GERD, but doctors use it to rule out other conditions that mimic GERD. This is especially important if your doctor is considering an anti-reflux surgery.
During an esophageal manometry:
- Your doctor places a pressure-sensitive catheter into the esophagus. (This may be performed right before esophageal pH impedance studies, as it determines where your doctor should place the catheter.)
- The catheter evaluates the strength and coordination of your muscle contractions. It also tests the strength and relaxation function of the lower esophageal sphincter.
An esophageal manometry is an essential part of the assessment process prior to anti-reflux surgery.
Barium contrast radiography, or a barium esophagram, is an X-ray study. It is one of the most common procedures to test for GERD.
During barium contrast radiography:
- You swallow a contrast solution called barium.
- The barium coats your esophagus and gastrointestinal tract, making it easier for the doctor to detect abnormalities.
- An X-ray is taken.
- During the X-ray, your doctor looks for a narrowing in the esophagus called a stricture.
A barium esophagram also evaluates the coordination of your esophageal motor function. While it does not test for the presence of reflux, it is useful for evaluating injury to your esophagus.
Johns Hopkins minimally invasive surgeon Gina Adrales answers important questions about gastroesophageal reflux disease (GERD) including the most common symptoms and the recovery process.
Patients with severe reflux may suffer from further complications, including:
- Esophageal strictures
- Barrett's esophagus
GERD Treatment at Johns Hopkins
There are two main approaches to treating GERD: medication and surgery. Most patients can effectively use a combination of lifestyle changes and drug therapy to treat their GERD. GERD is chronic, so most patients will have to continue some sort of treatment throughout their lives.
Surgery is an option for patients who do not respond to medical treatment or who have significant hiatal hernias. Others choose therapy as an alternative to a lifetime of taking medication. Learn more about GERD treatment at Johns Hopkins.
What Is GERD?
Gastroesophageal (pronounced: gas-tro-ih-sah-fuh-JEE-ul) reflux disease is a disorder that results from stomach acid moving backward from the stomach into the esophagus. GERD usually happens because the lower esophageal sphincter(LES) — the muscular valve where the esophagus joins the stomach — opens at the wrong time or does not close properly.
When the stomach contents move backward into the esophagus, this is known as gastroesophageal reflux. (Because the stomach makes acid to help a person digest food, gastroesophageal reflux is also known as acid reflux.) Almost everyone has this type of reflux at some time. Often a person isn't even aware this is happening.
Sometimes reflux causes the burning sensation of heartburn that most of us occasionally feel. But although lots of people have heartburn from time to time, that doesn't mean that they have GERD. When a person has GERD, heartburn or other symptoms happen much more often and cause serious discomfort.
GERD can be a problem if it's not treated because, over time, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. In adults, long-lasting, untreated GERD can lead to permanent damage of the esophagus and sometimes even cancer.
What Causes GERD?
No one knows for sure why people get GERD. Although lots of different things may contribute to the condition, doctors believe that the way the LES works is the main reason why people have gastroesophageal reflux.
The LES is a muscular ring at the bottom of the esophagus where it joins the stomach. As a person swallows, muscles in the esophagus move the food down into the stomach.
The LES relaxes just enough to allow food and liquids into the stomach, but then the powerful muscles in the LES contract (tighten) to stop food and liquids from moving back up the esophagus.
In other words, the job of the LES is to prevent reflux.
Sometimes, though, the LES might not be able to do its job for various reasons. In some people, the LES doesn't tighten properly. In other cases, the LES doesn't close quickly enough or at the right time, allowing stomach contents to wash back up.
If a person has eaten way too much, the stomach may be so stretched full that the LES can't do its job properly.
In some people who have GERD, a hiatal (pronounced: high-AY-tull) hernia is to blame.
A hiatal hernia is an opening in the diaphragm (the muscle that separates the abdomen and chest) where the esophagus joins the stomach.
The hernia can allow the uppermost part of the stomach to bulge through the diaphragm into the chest area, interfering with how the LES works. Most teens who have GERD do not have a hiatal hernia.
Doctors do know that some things can make GERD worse, including obesity, drinking alcohol, and pregnancy. Certain foods and medications can also worsen GERD symptoms; for example, these foods affect some people with GERD:
- citrus fruits
- drinks or foods with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, spaghetti sauce, chili, and pizza
How Do People Know They Have GERD?
Often, people who have GERD notice that they regularly have the pain of heartburn in the chest or stomach — and their heartburn can last up to a couple of hours. Lots of people who have GERD notice their heartburn is worse after eating.
Regurgitation is also a sign that a person may have GERD, although, heartburn, occasional regurgitation is common for everyone. (Regurgitation is when food and liquid containing stomach acid comes back up into the throat or mouth.)
Other symptoms of GERD include:
- a sore, raw throat or hoarse voice
- a frequent sour taste of acid, especially when lying down
- a feeling of burping acid into the mouth
- trouble swallowing
- a feeling that food is stuck in the throat
- a feeling of choking that may wake someone up
- a dry cough
- bad breath
You should talk to your parents and visit your doctor if you've had heartburn that doesn't seem to go away or any other symptoms of GERD for a while.
How Doctors Diagnose GERD
If a doctor thinks you might have GERD, he or she will do a physical examination. Your doctor will also ask about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.
If your doctor suspects you might have GERD, he or she may refer you to a pediatric gastroenterologist, a doctor who treats kids and teens who have diseases of the gastrointestinal system (the esophagus, stomach, intestines, and other organs that aid in digestion).
Doctors sometimes run the following tests to diagnose GERD or rule out other possible problems:
- A special X-ray called a barium swallow radiograph can help doctors see whether liquid is refluxing into the esophagus. It can also show whether the esophagus is irritated or whether there are other abnormalities in the esophagus or the stomach that can make it easier for someone to reflux. With this test, the person drinks a special solution (barium, a kind of chalky liquid); this liquid then shows up on the X-rays.
- A gastric emptying scan can help show whether a person’s stomach is emptying too slowly, which can make reflux more ly to happen. This test is done either by drinking milk that has a tracer in it or eating scrambled eggs that have a tracer mixed in. A special machine that doesn’t use radiation can detect the tracer to see where it goes and how fast it empties the stomach.
- An upper endoscopy (pronounced: en-DAS-ko-pee) allows the doctor to look at the esophagus, stomach, and part of the small intestines using a tiny camera. For this test, the doctor may give the patient a medicine to help him or her relax, and may spray the throat to numb it. This makes the test more comfortable. Most patients are given anesthesia and are “asleep” when this procedure is done. The doctor then slides a thin, flexible plastic tube called an endoscope down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. During the endoscopy, the doctor also may use small tweezers (forceps) to remove a piece of tissue for biopsy. A biopsy can reveal damage caused by acid reflux or infection and help rule out other problems.
- In another kind of test, called a 24-hour impedance-probe study, the doctor puts a tiny tube through the nose and down into the esophagus until the tip is just above the opening to the stomach. The tube will stay there for 24 hours. The tube is connected to a device that monitors the acid levels in the esophagus as the person goes about normal daily activities. It also monitors how many acid and non-acid reflux episodes take place. This test is useful for diagnosing people who have symptoms of GERD but have no damage to the esophagus. It also can detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing.
How Is GERD Treated?
Treatment for GERD depends on how severe symptoms are. For some people, treatment may just include lifestyle changes, such as changing what they eat or drink. Others will need to take medicines. In very rare cases, when GERD is particularly severe, a doctor will recommend surgery.
The following lifestyle changes can help ease the symptoms of GERD or even prevent the condition:
- quitting smoking
- avoiding alcohol
- losing weight if you are overweight
- eating small meals
- wearing loose-fitting clothes
- avoiding carbonated beverages
- avoiding foods that trigger reflux
It also can help to not lie down for 3 hours after a meal and to not eat 2 to 3 hours before going to bed. Doctors sometimes also recommend raising the head of the bed about 6 to 8 inches. Before you start a major bedroom makeover, though, talk to your doctor and your parents about the best sleeping position for you.
A doctor may also recommend different medications to relieve symptoms. Over-the-counter antacids, such as Alka-Seltzer or Maalox, work by neutralizing stomach acid and can help with mild symptoms.
Other medicines called H2 blockers are available over the counter and by prescription and help by blocking the production of stomach acid.
If your doctor thinks you should take these, he or she will recommend certain over-the-counter medications or write you a prescription.
More powerful prescription drugs called proton pump inhibitors also reduce the amount of acid the stomach produces. Some of these are also available over-the-counter. Doctors also prescribe these for people with more severe or persistent GERD.
Medications that belong to a class called prokinetics also can be used to help reduce the frequency of reflux by strengthening the lower esophageal sphincter muscle and also helping the stomach empty faster.
For some teens, doctors advise combining medicines to control different symptoms. For example, people who get heartburn after eating can try taking both antacids and H2 blockers. The antacid goes to work first to neutralize the acid in the stomach, while the H2 blocker acts on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.
Surgery is a last resort for people with GERD and is rarely needed in healthy teens. The typical surgical treatment for GERD is called fundoplication (pronounced: fun-doh-plih-KAY-shun).
During the surgery, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent reflux.
Fundoplication has been used in people of all ages, even babies with severe GERD.
Living With GERD
The key to living with GERD is to not ignore it. Early diagnosis and treatment can help reduce or even stop uncomfortable symptoms. Left untreated, however, GERD can cause permanent damage to the esophagus.
One possible long-term effect of GERD is something called Barrett's esophagus.
In this condition, the cells in the esophagus change and become precancerous because they have been irritated by stomach acid for so long. Eventually, it may lead to cancer of the esophagus.
Barrett's esophagus is mostly found in adults who have had GERD for many years. But you can help avoid it by dealing with your GERD now.
You'll probably find that one of the simplest ways to make living with GERD easier is to avoid the things that trigger your symptoms. Some people will have to limit certain foods; others may have to give them up entirely. It all depends on your individual symptoms.
It can be hard to give up sodas or favorite foods at first. But after a while, lots of people discover that they feel so much better that they don't miss the problem foods as much as they thought they would.
Reviewed by: J. Fernando del Rosario, MD
Date reviewed: January 2015
Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy
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GERD: Acid Reflux Symptoms, Treatment & Heartburn Relief
There are a variety of over-the-counter (for example, antacids and foam barriers) and prescription medications (for example, proton pump inhibitors, histamine antagonists, and promotility drugs) for treating GERD.
Antacids for GERD
Despite the development of potent medications for the treatment of GERD, antacids remain a mainstay of treatment. Antacids neutralize the acid in the stomach so that there is no acid to reflux. The problem with antacids is that their action is brief.
They are emptied from the empty stomach quickly, in less than an hour, and the acid then re-accumulates. The best way to take antacids, therefore, is approximately one hour after meals, which is just before the symptoms of reflux begin after a meal.
Since the food from meals slows the emptying from the stomach, an antacid taken after a meal stays in the stomach longer and is effective longer.
For the same reason, a second dose of antacids approximately two hours after a meal takes advantage of the continuing post-meal slower emptying of the stomach and replenishes the acid-neutralizing capacity within the stomach.
Antacids may be aluminum, magnesium, or calcium based. Calcium-based antacids (usually calcium carbonate), un other antacids, stimulate the release of gastrin from the stomach and duodenum.
Gastrin is the hormone that is primarily responsible for the stimulation of acid secretion by the stomach. Therefore, the secretion of acid rebounds after the direct acid-neutralizing effect of the calcium carbonate is exhausted.
The rebound is due to the release of gastrin, which results in an overproduction of acid. Theoretically at least, this increased acid is not good for GERD.
Acid rebound, however, has not been shown to be clinically important. That is, treatment with calcium carbonate has not been shown to be less effective or safe than treatment with antacids not containing calcium carbonate. Nevertheless, the phenomenon of acid rebound is theoretically harmful.
In practice, therefore, calcium-containing antacids such as Tums and Rolaids are not recommended for frequent use. The occasional use of these calcium carbonate-containing antacids, however, is not believed to be harmful.
The advantages of calcium carbonate-containing antacids are their low cost, the calcium they add to the diet, and their convenience as compared to liquids.
Aluminum-containing antacids have a tendency to cause constipation, while magnesium-containing antacids tend to cause diarrhea. If diarrhea or constipation becomes a problem, it may be necessary to switch antacids, or alternatively, use antacids containing both aluminum and magnesium.
Although antacids can neutralize acid, they do so for only a short period of time. For substantial neutralization of acid throughout the day, antacids would need to be given frequently, at least every hour.
The first medication developed for more effective and convenient treatment of acid-related diseases, including GERD, was a histamine antagonist, specifically cimetidine (Tagamet). Histamine is an important chemical because it stimulates acid production by the stomach.
Released within the wall of the stomach, histamine attaches to receptors (binders) on the stomach's acid-producing cells and stimulates the cells to produce acid. Histamine antagonists work by blocking the receptor for histamine and thereby preventing histamine from stimulating the acid-producing cells.
(Histamine antagonists are referred to as H2 antagonists because the specific receptor they block is the histamine type 2 receptor.)
As histamine is particularly important for the stimulation of acid after meals, H2 antagonists are best taken 30 minutes before meals. The reason for this timing is so that the H2 antagonists will be at peak levels in the body after the meal when the stomach is actively producing acid. H2 antagonists also can be taken at bedtime to suppress nighttime production of acid.
H2 antagonists are very good for relieving the symptoms of GERD, particularly heartburn. However, they are not very good for healing the inflammation (esophagitis) that may accompany GERD. In fact, they are used primarily for the treatment of heartburn in GERD that is not associated with inflammation or complications, such as erosions or ulcers, strictures, or Barrett's esophagus.
Four different H2 antagonists are available by prescription, including cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine, (Pepcid). All four are also available over-the-counter (OTC), without the need for a prescription. However, the OTC dosages are lower than those available by prescription.
Proton pump inhibitors
The second type of drug developed specifically for acid-related diseases, such as GERD, was a proton pump inhibitor (PPI), specifically, omeprazole (Prilosec). A PPI blocks the secretion of acid into the stomach by the acid-secreting cells.
The advantage of a PPI over an H2 antagonist is that the PPI shuts off acid production more completely and for a longer period of time.
Not only is the PPI good for treating the symptom of heartburn, but it also is good for protecting the esophagus from acid so that esophageal inflammation can heal.
PPIs are used when H2 antagonists do not relieve symptoms adequately or when complications of GERD such as erosions or ulcers, strictures, or Barrett's esophagus exist.
Five different PPIs are approved for the treatment of GERD, including omeprazole (Prilosec, Dexilant), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium), and dexlansoprazole (Dexilant).
A sixth PPI product consists of a combination of omeprazole and sodium bicarbonate (Zegerid). PPIs (except for Zegarid) are best taken an hour before meals.
The reason for this timing is that the PPIs work best when the stomach is most actively producing acid, which occurs after meals. If the PPI is taken before the meal, it is at peak levels in the body after the meal when the acid is being made.
Pro-motility drugs work by stimulating the muscles of the gastrointestinal tract, including the esophagus, stomach, small intestine, and/or colon. One pro-motility drug, metoclopramide (Reglan), is approved for GERD.
Pro-motility drugs increase the pressure in the lower esophageal sphincter and strengthen the contractions (peristalsis) of the esophagus. Both effects would be expected to reduce reflux of acid. However, these effects on the sphincter and esophagus are small.
Therefore, it is believed that the primary effect of metoclopramide may be to speed up emptying of the stomach, which also would be expected to reduce reflux.
Pro-motility drugs are most effective when taken 30 minutes before meals and again at bedtime. They are not very effective for treating either the symptoms or complications of GERD. Therefore, the pro-motility agents are reserved either for patients who do not respond to other treatments or are added to enhance other treatments for GERD.
Foam barriers provide a unique form of treatment for GERD. Foam barriers are tablets that are composed of an antacid and a foaming agent. As the tablet disintegrates and reaches the stomach, it turns into foam that floats on the top of the liquid contents of the stomach.
The foam forms a physical barrier to the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes into contact with the foam. The tablets are best taken after meals (when the stomach is distended) and when lying down, both times when reflux is more ly to occur.
Foam barriers are not often used as the first or only treatment for GERD. Rather, they are added to other drugs for GERD when the other drugs are not adequately effective in relieving symptoms.
There is only one foam barrier, which is a combination of aluminum hydroxide gel, magnesium trisilicate, and alginate (Gaviscon).
Get the Facts About Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach.
Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Doctors believe that some people suffer from GERD due to a condition called hiatal hernia.
In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.
Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents back up into the esophagus.
In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus.
The severity of GERD depends on LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.
Some doctors believe a hiatal hernia may weaken the LES and increase the risk for gastroesophageal reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus).
The diaphragm is the muscle separating the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus. Many people with a hiatal hernia will not have problems with heartburn or reflux.
But having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.
Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.
Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.
Dietary and lifestyle choices may contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may trigger reflux and heartburn. Studies show that cigarette smoking relaxes the LES. Obesity and pregnancy can also play a role in GERD symptoms.
Heartburn, also called acid indigestion, is the most common symptom of GERD and usually feels a burning chest pain beginning behind the breastbone and moving upward to the neck and throat. Many people say it feels food is coming back into the mouth leaving an acid or bitter taste.
The burning, pressure, or pain of heartburn can last as long as 2 hours and is often worse after eating. Lying down or bending over can also result in heartburn. Many people obtain relief by standing upright or by taking an antacid that clears acid the esophagus.
Heartburn pain is sometimes mistaken for the pain associated with heart disease or a heart attack, but there are differences. Exercise may aggravate pain resulting from heart disease, and rest may relieve the pain. Heartburn pain is less ly to be associated with physical activity. But you can’t tell the difference, so seek immediate medical help if you have any chest pain.
More than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn. Many pregnant women experience daily heartburn. Recent studies show that GERD in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing, and other respiratory problems.
Doctors recommend lifestyle and dietary changes for most people needing treatment for GERD. Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials.
Avoiding foods and beverages that can relax the LES is often recommended. These foods include chocolate, peppermint, fatty foods, caffeine, and alcoholic beverages. Foods and beverages that can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products, and pepper, should also be avoided if they cause symptoms.
Decreasing the size of portions at mealtime may also help control symptoms. Eating meals at least 2 to 3 hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially. In addition, being overweight often worsens symptoms. Many overweight people find relief when they lose weight.
Cigarette smoking weakens the LES. Stopping smoking is important to reduce GERD symptoms.
Elevating the head of the bed on 6-inch blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimize reflux of stomach contents into the esophagus. Do not use pillows to prop yourself up; that only increases pressure on the stomach.
Along with lifestyle and diet changes, your doctor may recommend over-the-counter or prescription treatments.
Antacids can help neutralize acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. These compounds are believed to form a foam barrier on top of the stomach that prevents acid reflux from occurring.
Long-term use of antacids, however, can result in side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and buildup of magnesium in the body. Too much magnesium can be serious for patients with kidney disease. If antacids are needed for more than 2 weeks, a doctor should be consulted.
For chronic reflux and heartburn, the doctor may recommend medications to reduce acid in the stomach. These medicines include H2 blockers, which inhibit acid secretion in the stomach. H2 blockers include: cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac).
Another type of drug, the proton pump inhibitor (or acid pump), inhibits an enzyme (a protein in the acid-producing cells of the stomach) necessary for acid secretion.
Some proton pump inhibitors include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), omeprazole/sodium bicarbonate (Zegerid), pantoprazole (Protonix), and rabeprazole (Aciphex).
People with severe, chronic esophageal reflux or with symptoms not relieved by the treatments described above may need more complete diagnostic evaluation. Doctors use a variety of tests and procedures to examine a patient with chronic heartburn.
Endoscopy is an important procedure for individuals with chronic GERD.
By placing a small lighted tube with a tiny video camera on the end (endoscope) into the esophagus, the doctor may see inflammation or irritation of the tissue lining the esophagus (esophagitis).
If the findings of the endoscopy are abnormal or questionable, biopsy (removing a small sample of tissue) from the lining of the esophagus may be helpful.
An upper GI series may be performed during the early phase of testing. This test is a special X-ray that shows the esophagus, stomach, and duodenum (the upper part of the small intestine). While an upper GI series provides limited information about possible reflux, it is used to help rule out other diagnoses, such as peptic ulcers.
Esophageal manometric and impedance studies — pressure measurements of the esophagus — occasionally help identify low pressure in the LES or abnormalities in esophageal muscle contraction.
For patients in whom diagnosis is difficult, doctors may measure the acid levels inside the esophagus through pH testing. Testing pH monitors the acidity level of the esophagus and symptoms during meals, activity, and sleep. Newer techniques of long-term pH monitoring are improving diagnostic capability in this area.
A small number of people with GERD may need surgery because of severe reflux and poor response to medical treatment. However, surgery should not be considered until all other measures have been tried. Fundoplication is a surgical procedure that increases pressure in the lower esophagus. The doctor can perform it through a laparoscope (small holes through the belly) or through open surgery.
The Stretta procedure is minimally invasive. The doctors goes down the esophagus with a small tube and uses radiofrequency to tighten the barrier between the esophagus and stomach.
With LINX surgery, your doctor wraps a band of titanium beads around the lower part of the esophagus to prevent stomach acids from splashing back up into the esophagus.
Your doctor performs this procedure using a laparoscope.
Sometimes GERD results in serious complications. Esophagitis can occur as a result of too much stomach acid in the esophagus. Esophagitis may cause esophageal bleeding or ulcers. In addition, a narrowing or stricture of the esophagus may occur from chronic scarring. Some people develop a condition known as Barrett's esophagus. This condition can increase the risk of esophageal cancer.
Although GERD can limit daily activities and productivity, it is rarely life-threatening. With an understanding of the causes and proper treatment, most people will find relief.
National Institute of Diabetes and Digestive and Kidney Diseases: “Heartburn, Gastroesophageal Reflux, and Gastroesophageal Reflux Disease (GERD).”
Pluta, R. Journal of the American Medical Association, May 18, 2011.
American College of Gastroenterology: “Understanding GERD.”
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