Consumer Information

Gastroesophageal Reflux Disease

GENERAL INFORMATION:

What is gastroesophageal reflux disease? Gastroesophageal (gas-troh-ee-sof-ah-JEE-al) reflux disease is also called GERD. GERD occurs when the lower muscle of the esophagus does not close properly. The esophagus is the tube that carries food and liquid from the throat to the stomach. This makes the stomach acid and food in the stomach reflux (back up) into the esophagus. When the acid irritates and damages the esophagus, it may cause a burning feeling called heartburn. The muscle in the lower esophagus is called the lower esophageal sphincter.

What causes GERD? The main cause of GERD is having a weak lower esophageal sphincter. The sphincter relaxes too often, causing stomach acid to back up into the esophagus. The following increases your risk of having GERD:

Alcohol: Drinking too much alcohol may also cause GERD. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks. Talk to your caregiver if you drink alcohol.
Diet: The following may also weaken the muscles of the esophagus:
- Foods and beverages, such as chocolate, peppermint, fried or fatty foods, and coffee.
- Frequently eating large meals.
- Lying down after eating.
Hiatal hernia: This occurs when a part of the stomach moves up into the chest through a small hole.
Medicines: Medicines that may irritate the esophagus include aspirin and antibiotics.
Obesity: Weighing more than what your caregiver suggests may put pressure on your stomach. This pressure causes stomach acid reflux and heartburn.
Pregnancy: Being pregnant makes your stomach work more slowly due to changes in hormone levels. Your enlarged uterus (womb) may also crowd your stomach, pushing stomach acids upward.
Smoking: This makes the sphincter relax more than usual.

What are the signs and symptoms of GERD? Heartburn is the most common symptom of GERD. It is a feeling of burning pain in your chest or below the sternum (chest bone). This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have one or more of the following signs and symptoms:

Bitter or acid taste in your mouth.
Choking, coughing, or shortness of breath.
Dysphagia (trouble or difficulty swallowing).
Frequent burping or hiccups.
Vomiting (throwing up) blood or having black, tarry stools.
Weight loss.

What problems can GERD cause? GERD may cause any of the following:

Bleeding: A small blood vessel in your esophagus may get weak and burst. This may cause blood to appear in your vomit (throw up) or bowel movement (stool).
Esophagitis and esophageal ulcers: These problems occur when the lining of the esophagus becomes irritated and swollen.
Stricture: Scarring can cause the esophagus to become narrow.
Barrett's esophagus: This is a problem of the lower esophagus. Cells lining the esophagus may change and lead to cancer.

How is GERD diagnosed? You may have one or more of the following tests:

Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.
Esophageal manometry: This test measures the pressure within the esophagus and stomach.
Esophageal pH monitoring: A small probe is placed inside the esophagus and stomach to check the pH of your stomach acid. The pH measures how much acid is in your stomach. This test also measures the amount of acid that refluxes into the esophagus.
Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.

How is GERD treated? You may have one or more of the following treatments:

Medicines:
- Antacids: This medicine group decreases the stomach acid that can irritate your esophagus and stomach.
- Histamine type-2 receptor blocker: H2 blockers is another name for this group of medicines which blocks acid production in the stomach.
- Promotility agents: These medicines cause the lower esophageal sphincter and stomach to contract (tighten) more.
- Proton pump inhibitor: This medicine group is also called a PPI. This medicine blocks acid from forming in the stomach. These medicines may cause miscarriages and should not be used by pregnant women.
Surgery: This may be done when your medicines cannot control your symptoms or other problems are present. Fundoplication is surgery to wrap the upper part of the stomach around the esophageal sphincter to strengthen it. Ask your caregiver for more information about fundoplication.

How can GERD be prevented? The following may prevent GERD:

Avoid drinking alcohol: Alcohol increases the chances of acid from your stomach backing up into the esophagus.
Avoid foods and drinks that may increase heartburn: These include chocolate, peppermint, fried or fatty foods, and drinks that contain caffeine. Caffeine may be found in coffee, tea, soda, and some sports foods and drinks. Foods and drinks that can irritate your esophagus, such as citrus fruits and juices, should also be avoided.
Do not eat large meals: Eating a lot of food at one time increases the amount of acid needed to digest it. Eat six small meals each day instead of three large ones, and eat slowly. Do not eat meals in the 2 to 3 hours before bedtime, as this may also decrease acid reflux.
Elevate the head of the bed: Place 6-inch blocks under the head of your bed frame. You may also use one or two pillows under your head and shoulders during sleep.
Keep a healthy weight: Talk to your caregiver about your weight to learn if you weigh too little or too much. If you are overweight, weight loss may help relieve symptoms of GERD.
Stop smoking: Cigarette and tobacco smoking weakens the lower esophageal sphincter.
Take an antacid: These medicines may decrease the acid in the esophagus and stomach and stop heartburn. Some antacids may be bought over-the-counter in a pharmacy or grocery store. Check with your caregiver before trying any of these medicines.

Where can I find support and more information? You may feel scared, confused, and anxious because you have GERD. You may blame yourself and think you have done something wrong. These feelings are common. Talk about these feelings with your caregiver or with someone close to you. Contact the following for more information:

National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-8915389
Web Address: www.digestive.niddk.nih.gov

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1-414-964-1799
Phone: 1-888-964-2001
Web Address: http://www.iffgd.org

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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