Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal Reflux Disease is a condition resulting from stomach acid moving backward from the stomach into the esophagus (the tube that connects the mouth to the stomach). The acid causes heartburn and can eventually damage the lining of the esophagus causing inflammation and pain. GERD usually occurs because the muscular valve where the esophagus joins the stomach does not close properly.

The condition is also known as peptic esophagitis, reflux esophagitis and chronic heartburn.

Also see: Crohn's Disease | Irritable Bowel Syndrome | Peptic Ulcers

What causes GERD and who is at risk?

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

Symptoms of GERD

• Heartburn
  • Involves a burning pain in the chest (under the breastbone)
  • Increased by bending, stooping, lying down, or eating
  • Relieved by antacids
  • More frequent or worse at night
• Belching
• Regurgitation of food
• Nausea and vomiting
• Vomiting blood
• Hoarseness or change in voice
• Sore throat
• Difficulty swallowing
• Cough or wheezing

Diagnosis

• A positive stool guaiac
• Continuous esophageal pH monitoring showing reflux
• Endoscopy showing ulceration or inflammation of the esophagus
• Esophageal manometry showing abnormal sphincter pressure
• A barium swallow showing reflux
• A positive Bernstein test for gastric acid reflux

Call your doctor if:

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Treatment Options

General measures include:

• Weight reduction
• Avoiding lying down after meals
• Sleeping with the head of the bed elevated
• Taking medication with plenty of water
• Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
• Avoiding alcohol and tobacco

Medications that alleviate symptoms include:

• Antacids after meals and at bedtime
• Histamine H2 receptor blockers
• Promotility agents
• Proton pump inhibitors

Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux. Also see: Crohn's Disease | Irritable Bowel Syndrome | Peptic Ulcers