Gastroesophageal Reflux Disease (GERD or heartburn)

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.

What causes GERD and who is at risk?

Gastroesophageal reflux is a common condition that often occurs with 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, smoking, being overweight, pregnancy, and scleroderma. Certain foods, such as citrus, tomato, mint, garlic, onions, chocolate or spicy foods can worsen reflux. Aspirin, ibuprofen, certain muscle relaxers and some blood pressure medications can aggravate symptoms, too. Alcohol, coffee, tea, and carbonated beverages, as well as eating too close to bedtime or laying down right after a meal can worsen reflux.

Symptoms of GERD

• Heartburn
  • Involves a burning pain in the chest (under the breastbone) that may move up into the throat; a sour or bitter-tasting acid may back up into the throat
  • Increased by bending, stooping, lying down, or eating
  • Relieved by antacids
  • More frequent or worse at night
• Belching, or burping
• Regurgitation of food
• Nausea and vomiting, bloating
• Vomiting blood, or black, tarry stools
• Hoarseness or change in voice
• Sore throat
• Difficulty swallowing
• Cough or wheezing
• Dysphagia -- a narrowing of the esophagus, which creates the sensation of food being stuck in your throat

Diagnosis

• A positive stool guaiac which may occur due to bleeding from the irritation in the esophagus
• 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, or if you have acid reflux symptoms two or more times per week.

Treatment Options

General measures include:

• Weight reduction
• Avoid 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, like metoclopromide (Reglan)
• 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.

See Also:

• Crohn's Disease
• Gastrointestinal Disorders
• Irritable Bowel Syndrome (IBS)
• Peptic Ulcers