How Is GERD Diagnosed and Treated?

If you have heartburn or acid reflux often, you may have gastroesophageal reflux disease, or GERD. To know for sure, you'll need to see your doctor.

Don't try to diagnose yourself with GERD or treat it on your own. Common symptoms like chest pain could be caused by a more serious health issue.

Physical Exam and Tests

Your doctor will start with a physical exam. She'll also ask some questions about the problems you're having and about your medical history. The next step may be a food diary. You'll write down the foods you eat and when you have symptoms. Then you'll share your notes with your doctor.

If she thinks it's GERD, she'll start to treat you for it. If that doesn't work or you have other symptoms, she may do some tests to figure out what's behind your issues:

  • Ambulatory acid probe test: This test measures how much acid is in your stomach over 24 hours. Your doctor will thread a long, thin, flexible tube called a catheter through your nose and down your esophagus. You'll wear a small device to track how much acid comes into your esophagus or throat from your stomach. Your doctor might also attach a small device that looks like a capsule to the wall of your esophagus. It measures acid and sends signals to a small device you wear. It will fall off your esophagus and pass through your stool about 2 days later.
  • X-rays: You'll swallow a chalky liquid called barium. It will coat the inside of your throat, stomach, and upper intestines. That will make it easier for your doctor to see any problems in these organs on an X-ray. You may feel bloated or be a little sick to your stomach afterward.
  • Endoscopy: Your doctor will put a long, thin tube and tiny camera into your digestive tract to look for damage. It will thread through your nose and down your esophagus. The tube can also be used for a biopsy if your doctor wants to take out a small sample of tissue to test.
  • Manometry: Your doctor will thread a long, thin tube into your esophagus to measure how your esophagus moves and how it pushes acid upward. This is also called esophageal motility testing.

 

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Over-the-Counter Medicines

Depending on what the exam and tests show, your doctor may recommend treating your condition with one or more over the counter medicines such as:

  • Antacids: These medications help get rid of stomach acid and ease mild heartburn. They include liquids you drink (Maalox, Mylanta) and chewable tablets (Rolaids, Tums). But they won't heal ulcers or fix damage to your esophagus from long-term GERD. Some can cause side effects like constipation or diarrhea.
  • H-2 receptor blockers: These work slower than antacids, but they ease symptoms for a longer time, up to 12 hours. They include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac). 
  • Proton pump inhibitors: These medicines offer stronger acid relief than H-2 receptor blockers. They also can help heal damage in your throat or esophagus from acid reflux. They include esomeprazole (Nexium), lansoprazole (Prevacid 24HR), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (AcipHex).

Prescription Medication

If over-the-counter medicines haven't worked after a few weeks, your doctor may give you stronger dosages of H-2 receptor blockers or proton pump inhibitors.

Your doctor may also prescribe a class of drugs known as prokinetics. These drugs help empty your stomach faster and make the muscles in the lower part of your esophagus stronger. They can cause side effects like nausea, diarrhea, fatigue, depression, or anxiety.

You may need a combination of prescription medications to treat severe GERD or frequent attacks. If you use these drugs for a long time, you can have side effects like fractures or a lack of vitamin B-12.

Surgery

If medications don't help your symptoms or you want to stop taking them because of side effects, your doctor might recommend surgery like one of the following to tighten your esophagus and control acid reflux while still letting food pass through:

  • Linx surgery: Your surgeon wraps a ring of tiny beads around your esophagus where it goes into your stomach.
  • Nissen fundoplication: Your surgeon wraps the top part of your stomach around the lower part of your esophagus.

 

Lifestyle Changes

You can do a few things to ease GERD symptoms like heartburn or acid reflux and help prevent other attacks:

  • Quit smoking: Smoking makes your esophagus weaker, so it can't work like it should.
  • Stay at a healthy weight: Extra pounds put pressure on your stomach. Talk to your doctor about healthy ways to shed a few pounds if you need to.
  • Avoid triggers: Some foods or drinks may lead to a GERD attack. Common ones are citrus fruits, tomato sauce, spicy foods, fatty or fried foods, alcoholic drinks, sodas or fizzy drinks, caffeine, chocolate, garlic, and onions. Keep track of what you eat to find your triggers so you can avoid them.
  • Wear loose-fitting, comfortable clothes: Outfits that fit tightly around your waist may press against your stomach and esophagus.
  • Eat smaller meals more often: Overeating may trigger GERD.
  • Sit up for a while after you eat: Wait about 3 hours to lie down or go to sleep after you eat.
  • Raise your bed: Acid reflux can be worse when you lie down. If you raise the head of your bed 6 to 9 inches, acid is less likely to come up into your throat. Put wooden or cement blocks under the legs at the top of your bed. Or get a wedge insert to put in between your mattress and box spring. Propped-up pillows don't work as well.

 

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Complementary Treatments

You also can try alternative therapies to relieve GERD symptoms or to ease triggers like stress:

  • Acupuncture is a traditional Chinese medicine therapy for many illnesses. An acupuncturist puts very thin needles into your skin at certain places to ease GERD.
  • Relaxation. Stress and anxiety can trigger GERD symptoms. You might keep your stomach calm with guided imagery to focus on peaceful memories or thoughts, or progressive muscle relaxation that teaches you how to release tension.

 

WebMD Medical Reference Reviewed by Minesh Khatri, MD on June 20, 2017

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases: "Acid Reflux (GER and GERD) in Adults."

MayoClinic.org: "GERD."

American Society for Gastrointestinal Endoscopy: "Diet and Gastroesophageal Reflux Disease (GERD)."

American Association of Family Physicians: "Reflux/Acid Reflux."

Cleveland Clinic: "GERD or Acid Reflux or Heartburn Overview."

University of Michigan Comprehensive Cancer Center: "Guided Imagery."

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