How Do I Know If I Have GERD?
Your doctor may be able to diagnose gastroesophageal reflux disease, or GERD, from your description of symptoms. The doctor may also suggest tests to rule out other possible causes of your symptoms, to monitor the degree of damage, or to determine the best treatment for you.
The three main tests used when GERD is suspected or known are esophageal pH monitoring, endoscopy, and manometry. With pH monitoring, the doctor measures the amount of acid in the esophagus over a 24-48 hour period. This test is used mainly to rule out GERD if symptoms are not typical for acid reflux. It is also very helpful in identifying patients who may need surgery as a treatment for GERD.
Endoscopy uses a flexible tube with a light and video camera on the end. The tube is passed through the throat into the esophagus so the doctor can examine the esophagus for esophagitis (inflammation of the esophagus), strictures (narrowing of the esophagus, and for Barrett's esophagus (a specific, abnormal change in the lining of the esophagus). This is important to recognize because -- rarely -- Barrett's can lead to cancer of the esophagus. Endoscopy usually is not done if symptoms are mild. If they are more severe, prolonged, or do not respond to treatments, including lifestyle changes and medications, your doctor may want an endoscopy. If you have Barrett's esophagus or severe esophagitis, your doctor may suggest regular endoscopy monitoring to screen for cancer.
Manometry identifies problems with motility and valve pressure in the esophagus. This study allows doctors to measure function of the lower esophageal valve (LES). Manometry can also be helpful in evaluating GERD patients for surgery.
What Are the Treatments for GERD?
GERD is a chronic disease, and the goal of treatment is to manage it; that means reducing the amount of acid in the stomach and the amount of reflux that occurs. For mild GERD, this can sometimes be accomplished by using over-the-counter antacids and making certain lifestyle changes. If more treatment is needed, other types of drugs, either over-the-counter or prescription, are available. Treatments are also available that can be done using the endoscope. Very rarely, surgery will be needed.
Conventional Medicine for GERD
Three types of drugs are generally used to treat GERD. They are:
- Antacids such as Maalox, Rolaids, and Tums
- Histamine H2-blockers such as nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac)
- Proton pump inhibitors such as rabeprazole (Aciphex), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and dexlansoprazole (Dexilant),
Taking antacids when needed may be appropriate for the initial treatment of minor symptoms. H2-blockers help cut the stomach's production of acid and work best for people with mild GERD. They are available in prescription strength and over-the-counter (half) strength. For moderate or severe GERD, doctors may start with these drugs or another type of drug known as a proton pump inhibitor, which is stronger than H2-blockers. These drugs turn off the acid pumps that stimulate the production of acid from the stomach. They are all available in prescription strength, and Prilosec OTC, Prevacid 24hr, Nexium 24HR, and Zegerid OTC are available over the counter. For complicated or chronic GERD, proton pump inhibitors are often taken indefinitely. A doctor needs to be consulted if these medications are used more than occasionally, because more serious problems may be overlooked.
Proton pump inhibitors are effective in reducing symptoms and promoting healing of any inflammation. But when you stop taking the drugs, symptoms may rebound or return quickly. So if you use these drugs, you should work out a plan with your doctor for long-term GERD management.
Occasionally, motility drugs such as Reglan (metoclopramide) can be used to strengthen the lower esophageal sphincter and speed the emptying of the stomach to reduce symptoms of GERD. Unfortunately, these drugs have multiple side effects that limit their usefulness. Long-term (more than three months) use of Reglan is not recommended due to possible development of irreversible neurologic side effects. In fact, there is a warning from the FDA against long-term use of Reglan.
If drug therapy is ineffective, your doctor may suggest surgery or an endoscopic procedure to help prevent GERD.
If you have GERD, be sure your doctor knows about other medicines -- prescription and nonprescription -- that you take. Drugs such as aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and birth control pills, can worsen symptoms of GERD. Also, some medications may have side effects if combined with some GERD medications.