What is GERD?
Gastroesophageal reflux, commonly known as heartburn, is a burning feeling in the center of your chest. It often happens after you eat, after you bend over, or when you lie down. Nearly everyone experiences mild reflux symptoms at some point in life. But GERD, or gastroesophageal reflux disease, is reflux that occurs often enough that the symptoms are bothersome.
When you swallow, food passes down your throat and through your esophagus to your stomach. A muscle called the lower esophageal sphincter controls the opening between the esophagus and the stomach. It remains tightly closed except when you swallow. When this muscle fails to close, the contents of the stomach, which contain acid, can travel back up into the esophagus. This backward movement is called reflux. When stomach acid enters the lower part of the esophagus, it can produce the burning sensation of heartburn.
When reflux happens only occasionally, it is not really a concern. If it happens more than two times per week, reflux becomes GERD.
Who Gets GERD?
GERD can happen to people at any age.
What Are the Symptoms of GERD?
Frequent heartburn (also called acid indigestion or acid reflux) is the most common symptom of GERD. However, some adults with GERD and most children under the age of 12 do not have heartburn. In these people, symptoms of GERD might include coughing, problems swallowing, and/or asthma-like breathing symptoms.
How Is GERD Diagnosed?
A doctor will do a physical exam and take a medical history to diagnose GERD. He or she may also order certain tests, including:
- Barium swallow
- Upper endoscopy, which uses an endoscope -- a thin, flexible tube that has a light and a camera
- pH monitoring exam
How Is GERD Treated?
Your doctor might offer suggestions for treatment of GERD that involve lifestyle changes and medications. The following lifestyle changes might help you avoid GERD symptoms:
- Stopping smoking
- Losing weight, if necessary
- Eating frequent, small meals
- Avoiding tight clothing
- Not lying down for three hours after eating
- Raising the head of your bed by 6-8 inches
- Avoiding food or beverages that might make symptoms worse
Foods that might make symptoms worse include:
- Beverages that contain caffeine
- Tomato-based food products (such as spaghetti, chili, or pizza)
- Citrus fruits or juices
- Greasy or fried foods
- Alcoholic drinks
- Spicy foods
- Mint flavors
What Types of Drugs Treat GERD?
You might find relief from over-the-counter (OTC) drugs. Or your doctor may prescribe drugs to treat your GERD. You should consult your health care provider before adding any kind of medication, including OTC drugs. The drugs work to control acid production or to improve the functioning of digestive muscles. GERD treatments may include antacids, foaming agents, proton pump inhibitors, H2 blockers, and prokinetics.
Antacids are often the first treatment for GERD. Many of these products combine aluminum, magnesium, or calcium with hydroxide or bicarbonate ions to neutralize stomach acid. Common brands include Alka-Seltzer, Maalox, Rolaids, and Tums. A similar product is the foaming agent, Gaviscon, which provides the stomach lining with a layer of foam protection against the acid.
Histamine 2 blockers (H2 blockers or H2-receptor antagonists) also treat GERD. Histamine is a compound that has wide effects in the body. In the stomach, it's involved in acid production. H2 blockers prevent histamine from landing on H2 receptors. That prevents the stomach from getting the message to make more acid. Therefore, less acid is produced, reducing heartburn. H2 blockers are used to treat both GERD and peptic ulcers. These products are available in a lower strength as OTC medications and at a higher strength as prescription drugs. Commonly used H2 blockers are:
- Famotidine (Pepcid as a prescription, Pepcid-AC as an OTC medication)
- Cimetidine (Tagamet and Tagamet-HB)
- Nizatidine (Axid and Axid AR)
- Ranitidine (Zantac and Zantac 75)
Proton pump inhibitors (PPIs) block the enzyme in the stomach wall that makes acid. They work a little differently than the H2 blockers. Commonly used PPIs are:
The prokinetic class of drugs does not reduce acid production. Instead, prokinetics act to make the lower esophageal sphincter stronger. They also help the stomach process and move food more quickly. That reduces the likelihood that stomach contents move back up through the esophagus. However, because of their side effects, including sleepiness, emotional changes, and difficulty moving, prokinetics are used less often than the other kinds of medication. Metoclopramide (Reglan) is one example and it also makes muscles in the digestive tract work more effectively.
Are There Other Treatments for GERD?
Your doctor might recommend surgery to treat GERD if lifestyle changes and medications fail. Or surgery might be an option if you and your doctor feel it is preferable to years of taking medications and have serious GERD complications.
The standard surgical treatment for GERD is called fundoplication. Nissen fundoplication surgery is used most often. In this surgery, part of the stomach is wrapped around the lower esophageal sphincter to make it stronger, stop reflux, and repair a hiatal hernia.
In addition to Nissen fundoplication surgery, there are various endoscopic methods to treat GERD. These include the Bard EndoCinch system and NDO Plicator. These techniques make the sphincter stronger by putting stitches into the sphincter.
What Are the Long-Term Effects of Untreated GERD?
If GERD is not treated, complications can result, including:
- Esophagitis -- inflammation in the esophagus
- Scarring that will make the esophagus more narrow, causing swallowing problems
- Worsening of asthma, chronic cough, or pulmonary fibrosis
- Barrett's esophagus, or abnormal cells in the esophageal lining; this condition is associated with esophageal cancer.