What is gastroesophageal reflux disease (GERD)?
Gastroesophageal reflux disease (GERD) develops when
stomach acid and juices back up, or reflux, into the
esophagus when the valve between the lower end of the
esophagus and the stomach (the
lower esophageal sphincter) does not close tightly
enough. The most common symptoms are a sour taste in the mouth or an
uncomfortable feeling of burning, warmth, heat, or pain just behind the
breastbone. This feeling is commonly referred to as
See a picture of
how reflux happens .
GERD most commonly occurs when the lower
esophageal sphincter relaxes at the wrong time-that is, when you are not
swallowing-and remains open too long. Normally, the valve opens for only a few
seconds when you swallow. But certain foods may relax the valve so that it does
not close as tightly, making reflux more likely. These foods include chocolate,
onions, peppermint, coffee, high-sugar foods, and high-fat foods. Smoking may
also affect your symptoms.
Other factors that can allow stomach
juices to back up into the esophagus include:
Hormonal changes during pregnancy. The valve may not close as tightly during pregnancy because of
hormonal changes.1 Heartburn is common during
pregnancy because hormones cause the digestive system to slow down. Increased
abdominal pressure caused by the growing fetus in the woman's body may also
make reflux and heartburn symptoms worse.
A weak lower esophageal sphincter. If this valve is weak, it will not close properly, and reflux
will occur frequently. This is a rare cause of mild GERD, but among people who
have severe GERD, about 25% have this problem.1
Hiatal hernia. GERD is common among people with a
hiatal hernia. GERD symptoms in people with a hiatal
hernia can vary from mild to severe. But if you have GERD, it does not mean
that you have a hiatal hernia for sure. And some people who have a hiatal
hernia never have any GERD symptoms.
Slow digestion. If food stays in your stomach too long before it goes to the
small intestine (because it does not empty properly, called delayed gastric
emptying), the stomach contents are more likely to get pushed up into the
esophagus and cause heartburn.
Overfull stomach. Having a very full stomach-such as from eating a very large
meal-increases the likelihood that the lower esophageal sphincter will relax
and allow stomach juices to back up (reflux) into your esophagus.
Treatment for GERD is aimed at reducing the reflux
of stomach acid and juices into the esophagus to prevent injury to the lining
of the esophagus or to help the esophagus heal if injury has already occurred,
to prevent GERD from reoccurring, and to prevent other conditions that might
arise as complications of GERD.
How effective are medicines for GERD symptoms?
effectiveness of medicines used to control symptoms of GERD depends on the
severity of your symptoms. Nonprescription medicines may not be strong enough
to control your symptoms, and you may need prescription medicines. Keep in mind
that some of these medicines are not as effective for some people who may need
to try other medicines or consider surgery. If your symptoms cannot be
controlled with medicines, or if you have severe symptoms caused by the
regurgitation of stomach juices into the esophagus, surgery may be
The following nonprescription and prescription drugs
may be used to treat GERD:
- Antacids (such as Gaviscon, Mylanta, Rolaids, or Tums)
neutralize stomach acid and relieve heartburn. Making lifestyle changes and
taking antacids are usually the first steps to try when symptoms of GERD are
infrequent and mild. If you want to take medicine only when your symptoms
bother you, antacids are a good choice. They relieve symptoms quickly.
- H2 blockers, such as nizatidine (Axid), famotidine (Pepcid), cimetidine
(Tagamet), or ranitidine (Zantac), reduce the amount of acid in the stomach.
They are available in both nonprescription and prescription strengths.
Generally most people with mild to moderate GERD symptoms who take H2 blockers
find their symptoms get better. Taking H2 blockers and making lifestyle changes
often help people with more frequent GERD symptoms. H2 blockers are not as
effective as proton pump inhibitors in treating moderate to severe cases of
GERD that have caused inflammation or wearing away (erosion) of the lining of
the esophagus (esophagitis).
- Proton pump inhibitors, such as esomeprazole (Nexium),
lansoprazole (Prevacid), omeprazole (Prilosec ), pantoprazole (Protonix), or
rabeprazole (Aciphex), are prescription medicines that reduce the amount of
acid in the stomach. These medicines often help when H2 blockers have failed to
control symptoms of GERD. They are also used to treat severe inflammation of
the esophagus (esophagitis). A nonprescription version of omeprazole (Prilosec
OTC) is available for treatment of frequent heartburn. But if you have been
using Prilosec OTC to treat your symptoms for longer than 2 weeks, talk to your
doctor. If you have GERD, the stomach acid could be causing damage to your
esophagus. Your doctor can help you find the right treatment.
Depending on how bad your symptoms are, medicines may
need to be taken daily or only occasionally when GERD symptoms occur.
Long-term-often lifelong-medication treatment is usually needed for GERD
symptoms that are more severe, because symptoms tend to return when medication
treatment is stopped.
What new problems could develop if I take medicines for GERD?
To be effective, the medicines need to be taken regularly.
If you forget to take your medicine, your symptoms will return.
While the medicines used to treat GERD symptoms are generally safe, each
has a different chance of causing side effects.
- Antacids are made with many different ingredients. Antacids
that contain aluminum may cause constipation. Antacids that contain magnesium
may cause diarrhea. Many antacid preparations combine active ingredients to
balance side effects. For example, antacids may contain both magnesium and
aluminum to prevent diarrhea and constipation. You should not use antacids that
contain aluminum or magnesium if you have serious kidney problems.
- H2 blockers have been in use since the late 1960s. They are
well studied and are considered very safe. But they sometimes cause headache,
dizziness, diarrhea or constipation, or nausea and vomiting.
- Proton pump inhibitors are generally well tolerated by the
people who take them. Headache and diarrhea are the most frequent side effects
that may occur. Also, these medicines may interfere slightly with the actions
of warfarin (such as Coumadin) or phenytoin (such as Dilantin). So if you are
taking warfarin or phenytoin, talk with your doctor about the effect of taking
a proton pump inhibitor for GERD. Proton pump inhibitors may also reduce the
amount of calcium your body absorbs. This may be linked to an increased risk of
Pregnant women often have symptoms of GERD during
pregnancy. Heartburn is common during pregnancy because hormones cause the
digestive system to slow down. The muscles that push food down the esophagus
also move more slowly during pregnancy. In addition, as the uterus grows, it
pushes on the stomach and sometimes forces stomach acid up into the esophagus.
Lifestyle changes and antacids are usually tried first to treat pregnant women
who have GERD. Antacids are safe to use for heartburn symptoms during
pregnancy. If lifestyle changes and antacids don't help control your symptoms,
talk to your doctor about using other medicines. Most of the time, symptoms get
better after the baby is born.
How effective is surgery in treating GERD?
to control the symptoms of GERD, called
fundoplication surgery, usually includes wrapping part
of the stomach around the esophagus to strengthen it. The same procedure is
often done to correct a
hiatal hernia that may be causing some of the GERD
symptoms. This procedure is most often done using a
laparoscopic surgical technique.
show that laparoscopic fundoplication improves GERD symptoms in about 6 to 9
out of 10 people who have the surgery (depending on how experienced the surgeon
is). But no studies have proven that laparoscopic fundoplication surgery will
work to keep the esophagus from getting irritated or inflamed again over the
A successful surgery does not
guarantee that you will never have symptoms again. Some studies show that only
about 1 out of 10 people who have fundoplication surgery done by an experienced
surgeon have symptoms come back in the 2 years after surgery.1 But there isn't much research on how many people have
symptoms come back after more than 2 years.
But compared to
people who do not have surgery, people who have surgery are less likely to need
medicine every day and have less severe symptoms when they stop taking
medicine. Also, people who have surgery for GERD seem to be happy with the
results, even if their symptoms do come back and they have to take medicine
About 2 or 3 out of 10 people
who have surgery to relieve GERD symptoms have new problems (such as difficulty
swallowing, intestinal gas, or bloating) after the surgery.1 These new symptoms may or may not respond to treatment with
What new problems could develop if I have surgery for GERD?
All major surgical procedures have a slight
risk caused by the anesthesia as well as a risk of
bleeding, infection, and pain. The risk of death from laparoscopic
fundoplication has been estimated to be about 0.2%. There is no known risk of
death from GERD treatments using medicines.3
It is common for people to complain of abdominal bloating or excessive
intestinal gas (flatulence) after the surgery.
If the stomach is
wrapped too tightly, you may have difficulty swallowing. This complication may
be more likely to occur in people who receive fundoplication surgery using a
laparoscopic surgical technique. It is also possible for the stomach wrap to
slide down around the stomach instead of staying around the esophagus. Either
of these situations may require another surgery to correct the problem. Both of
these are rare problems.
There is some risk that the stomach wrap
will loosen, so that GERD symptoms return. This may require a second surgery to
correct, which carries its own risks.
If you need more information, see the topic
Gastroesophageal Reflux Disease (GERD).