Gastroesophageal Reflux Disease (GERD)/Heartburn

GERD
(gastroesophageal reflux disease) is a digestive disorder. It’s caused when gastric acid
from your stomach flows back up into your food pipe (esophagus).

Heartburn is the most common symptom of GERD.

GERD
happens when gastric acid from your stomach backs up into your food pipe
(esophagus).

A
muscle at the bottom of the esophagus opens to let food in. And it closes to keep food
in the stomach. This muscle is called the lower esophageal sphincter (LES). When your
LES relaxes too often or for too long, acid backs up into your esophagus. This causes
heartburn and may cause damage.

Some lifestyle issues that can cause GERD may include:

  • Being overweight
  • Overeating
  • Eating foods such as citrus, chocolate, and fatty or spicy foods
  • Having caffeine
  • Having alcohol
  • Smoking
  • Using
    aspirin and over-the-counter pain and fever medicines. These include nonsteroidal
    anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. 

Some health problems that may cause heartburn may include:

  • Swelling
    of your stomach lining (gastritis)
  • Painful
    sores (ulcers) on the lining of your stomach or esophagus, or the first part of your
    small intestine (duodenum)
  • An
    allergic condition in the esophagus (eosinophilic esophagitis)

You may be more at risk for GERD if you:

  • Have a
    part of your stomach slide up out of the belly cavity next to your esophagus (hiatal
    hernia)
  • Have a weak lower esophageal sphincter or LES
  • Are obese
  • Are pregnant
  • Use
    some medicines, such as aspirin or over-the-counter pain and fever medicines such as
    NSAIDs
  • Smoke or are around secondhand smoke
  • Drink alcohol
  • Are older

Heartburn, also called acid indigestion, or acid reflux, is the most common symptom of
GERD. Heartburn is a burning chest pain that starts behind your breastbone and moves up
to your neck and throat. It can last as long as 2 hours. It often feels worse after you
eat. Lying down or bending over can also cause heartburn. Another common symptom of GERD
is bringing swallowed food up again to the mouth (regurgitation). Some people can have
trouble swallowing.

Heartburn is not a GERD symptom for most children younger than 12 years old, and for
some adults. They may have a dry cough, asthma symptoms, or trouble swallowing
instead.

Each
person’s symptoms may vary. GERD symptoms may seem like other health problems. Always
see your healthcare provider to be sure.

To
see if you have GERD, your healthcare provider will give you a physical exam and ask
about your past health. Some people with typical symptoms may be treated without more
testing.

Other
tests for GERD may include:

  • Upper GI (gastrointestinal) series, also called a barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of your small intestine (duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. 
  • Upper
    endoscopy or EGD (esophagogastroduodenoscopy).
    This test looks at the lining
    or inside of your esophagus, stomach, and duodenum. This test uses a thin, lighted
    tube (endoscope). The tube has a camera at one end. The tube is put into your mouth
    and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare
    provider can see the inside of these organs. He or she can also take a small tissue
    sample (biopsy) if needed.
  • Bernstein
    test.
    This test helps to see if your symptoms are caused by acid in your
    esophagus. The test is done by dripping a mild acid through a tube placed in your
    esophagus.
  • Esophageal manometry. This test checks the strength of your esophagus muscles. It can see if you have any problems with backward flow of fluid (reflux) or swallowing. A small tube is put into your nostril, then down your throat and into your esophagus. The tube checks how much pressure your esophageal muscles make when they are at rest.
  • pH
    monitoring.
    This test checks the pH (acid level) in your esophagus. A thin,
    plastic tube is placed into your nostril, down your throat, and into your esophagus.
    The tube has a sensor that measures pH level. The other end of the tube outside your
    body is attached to a small monitor that records your pH levels for 24 to 48 hours.
    During this time you can go home and do your normal activities. You will need to keep
    a diary of any symptoms you feel, and also of the food you eat. Your pH readings are
    checked and compared to your activity for that time period.
  • Impedance testing. This test is able
    to see reflux of acid, plus nonacid liquid and air. It is combined with pH
    monitoring.

Treatment will depend on your child’s symptoms, age, and general
health. It will also depend on how severe the condition is.

In
many cases making diet and lifestyle changes can help reduce GERD symptoms. Always check
with your healthcare provider before making any changes.

If
you have GERD, be careful about what you eat and drink. Don’t have too much of
these:

  • Fried
    and fatty foods
  • Peppermint
  • Chocolate
  • Alcohol
  • Citrus
    fruit and juices
  • Tomato
    products
  • Drinks
    with caffeine, such as coffee, soda, and energy drinks

You
should also:

  • Eat
    smaller amounts
  • Not
    overeat
  • Quit
    smoking
  • Not
    drink too much alcohol
  • Wait a
    few hours after eating before you lie down or go to bed
  • Lose
    weight if needed
  • Raise
    the head of your bed 6 inches (to do this, put bricks, cinderblocks, or bedrisers
    under the bed legs at the head of the bed)

Check any medicines you are taking. Some may cause problems with the lining of your
stomach or esophagus. You may also want to talk with your healthcare provider about:

  • Taking
    medicines to reduce your stomach acid (antacids)
  • Taking
    medicines called H2-blockers and proton pump inhibitors. Taking these medicines
    before eating may stop heartburn from happening.
  • Taking
    medicines that help to empty food from your stomach (promotility medicines). You will
    need a prescription for these. But these medicines are rarely used to treat reflux
    disease unless there are other problems, too.
  • Having
    surgery called fundoplication. This is sometimes done to help keep the esophagus in
    the right place and to stop the backward flow of fluid (reflux).

If GERD is not treated, it can lead to other health problems. These may include:

  • Esophagitis. This is an irritation of the esophagus caused by the acid in your stomach contents.
  • Narrowing of the esophagus, also called strictures. This can make it hard to swallow.
  • Breathing problems. This happens when stomach contents from your esophagus go into your lungs.
  • Barrett’s esophagus. This affects the lining of your esophagus. In some cases it can lead to esophageal cancer.

Some of the same diet and lifestyle
changes that are used to treat GERD can also help to prevent it.

Your healthcare provider will give you advice on how to manage your GERD symptoms. In most cases you will need to make some diet and lifestyle changes so that GERD pain won’t get in the way of your normal activities.

Call your healthcare provider if:

  • Your GERD symptoms don’t get better with treatment, or they
    get worse
  • You have new symptoms
  • You start vomiting
  • You have involuntary weight loss
  • You have trouble or pain with swallowing
  • You have blood in your vomit or stool
  • GERD is
    a digestive disorder. It is caused by gastric acid flowing from your stomach back up
    into your food pipe (esophagus).
  • Heartburn is the most common symptom of GERD.
  • Some
    lifestyle issues that may cause GERD include being overweight, overeating, having
    caffeine and alcohol, and eating chocolate and spicy foods.
  • There
    are several tests that can be done to see if you have GERD.
  • If it is
    not treated, GERD can lead to other health problems.
  • Making
    diet and lifestyle changes can help reduce GERD symptoms. Some medicines may also
    help reduce symptoms.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider
    tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines,
    treatments, or tests. Also write down any new instructions your provider gives
    you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also
    know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or
    procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that
    visit.
  • Know how you can contact your provider if you have questions.