Heartburn

What is GERD?

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

Heartburn is the most common symptom of GERD.

What causes GERD?

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

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

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 (nonsteroidal anti-inflammatory drugs or NSAIDs) 

Some health problems that may cause heartburn may include:

• Gastritis, a redness or swelling (inflammation) of your stomach lining
• Ulcers, painful sores on the lining of your stomach, esophagus or the first part of your small intestine (duodenum)

Who is at risk for GERD?

You may be more at risk for GERD if you:

• Have a 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 (nonsteroidal anti-inflammatory drugs or NSAIDs)
• Smoke or are around secondhand smoke
• Drink alcohol
• Are older

What are the symptoms of GERD?

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 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 look like other health problems. Always see your healthcare provider to be sure.

How is GERD diagnosed?

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 further testing.

Other tests for GERD may include the following:

• 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, called an 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 performed 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 or 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.

How is GERD treated?

Your healthcare provider will make a care plan for you based on:

• Your age, overall health, and past health
• How serious your case is
• How well you handle certain medicines, treatments, or therapies
• If your condition is expected to get worse
• What you would like to do

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 the following:

• 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 portions
• 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 by putting bricks or cinderblocks or bedrisers under the bed legs under the head of the bed

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

• Taking medicines to reduce your stomach acid (antacids)
• Taking medicines called H2-blockers and protein 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. However, 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).

What are the complications of GERD?

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.

What can I do to prevent GERD?

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

Living with GERD

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.

When should I call my healthcare provider?

Call your healthcare provider if your GERD symptoms don’t improve with treatment or they get worse. Also call if you have new symptoms.

Key points

• GERD (gastroesophageal reflux disease) 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.

Next steps

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

• 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• 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.