Gastroesophageal reflux disease (GERD) is a more serious form of the more common gastroesophageal reflux (“acid reflux”).
Reflux occurs when the lower esophageal sphincter (a ring of muscle) either opens spontaneously or else does not close properly, allowing stomach contents to rise up into the esophagus.
This sphincter acts like a valve connecting the stomach to the esophagus, and when that valve stops working properly, reflux develops.
The digestive juices of the stomach contain powerful acid that can, over time, damage the lining of the esophagus. While reflux may occur commonly, GERD is a more serious condition, occurring more than twice a week, and can cause health problems if untreated.
What Causes GERD?
Why some people develop GERD is not fully understood at this time. In individuals with GERD, the lower esophageal sphincter tends to relax while the rest of the esophagus is working. In individuals who have a hiatal hernia (in which the upper part of the stomach moves into the lower esophagus), GERD is likelier to develop.
Signs & Symptoms
Frequent heartburn (acid indigestion) is the most common symptom of patients with GERD. It may be a burning pain or ache in the lower part of the middle of the chest, behind the breastbone, or mid-abdomen. In children and some adults, GERD may occur without heartburn, but may have other symptoms, such as:
- Dry cough
- Asthma symptoms
- Difficulty swallowing
Risk Factors for GERD
Some factors that may increase the risk of GERD are:
Some foods may also worsen reflux symptoms, including:
- Citrus fruit
- Caffeinated drinks
- Alcoholic beverages
- Fatty and/or fried foods
- Garlic and/or onions
- Spicy foods
- Tomato-based foods such as chili, spaghetti cause, pizza or salsa
What is the Treatment of GERD?
If you have had GERD symptoms or have been using antacids or over-the-counter acid reducers for more than 2 weeks to attempt to relieve those symptoms, you should contact your physician, who may refer you to a gastroenterologist, a specialist who treats diseases of the stomach and intestines.
Changes in lifestyle may help lessen the symptoms of GERD, including:
- Avoiding foods and beverages that worsen symptoms
- Weight loss
- If a smoker, quitting smoking
- Wearing loose-fitting clothes
- Eating small, frequent meals instead of a few large meals
- Avoiding lying down sooner than three hours after a meal
- Elevating the head of your bed six to eight inches by means of securing wooden blocks under the bedposts
Elevating the head of the bed is one of the most effective lifestyle changes one can adopt in coping with GERD, but it should be noted that using extra pillows will not help—the bed itself should be elevated by means of blocks.
There are a number of medications that can help alleviate the pain and discomfort of GERD, many of them over-the-counter medications, such as:
- Antacids: drugs such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Tums may relieve mild symptoms of GERD.
- Foaming agents: these drugs (such as Gaviscon) work by covering the stomach contents with foam to prevent reflux.
- H2 blockers: these drugs decrease acid production in the body, and include drugs such as Tagamet HB (cimetidine), Pepcid AC (famotidine), Axid AR (nizatidine), and Zantac 75 (ranitidine). These offer short-term relief and are also available in prescription strength.
- Proton pump inhibitors: drugs such as Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Nexium (esomeprazole) may be available by prescription, and are a stronger treatment than H2 blockers.
- Prokinetics: these drugs strengthen the lower esophageal sphincter and make the stomach empty its contents faster, and includes drugs such as Urecholine (bethanechol), Reglan (metoclopramide). However, prokinetics have a number of side effects that may limit their value.
Sometimes combinations of drugs may be taken to help treat symptoms of GERD. For example, taking an antacid and an H2 blocker may help an individual by first neutralizing the acid in the stomach (the antacid) and then limiting additional acid production (the H2 blocker). Your doctor will suggest the proper combination of medications, if this approach is used.
Diagnosis & Testing
If GERD symptoms do not resolve from changes in lifestyle and medications, additional tests may need to be done.
- Barium swallow radiograph: this test involves drinking a barium solution which will allow an X-ray image to spot abnormalities such as hiatal hernia or strictures (narrowing) in the esophagus or ulcers.
- Upper endoscopy: this test may be performed in a doctor’s office, or in a hospital. Your doctor will lightly sedate you and numb your throat and slide a thin, flexible plastic tube with a light and a lens at the end of it (an endoscope) down your throat. This tiny camera lets the doctor see the surface of the esophagus, to confirm GERD. The doctor may, if necessary, perform a biopsy using tiny tweezers (forceps) that are passed through the endoscope and allow the doctor to obtain small tissue samples from your esophagus. This may then be examined by a pathologist to determine if the tissues are abnormal.
- pH monitoring examination: this test uses a small tube inserted in the esophagus for 24 to 48 hours that monitors how and when acid enters the esophagus, and, if used in conjunction with a food diary (a log indicating amounts of food eaten, what, and when), allows your doctor to find a correlation between symptoms and reflux. This test may be used to determine whether respiratory symptoms are caused by reflux.
In some cases, surgery may be considered as an alternative to long-term use of drugs or physical discomfort.
- Nissen fundoplication: in this specific fundoplication procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to repair a hiatal hernia, prevent acid reflux, and strengthen the sphincter itself. This surgery may be performed using a laparoscope, which is inserted into the body through tiny incisions in the abdomen. Patients who receive this surgery typically leave the hospital in 1 to 3 days, and may return to work in 2 to 3 weeks.
- Endoscopic techniques: these techniques use an endoscope to perform the operation, and include: Bard® EndoCinch™ system, NDO Plicator and Stretta system
Complications of GERD
It is important to treat GERD, as failure to do so can cause a number of serious complications, including:
- Esophagitis: inflammation of the esophagus
- Swallowing disorders: scar and tissue damage can narrow the esophagus, causing strictures that may swallowing difficult
- Barrett’s esophagus: in some cases, chronic GERD may cause Barrett’s esophagus, in which abnormal cells develop in the esophageal lining, increasing the risk of esophageal cancer
Why Choose Northwestern Memorial?
The Thoracic Surgery Program at Northwestern Memorial Hospital offers the latest surgical procedures for benign and malignant diseases of the esophagus. Your doctor will discuss the most appropriate treatment for esophageal disease.