GERD FAQs

Picture of GERD (Gastroesophageal Reflux disease, heartburn)

• Gastroesophageal reflux disease (GERD) is a condition in which stomach contents, including acid, back up (reflux) from the stomach into the esophagus and even the throat.
• The main symptom of GERD is frequent and persistent heartburn, which is pain or a burning sensation in the stomach or upper abdomen. Other symptoms of GERD include
  • regurgitation of bitter acid up into the throat,
  • a bitter taste in the mouth,
  • persistent dry cough,
  • hoarseness,
  • feeling of tightness in the throat,
  • feeling as if a piece of food is stuck in the throat,
  • wheezing, and
  • bad breath.
• Causes of GERD include the:
  • A person's lifestyle (such as smoking, obesity, excessive alcohol intake)
  • Medications
  • Foods such as fried foods, chocolate, garlic, onions, caffeine, citrus fruits, tomatoes, spicy foods, and mint), eating large meals, eating before bedtime
  • Medical conditions (including hiatal hernia, pregnancy, diabetes)
  • Tests to diagnose GERD include an upper GI (gastrointestinal) endoscopy, upper GI series (barium swallow), esophageal manometry, and 24-hour pH monitoring.
• Lifestyle changes are the first-line treatment for GERD, including
  • not eating large meals,
  • not eating before bedtime, avoiding trigger foods,
  • avoiding alcohol and caffeine, quitting smoking,
  • losing weight if overweight,
  • maintaining a good posture (avoid stooping and slouching), and
  • talking to your doctor about changing medications to ones that might not aggravate your GERD symptoms (do not stop taking any medication without first consulting your doctor).
• Over-the-counter medications to treat GERD include antacids and acid blockers.
• Prescription medications to treat GERD include proton pump inhibitors (PPIs), or promotility drugs.
• Surgery called fundoplication to treat GERD is a last resort in severe cases.
• Prevention of GERD involves modifying lifestyle factors in diet, activity, and habits that trigger symptoms.

What is GERD (acid reflux)?

Gastroesophageal reflux disease (GERD) is a condition in which the esophagus (food pipe) becomes irritated or inflamed by stomach contents, including acid, backing up from the stomach. This backing up is called reflux. The main symptom is heartburn, but other symptoms may occur.

What are heartburn symptoms?

Heartburn symptoms include a burning pain in the center of the chest, behind the breastbone (see Media file 1). It often starts in the upper abdomen and spreads up into the neck. It usually starts about 30-60 minutes after eating and can last as long as 2 hours. Lying down or bending over can bring on heartburn or make it worse. It is sometimes referred to as acid indigestion. Not everyone with GERD has heartburn.

Gastroesophageal reflux disease and heartburn have nothing to do with the heart, even though it seems like a burning sensation in the chest. The esophagus lies just behind the heart, so heartburn can be confused with a heart problem. One important difference is that heartburn usually does not start or worsen with physical activity, while pain related to the heart often comes on with exertion (angina).

The chest pain of gastroesophageal reflux disease (GERD) can be confused with pain from a heart problem. If you have any of the following, call your doctor and/or go immediately to the closest hospital emergency department:

• Severe chest pain or pressure, especially if it radiates to the arm, neck, or back
• Shortness of breath
• Severe sweating
• Vomiting followed by severe chest pain
• Vomiting blood
• Dark, tarry stools
• Difficulty swallowing solids or liquids

What is the esophagus?

The esophagus is a muscular tube stretching from the throat to the stomach. All the foods and liquids that are swallowed travel through the esophagus.

What is stomach acid?

Stomach acid is a strong acid produced by the stomach to help digest food.

Why doesn't the acid irritate the stomach?

The stomach has a protective lining that resists damage by the acid. The thick cells that line the stomach secrete large amounts of protective mucus so the acid produced does not irritate the stomach. The esophagus does not have this protection.

Why does the acid back up into the esophagus?

Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), prevents acid reflux. This muscle acts like a drawstring that opens or closes off the opening between the esophagus and stomach. It is supposed to close tightly between bites and when you are not eating.

With gastroesophageal reflux disease, the lower esophageal sphincter relaxes between swallows and after eating, allowing stomach contents and corrosive acid to back up and burn or irritate the lining of the esophagus.

How does GERD differ from heartburn?

The problem of gastric reflux is the same in heartburn and GERD. The condition is called GERD when it becomes a frequent, persistent (chronic) problem.

Gastroesophageal reflux disease affects 20% of Americans to some degree at least once a month. Some adults experience GERD weekly or daily. Not just adults are affected: even infants and children can have GERD.

We don't know the exact cause of gastroesophageal reflux disease. We do know what makes it worse, either by relaxing the lower esophageal sphincter or directly by irritating the esophagus.

• Lifestyle - Use of alcohol or cigarettes, obesity, poor posture (slouching)
• Medications - Blood pressure drugs called calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines
• Diet - Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
• Eating habits - Eating large meals, eating before bedtime
• Other medical conditions, for example, hiatal hernia, pregnancy, diabetes

GERD and heartburn cause the same symptoms, though GERD may have additional symptoms. GERD is diagnosed when you have constant, frequent, chronic heartburn. Heartburn and GERD feels like a painful or burning sensation in your upper abdomen behind the breastbone, sometimes going up into your throat. It may feel as if there is a hot, acidic, or sour tasting fluid at the back of the throat or you may have a sore throat.

Heartburn and GERD may make you feel like it's difficult to swallow or you may feel a tightness in the throat, as if food is stuck in your throat or esophagus.

You may have chest pain when lying down, bending over, or after eating. (See your doctor for any undiagnosed chest pain - do not assume you are experiencing heartburn or GERD until a doctor has diagnosed it.)

• Not everyone with gastroesophageal reflux disease has heartburn.
• Other symptoms of GERD include
  • regurgitation of bitter acid up into the throat while sleeping or bending over;
  • bitter taste in the mouth; persistent dry cough;
  • hoarseness (especially in the morning);
  • feeling of tightness in the throat, as if a piece of food is stuck there;
  • wheezing; and
  • bad breath.

The most common symptoms of acid reflux in children are

• nausea, repeated vomiting,
• coughing, and other
• respiratory problems.

• GERD may be initially diagnosed by your family or general practitioner (primary care provider), who may then refer you to a gastroenterologist, a specialist in disorders of the gastrointestinal (GI) tract.
• If your symptoms are severe and require surgery, you will be referred to a general surgeon.
• Certain diagnostic tests for GERD are done by a radiologist.

Call your health-care pprofessional if you have any symptoms of gastroesophageal reflux disease (GERD) that occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by taking nonprescription antacids. If you have heartburn 3 or more times a week for at least 2 weeks, a visit to your health-care professional is warranted.

If you have been taking antacids, tell your health care provide so that he or she can monitor how well they work and how often you need to use them.

Your health-care professional may be able to diagnose gastroesophageal reflux disease just by the symptoms you report. If symptoms continue for more than 4 weeks despite this therapy, you may be referred to a gastroenterologist. If your symptoms are severe, you may have to undergo some tests.

There is no simple blood test for GERD. The tests used to diagnose GERD include the following:

• Upper GI (gastrointestinal) endoscopy
• Upper GI series (barium swallow)
• Esophageal manometry
• 24-hour pH monitoring

The goals of treating gastroesophageal reflux disease are

• reducing reflux,
• relieving symptoms, and
• preventing damage to the esophagus.

Your health-care professional may recommend treating GERD in a stepwise fashion.

• For mild symptoms, simple lifestyle modifications may be enough.
• The next step is nonprescription antacids such as Maalox, Mylanta, Tums, or Rolaids.
• Other treatments include acid blockers and even surgery.
• In most cases, one or more of these treatments provide relief from GERD and prevent it from turning into a more serious disease.

I take nonprescription antacids when I have symptoms, but they don't seem to help.

Nonprescription antacids are only part of the treatment for GERD. They can work very well, but these antacids alone usually can't stop the symptoms. Your health-care professional will probably recommend that you make changes in your lifestyle as well.

• Don't eat within 3 hours of bedtime. This allows your stomach to empty and acid production to decrease. If you don't eat, your body isn't making acid to digest the food.
• Similarly, don't lie down right after eating at any time of day.
• Elevate the head of your bed 6 by inches with blocks, bricks, or books. Gravity helps prevent reflux. Just using more pillows won't help, because that actually increases the pressure on your stomach.
• Don't eat large meals, especially before bedtime. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day.
• Avoid fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomatoes. These foods can irritate the already damaged lining of the esophagus.
• Avoid drinking alcohol without eating food, and definitely avoid drinking alcohol before bed. Alcohol increases the likelihood of acid backing up from your stomach.
• Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux.
• Lose excess weight. Overweight and obese people are much more likely to have bothersome reflux than people of healthy weight.
• Stand upright or sit up straight, maintain good posture. This helps food and acid pass through the stomach instead of backing up into the esophagus.
• Talk to your health-care professional if you take over-the-counter pain relievers such as aspirin and ibuprofen (Advil, Motrin). These can aggravate reflux in some people.

Some of these changes are difficult for many people to make. Talk to your health-care professional if you need some tips on losing weight or quitting smoking. Knowing that your symptoms will get better may keep you motivated.

Will these lifestyle changes stop the symptoms?

They may. If they don't, adding a nonprescription antacid or acid blocker can be helpful.

Antacids and how they work

Antacids work by neutralizing acid and coating the stomach. Antacids should be taken 1 hour after meals or when gastroesophageal reflux disease symptoms occur. Liquid antacids usually work faster than tablets or chewables. If symptoms occur soon after meals, they should be taken before the meal.

Antacids are useful because they relieve symptoms rapidly. But relief is only temporary. Over-the-counter antacids do not prevent symptoms from returning or rarely allow an injured esophagus to heal. If you need antacids for more than 2 weeks, talk with your health-care professional to get a better diagnosis of your condition and appropriate investigation and treatment.

Most varieties of antacids you can buy without a prescription are combinations of aluminum hydroxide and magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation. Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.

When taking antacids, follow label instructions and do not take more than the recommended daily dose. Take antacids before or after meals and at bedtime - or when you have symptoms.

Always tell your health-care professional about your antacid use.

What if lifestyle changes and antacids don't work?

If you still have symptoms after lifestyle modifications and antacids, your health-care professional probably will prescribe a stronger drug. The usual choice is one of the histamine-2 (H2) blockers, or acid blockers.

Acid blockers for GERD

The name says it all. These drugs block the biochemical process that creates acid in the stomach. Less acid in the stomach means less acid available for back-up into the esophagus. Some examples are cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid). Low doses of these drugs are available without a prescription. More potent doses require a prescription. These drugs relieve symptoms within 30 minutes and are taken twice a day. Pepcid Complete also has antacids in it.

If these acid blockers do not relieve your symptoms, your health-care professional probably will recommend one of the drugs, which are even stronger, called proton pump inhibitors. Examples of these drugs are omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), dexlanzoprazole (Dexilant), and esomeprazole (Nexium). These tablets virtually stop all acid production in the stomach. They typically are taken only once a day. These drugs usually are prescribed if other drugs have not helped.

• Surgery is never the first option for treating gastroesophageal reflux disease.
• If prescription drugs are not relieving symptoms, or if you have serious complications, you may need surgery.
• The operation is relatively simple and is called fundoplication.
• Its purpose is to tighten the lower esophageal sphincter muscle.
• The stomach is tied in such a way as to prevent acid from flowing backward into the esophagus.
• This surgery is successful for most of the people.

The best and safest way to prevent reflux from occurring is to change the things that cause reflux. Gastroesophageal reflux disease symptoms usually can be prevented by simple lifestyle modifications in diet, activity, and habits. Watching what kinds of foods you eat and how much you eat can reduce your symptoms. Also, pay attention to your body position after eating. Don't lie down. Limit alcohol intake, quit smoking, and lose weight to improve not only your GERD symptoms but also your overall health.

Probably not. It depends how well lifestyle changes control your reflux.

Most cases of gastroesophageal reflux disease get better with lifestyle modifications, antacids, or prescription drugs. However, relapse is common when treatment is stopped.

What will happen if GERD is not treated?

• Serious complications, such as bleeding or difficulty swallowing, can occur, although they are rare.
• Other possible problems caused by acid back-up include inflammation of the esophagus (esophagitis), throat, voice box, and airways.
• If left untreated for years, it is possible but not proven that GERD can lead to Barrett's esophagus which can possibly lead to cancer of the esophagus.