Gastroesophageal Reflux Disease—Overview
(Chronic Heartburn; Gastro-oesophageal Reflux Disease [GORD]; GERD; Reflux)
Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. The pain is often worse after eating, in the evening, or when lying down or bending over.
Heartburn that happens often and gets in the way of daily life may be gastroesophageal reflux disease (GERD). It can harm the esophagus. GERD can also cause Barretts esophagus, which is a change in the cells that can lead to cancer.
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A ring of muscle controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not fully close, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are many reasons that the ring may not close tightly, including:
- Problems with the nerves that control the muscles of the ring
- Problems with muscle tone of the ring
- Muscles that move food down into the stomach are weak
- Abnormal pressure on the area
- The muscles relax more than they should
- More pressure within the belly that pushes up against the stomach
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Things that may raise the risk of heartburn or GERD include:
- Alcohol use
- Exercising or intense activity right after eating
- Lying down, bending over, or straining after eating
- Past surgery for heartburn
- Certain nervous system disorders
- In-dwelling nasogastric tube
Foods and drinks that are more likely to cause symptoms include:
- Caffeinated products
- Carbonated drinks
- Citrus fruits
- Fried foods
- Spicy foods
- Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
- Large or fatty meals
Medicines and supplements that can cause symptoms may include:
- Calcium channel blockers
- Theophylline, bronchial inhalers, and other asthma medications
Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.
Common symptoms may include:
- Burning feeling that starts in the lower chest and moves up the throat—most common symptom
- Regurgitation—a feeling that food is coming back up
- Sour or bitter taste in the throat
The repeated, regular episodes can lead to other symptoms such as:
- Sore throat
- Chronic laryngitis
- Chronic cough
- Feeling of a lump in the throat
- Waking up with a feeling of choking
- Problems swallowing
Problems that GERD can cause after a long time may include:
- Swelling and scarring of the esophagus—esophagitis
- Bleeding and ulcers in the esophagus
- Narrowing of the esophagus— esophageal stricture
- Dental problems, which may happen because stomach acid harms tooth enamel
- Asthma attacks
- Vomiting blood
- Black or tarry stools
- Precancerous condition that can lead to esophageal cancer— Barrett esophagus
- Esophageal cancer
The doctor will ask about symptoms and past health. Heartburn or GERD will be suspected based on symptoms. The doctor may do a trial with medicine. If the symptoms are managed with medicine it will confirm GERD.
More testing is not always needed. To better plan treatment the doctor may order:
- Upper GI series
- 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
- Manometry to test muscle strength in the lower esophagus
The goals of treatment are to prevent more symptoms and heal any damage. How this is done will depend the cause of the heartburn. Some options are:
There are no current guidelines to prevent GERD.
When Should I Call My Doctor?
People who have heartburn two or more times a week, every week, should make an appointment to see their doctor.
- Acid reflux (GER & GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults.
- Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.dynamed.com/condition/gastroesophageal-reflux-disease-GERD.
- Heartburn. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/heartburn.
- Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp#.WsUYIy7wZQJ.
- 4/25/2014 DynaMed Systematic Literature Surveillance http://www.dynamed.com/condition/gastroesophageal-reflux-disease-GERD: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One, 2013; 8 (6): e65996.
- Nicole S. Meregian, PA
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