Gastroesophageal Reflux Disease

An In-Depth look at Gastroesophageal Reflux Disease

Gastroesophageal reflux, also known as GERD, is a disorder of the digestive system that involves the esophagus. GERD occurs when digestive enzymes in the stomach move back into the esophagus. This “reflux” causes inflammation in the esophageal lining and leads to heartburn and other symptoms. If left untreated, GERD can cause permanent damage in the esophagus.

The esophageal sphincter is a muscular structure located between the esophagus and the stomach.

The structure opens when food is swallowed and closes tightly to keep food and digestive juices from backing up into the esophagus. Individuals with GERD have a sphincter that does not close tightly, so it allows food and acid to flow backwards and irritate the esophagus. There are many factors that can loosen the esophageal sphincter and these include smoking, alcohol, pregnancy, medications, a hernia that bulges above the diaphragm, and certain foods. If the esophagus continues to be irritated by acids, it may become narrow and inflamed and develop open sores. Long-term acid irritation can also cause a condition called Barrett’s esophagus, which increases the risk of esophageal cancer. Many people with GERD have frequent or daily heartburn.


Heartburn is the most common symptoms associated with GERD and is characterized as burning pain behind the breastbone. Heartburn tends to worsen after meals, when bent over, or when lying down.

Tightness in the chest, nausea, regurgitation, and a recurring bitter taste inside the mouth are commonly associated symptoms of heartburn. Other associated symptoms include sore throat, coughing, hoarseness and difficulty swallowing.


A doctor can diagnose GERD by inquiring about symptoms and reviewing medications that may potentially cause the discomfort.

The doctor will ask about the frequency of symptoms, especially heartburn. He or she will also be interested in what aggravates and alleviates the symptoms. Muscle relaxants, antihistamines and medications for asthma, anxiety, blood pressure and migraines are among the many drugs that could cause the lower esophageal sphincter to weaken. The doctor will want to run tests to ensure that the chest pain is not a symptom of a more serious heart condition such as coronary artery disease.


If mild heartburn is the only complaint, the doctor may suggest over the counter medications; lifestyle changes and prescription medications may not be necessary. If the symptoms are more serious, then further testing will be required. Serious symptoms include weight loss, difficulty swallowing, and painful, long-lasting heartburn. An endoscopy is the best test to diagnose GERD. Endoscopies involve inserting a tube that goes through the mouth and into the throat in order to look at the esophagus. The doctor, usually a gastroenterology specialist, may take a sample of esophageal tissue to be inspected in the lab.

Further testing may be necessary in order to diagnose GERD. A barium swallow is an x-ray that outlines the esophagus, usually performed to check for damage. Esophageal motility studies can also be performed to observe the squeezing motion of the esophagus when swallowing. pH monitoring of the esophagus is also an option, and this measures the acid level within the esophagus using electrodes.

GERD is generally a long lasting issue if it goes untreated. Once treatment begins, symptoms can clear up within a matter of days, but it often takes several weeks. Often, people with reflux will continue to have symptoms even with the daily use of medication.

Simple lifestyle changes can prevent symptoms of GERD. These include:

-Elevating the head at least six inches when laying down

-Avoid ingesting foods that cause the sphincter to relax during digestion such as coffee, chocolate, fatty foods and peppermint

-Limit the intake of acidic foods

-Avoid carbonated beverages

-Do not eat three hours before going to bed

-Do not smoke

-Avoid tight-fitting clothing that increase pressure on the stomach as this can open the sphincter

Acid buffers are effective in neutralizing acid and are available over the counter. These medications work quickly and in the short-term, but they do not heal esophageal inflammation. However, over the counter H2 blockers are available, and these work by causing the stomach to produce less acid. Over the counter pump inhibitors turn off the stomach’s acid production and are especially helpful for individuals who do not respond to the acid buffers or H2 blockers. Prescription H2 blockers are also available in higher doses. Other treatments include motility medication that the doctor can prescribe to help the stomach empty faster. If symptoms of GERD are difficult to control, or if an individual also has asthma or scar tissue within the esophagus, surgery may be necessary.

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