Gastroesophageal Reflux Disease - GERD - What is Acid Reflux

What Causes GERD?

Under normal conditions, when you eat and drink, the muscle at the bottom of your esophagus closes off so food and liquids will remain in your stomach. This muscle is the lower esophageal sphincter (LES).

However, GERD occurs chiefly because of the following three reasons: The esophagus's normal defenses are overwhelmed by the acid content of the stomach, the contents of the stomach are too acidic, or the food is not cleared from the esophagus fast enough.

When "refluxed" stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even reach the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

For some patients, GERD can cause erosive esophagitis, a condition that causes inflammation, swelling, or irritation of the esophagus. More than half of GERD patients, however, have a non-erosive type of GERD. With the non-erosive form of GERD, referred to as Nonerosive Reflux Disease (NERD), patients experience typical GERD symptoms caused by acid reflux, but they do not have visible esophageal injury.

There is a group of patients who continue to have symptoms of gastroesophageal reflux despite a standard treatment with proton pump inhibitors (PPIs).

They have what is known as Refractory Gastroesophageal Reflux Disease (Refractory GERD). Patients who experience refractory GERD usually fall into one of two groups: Those who need more aggressive treatment, and those who have other causes of their reflux symptoms.

Only a small percentage of patients will need the tests described below. The majority of doctors will prescribe a trial of acid-suppressive therapy, and make a diagnosis based on the patient's response to this.

If a doctor decides to order a diagnostic test, it may be one of the procedures below.

Upper Endoscopy
The upper endoscopy (also known as esophagogastroduodenoscopy or EGD) allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum (the first part of the small intestine) with an instrument called an endoscope, a thin flexible lighted tube.

The doctor will be able to see the walls and tissue of the upper digestive tract. During this procedure, a doctor may take a biopsy to see if there are any changes to the lining of the esophagus that may require further monitoring

24-hour Esophageal PH Monitor Examination
This procedure is done with a thin, plastic tube with a sensor that measures the amount of acid backing up into the esophagus. It is the most sensitive test for diagnosing GERD. The doctor inserts a tube through the nose, and the patient swallows it until it enters the esophagus. The tube is attached to a Walkman-size box that measures how often and for how long stomach acid reaches the esophagus in a 24-hour period. During this time, a patient will keep a record of symptoms. The data from the monitor is analyzed to determine the frequency of reflux, and the association of those reflux episodes to patient symptoms. The pH monitoring is particularly useful for people with ongoing symptoms who fail a trial of acid-suppressive therapy and who have a normal endoscopy exam.

Barium X-rays
Barium x-rays are diagnostic x-rays in which barium is used to diagnose abnormalities of the digestive tract. The patient drinks a liquid that contains barium, which will coat the walls of the esophagus and stomach. X-rays are then taken, which can then show if there are strictures, ulcers, hiatal hernias, erosions or other abnormalities.

This test will sometimes show how efficiently the esophagus empties. Since this test is not very useful for diagnosing reflux, it may only be used in conjunction with other testing.

Esophageal Manometry
Manometry is a technique that records muscular pressure. A small tube is guided through the patient's nose and into the esophagus. A computer connected to the sensor on the tube will measure the muscular pressure in the esophagus and stomach. It can determine if the lower esophageal sphincter is functioning properly.

Both the barium x-rays and manometry exams have limited usefulness in diagnosing GERD, but if a patient has certain symptoms, particularly difficulty swallowing, a doctor may recommend one.

Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes

Avoid reflux producing foods
These foods include:
  • Fried foods
  • Fatty foods
  • Citrus fruits
  • Tomato products
  • Caffeine
  • Alcoholic beverages
  • Citrus fruit drinks
  • Chocolate
  • Peppermint
  • Pepper

If you smoke, stop.
Smoking inhibits the production of saliva. Saliva is one of your body's defenses against damage to the esophagus.

Saliva also aids in neutralizing refluxed acid. Smoking also stimulates the production of stomach acid, and can weaken and relax the lower esophageal sphincter (LES).

Do not drink alcohol.
Alcohol increases the production of stomach acid, relaxes the lower esophageal sphincter, allowing stomach contents to reflux back up into the esophagus, and can make the esophagus more sensitive to stomach acid.

Lose weight if needed.
Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. Losing weight may help reduce acid reflux.

Eat small meals.
Large meals expand your stomach and increase upward pressure against the esophageal sphincter.

Wear loose-fitting clothes.
Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

Avoid lying down for 3 hours after a meal.
Gravity helps to keep the stomach juices from backing up into the esophagus. Lying down with a full stomach makes reflux more likely.

Raise the head of your bed
With the head higher than the stomach, gravity helps reduce this pressure. You can elevate your head in a couple of ways.

You can place bricks, blocks or anything that's sturdy securely under the legs at the head of your bed to raise it 6 to 8 inches. A foam wedge under the mattress can also be used. You can also use a wedge pillow to elevate your shoulders and head.


Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Tums, Rolaids, and Riopan are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts--magnesium, calcium, and aluminum--with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.

H2 blockers, such as Tagamet (cimetidine), Pepcid (famotidine), Axid (nizatidine), and Zantac (ranitidine), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor. H2 blockers shouldn't be used for more than a few weeks at a time without evaluation by a doctor.

Proton pump inhibitors include Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Aciphex (rabeprazole), and Nexium (esomeprazole), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD. Prilosec is available in an over-the-counter form (Prilosec OTC). Proton pump inhibitors shouldn't be used for more than a few weeks at a time without evaluation by a doctor.

For more information on these and other medications, please see Drugs A-Z.

Surgical Options

Fundoplication Surgery
Fundoplication is the standard surgical treatment for GERD. The purpose of the surgery is to reduce heartburn caused by acid reflux.

Radiofrequency Treatment for GERD
Radiofrequency treatment is a minimally invasive endoscopic procedure that is performed on an outpatient basis. It is used to treat gastroesophageal reflux disease (GERD).

Most patients with GERD will not develop serious complications if they receive adequate treatment. However, there are serious complications that can occur in patients with severe GERD.

Barrett's Esophagus
Barrett's esophagus is a condition in which the esophagus, the muscular tube that carries food and saliva from the mouth to the stomach, changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine.

A small percentage of people with longstanding GERD will develop Barrett's esophagus, and a smaller percentage of those people will go on to develop a certain type of esophageal cancer.

Esophageal Cancer
Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. There is an association between gastroesophageal reflux disease (GERD) and the adenocarcinoma type of esophageal cancer. If a patient has Barrett's esophagus, a doctor will want to do an endoscopy periodically to screen for changes.

Erosive Esophagitis
Esophagitis is an inflammation and swelling of the esophagus, and is most often caused by acid-containing stomach contents refluxing back up into the esophagus.

Esophageal Strictures
An esophageal stricture is a gradual narrowing of the esophagus, which can lead to swallowing difficulties.

Points to Remember About GERD

  • Heartburn, also called acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD.
  • You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth or pain in the chest.
  • If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most doctors can treat GERD. Or you may want to visit an internist--a doctor who specializes in internal medicine--or a gastroenterologist--a doctor who treats diseases of the stomach and intestines.
  • Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.


"Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)." NIH Publication No. 03–0882 June 2003. National Digestive Diseases Information Clearinghouse. Accessed on 14 Oct 2006 <>.

Peter J Kahrilas, MD, Anne Charette, RN, MSN, ANP. Patient information: Gastroesophageal reflux disease. 2006. 14 Oct 2006 <>. Accessed on October 14, 2006.

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