Your Guide to GERD

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach. 

What is GERD?

Mature man suffering from a sore throat
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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 be tasted in 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.

Anyone, including infants, children, and pregnant women, can have GERD.

What Causes GERD

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD

  • alcohol use
  • overweight
  • pregnancy
  • smoking

Foods can be associated with reflux events, including:

  • citrus fruits
  • chocolate
  • drinks with caffeine
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, chili, and pizza

Symptoms of GERD

Symptoms of GERD include:

  • Persistent heartburn and acid regurgitation.
  • These are the main symptoms GERD, though some people have GERD without heartburn. Symptoms of heartburn include:
  • A burning feeling starts in the chest just behind the breastbone (the sternum) that occurs after eating and can last a few minutes to several hours
  • Lying down and bending over often makes symptoms worse.
  • Symptoms are often made worse by eating food
  • Burning in the throat
  • Sour or bitter taste in the mouth
  • Swallowing can be difficult
  • Belching
  • Chronic coughing
  • Hoarseness
  • Loss of voice for no apparent reason
  • Wheezing or other asthma-like symptoms
  • An antacid usually provides relief
  • If an infant spits up or throws up almost every time he eats and seems fussy, the infant may have gastric reflux
  • Symptoms of heartburn are often mistaken for signs of a heart attack. Pain from a heart condition is usually made worse by physical activity, but heartburn is not usually caused by physical activity. However, if you think you are having a heart attack, or you're not sure, it's important that you go to the emergency room immediately.
  • Pain in the chest
  • Hoarseness in the morning
  • Trouble swallowing
  • May feel like food is stuck in the throat
  • Choking sensation
  • Persistent dry cough
  • Bad breath

Diagnosing GERD

The following tests are routinely performed when trying to diagnose GERD.

A barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x-rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus--called stricture--ulcers, hiatal hernia, and other problems will.

Upper endoscopy is performed in a hospital or a doctor's office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.

In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

Treating GERD

Lifestyle Changes to Control GERD

  • If you smoke, stop.
  • Do not drink alcohol.
  • Lose weight if needed.
  • Eat small meals.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts--just using extra pillows will not help.

Medications 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 Mylanta and Tums are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms.

H2 blockers, such as Tagamet HB (cimetidine), Pepcid AC (famotidine), Axid AR (nizatidine), and Zantac 75 (ranitidine), impede acid production. They are available in prescription strength and over the counter. They are effective for about half of those who have GERD symptoms.

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 have been shown to relieve symptoms in most people who has GERD.

If Symptoms Persist

If symptoms do not improve with lifestyle changes and medications, your doctor may consider surgery. Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

Complications of Long-standing GERD

Long-standing heartburn, especially if it isn't properly treated, may lead to complications. These complications include:

  • Barrett's Esophagus
    Studies have shown a link between Gastroesophageal Reflux Disease and Barrett's esophagus which, in turn, may lead to a relatively rare but often deadly type of cancer called esophageal adenocarcinoma.
  • Esophageal Cancer
    Those individuals with Gastroesophageal Reflux Disease and Barrett's esophagus are at a higher risk of developing esophageal cancer. Esophageal adenocarcinoma is the fastest growing cancer in the western world.
  • Erosive Esophagitis
    Esophagitis is an inflammation and swelling of the lining of the esophagus. It is most often caused by gastroesophageal reflux disease (heartburn).
  • Esophageal Strictures
    An esophageal stricture is a narrowing of the esophagus. It occurs when scar tissue builds up in the esophagus. Since the esophagus isn't designed to handle refluxed stomach contents, so if the reflux is chronic, scar tissue may form and lead to a stricture.

There are, however, six steps you can take that can drastically reduce your chances of developing one of these complications.

  • Make the necessary lifestyle changes
  • Watch what you eat
  • Keep track of your heartburn triggers
  • Learn how to prevent heartburn before it happens
  • Reduce nighttime heartburn
  • Take prescribed medications

For detailed information on these preventative steps, please read 6 Steps To Preventing Heartburn-related Complications

Good Foods / Bad Foods

You need to know what foods are safe, and avoid the foods that can trigger your heartburn. You need to know how to prepare your foods to avoid heartburn-triggering ingredients.

Safe Foods For Heartburn Sufferers
The foods listed in this table are the most common foods that are usually pretty safe for heartburn sufferers to eat.

Foods Okay In Moderation
The foods listed in this table are foods that you may be able to enjoy occasionally, in moderation.

Foods To Avoid
The foods listed in this table are the most common foods that can produce heartburn.

Recipes For Heartburn Sufferers
These recipes that will help heartburn-sufferers prepare food that will aide in good digestion. It isn't just the foods you select that help you with the heartburn. It is also important how the foods are prepared. Categories of recipes include:

Meal Plans For Heartburn Sufferers

Weekly Menus - Index
These charts are arranged Sunday through Saturday. These are suggestions only, and not the only foods you may be able to eat. You can add or subtract foods according to your preferences and what may or may not be your heartburn triggers.

Living with GERD

Eat 6 small meals instead of 3 big meals.
This keeps your stomach from getting too full, and reduce gastric pressure.

Don't eat or drink anything for at least 2 hours before going to bed.
Lying down with a full stomach increases the chances of refluxed food.

Avoid foods that can trigger your heartburn.
There are several foods and beverages that can trigger your heartburn, either by increasing acid production and gastric pressure or by loosening the lower sphincter muscle.

Avoid alcohol.
Alcohol increases the production of stomach acid. Alcohol also relaxes the lower esophageal sphincter (LES), which allows acid reflux.

Use an antacid.
Antacids will work very quickly on heartburn. Your doctor may suggest taking a H2 blocker, which works up to 12 hours. Since they take an hour or so to begin working, your doctor may suggest taking a H2 blocker in combination with an antacid. If you don't find relief from these, your doctor may prescribe a proton pump inhibitors.

Sleep with your head and shoulders elevated.
With the head higher than the stomach, gravity helps reduce this pressure, and keeps stomach contents where they belong--in the stomach.

Don't smoke.
Smoking stimulates the production of stomach acid.

While stress hasn't been linked directly to heartburn, it is known that it can lead to behaviors that can trigger heartburn. Follow these relaxation tips to alleviate stress.