GERD (Gastroesophageal Reflex Disease)

GERD often happens because of a faulty muscle at the bottom of the esophagus called the lower esophageal sphincter (LES).

Let’s say you’re fixin’ to eat a fully dressed po-boy. Normally, when you swallow a bite, it goes down your esophagus. Your LES relaxes, so the food flows into your stomach, where acid breaks it down more. Then the LES valve closes, so food stays in the stomach.

If your LES relaxes too often or for too long, acid from your stomach can flow back up into your esophagus, causing heartburn and sometimes other damage. The problem with the backflow of acid is that the esophagus doesn’t have the same protective lining as the stomach. So, the acid can damage the esophagus.

Some conditions and lifestyles can weaken the LES valve, increasing your risk for GERD. You may have a higher risk of GERD if you:

• Are overweight
• Are pregnant
• Drink alcohol or beverages with caffeine, such as coffee
• Eat too much, especially citrus, chocolate and fatty or spicy foods
• Have diabetes
• Smoke or are around a lot of secondhand smoke
• Take aspirin and over-the-counter pain and fever medicines or medicines to treat high blood pressure and heart conditions

Note: A risk factor is anything that affects your chance of getting a disease. Having one or more risk factors doesn’t guarantee you’ll get the disease. And some people who get a disease may not have any of the risk factors. This list is not a complete list of all risk factors for GERD, so talk to your doctor if you have concerns about your risk.

See if you’re at risk for GERD

Heartburn, also called acid indigestion or acid reflux, is the most common symptom of GERD. However, heartburn isn’t a symptom of GERD for most children younger than 12 and for some adults. Other GERD symptoms may include:

• Asthma symptoms
• Dry cough
• Feeling like there’s a lump in the throat
• Regurgitation of food (when swallowed, food comes back to the mouth)
• Stomach or chest pain
• Trouble swallowing (dysphagia)

If you think you may have GERD, your doctor may refer you to a gastroenterologist. A gastroenterologist is a doctor who specializes in gastrointestinal (GI) conditions.

A gastroenterologist will give you a physical exam and ask about your health history. If you have typical GERD symptoms, you may receive treatment without other testing.

Tests for GERD can include:

• Barium swallow (upper GI series): You swallow a metallic fluid called barium. It coats your organs, so they show up on an X-ray. This test specifically looks at the top part of your digestive system, including the esophagus, stomach and top of the small intestine.
• Upper endoscopy (esophagogastroduodenoscopy): A thin tube with a light and camera at the end (the endoscope) goes into your mouth or nose and throat while you are sedated. It helps your provider see inside your esophagus, stomach and small intestine on a larger screen. They can also take a small sample of a tissue for testing if needed.
• Bernstein test: This test is rare, but it can help test the amount of acid in your esophagus. Your provider will drip a mild acid through a tube placed in your esophagus to see if it causes symptoms.
• Esophageal manometry: This test measures the pH (acid) levels in your esophagus. You may have a small tube put in your nostril. It has a sensor that measures the pH levels in your esophagus for 24 to 48 hours. Or, you may have a small capsule attached to the lining of the esophagus. It sends pH data wirelessly to a receiver. With both methods, you can do your normal daily activities.
• Impedance testing: This test can be done with pH monitoring tests. It can see acid reflux, along with nonacid liquid and air.

GERD treatments depend on your symptoms, age and overall health. Your provider often will recommend lifestyle changes and over-the-counter medicine first. If these methods don’t improve your symptoms, you may need more testing and advanced treatments.

Here are a few diet and lifestyle changes that can help with GERD:

• Avoid eating or drinking foods and drinks that are more likely to cause reflux:
  • Alcohol
  • Chocolate
  • Citrus fruit and juices
  • Drinks with caffeine, such as coffee, soda and energy drinks
  • Fried and fatty foods
  • Peppermint
  • Tomato products
• Eat smaller amounts of food and chew your food well before swallowing
• Keep a healthy weight
• Quit smoking
• Wait a few hours after eating before you lie down or go to bed (it also may help to use a wedge pillow or to adjust your bed, so your chest and head are raised above your stomach)

There are some over-the-counter medicines that may help with GERD symptoms:

• Antacids that offer quick heartburn relief, such as Rolaids and Tums
• H2-blockers and proton pump inhibitors that decrease how much acid your body makes. Examples include Pepcid AC, Axid HR and Tagamet HB.
• Proton pump inhibitors that block acid production to heal the esophagus. Examples include Prevacid 24 HR, Priolsec OTC and Nexium 24 HR.

Note: You should always tell your doctor if you take any medicine to treat GERD.

Your provider may prescribe stronger medications to help with GERD. But if medication doesn’t help, your provider may suggest surgery or other procedures. Examples include:

• Fundoplication: Helps keep the esophagus in the right place and stop the backward flow of acid. The surgeon tightens the LES, usually with a minimally invasive procedure.
• LINX device: Wraps a ring of tiny magnetic beads around the LES. It helps keep the LES closed but also allows food to pass through. The procedure is usually minimally invasive.
• Transoral incisionless fundoplication: This type of fundoplication happens through the mouth with an endoscope, meaning you don’t need an incision.