Acid Reflux (GERD)

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Definition and Facts about Acid Reflux (GERD)

  • Acid reflux (GERD) is a condition in which acid backs up from the stomach into the esophagus and even up to the throat, irritating their lining tissues.
  • Acid reflux can be aggravated by many different things, including lifestyle, medication, diet, pregnancy, weight gain, and certain medical conditions.
  • Symptoms of acid reflux include heartburn, regurgitation of bitter acid into the throat, bitter taste in mouth, ches pain, dry cough, hoarseness, feeling of tightness in the throat, and wheezing.
  • Tests to diagnose acid reflux (GERD) include upper GI series (X-rays of the esophagus, stomach, and upper part of the intestine), an upper GI endoscopy, esophageal manometry, and a 24-hour pH probe study.
  • Home remedies for acid reflux include changes in lifestyle, diet, and habits.
  • Treatment of acid reflux includes over-the-counter (OTC) medications including antacids and H2-blockers; prescription medications such as proton pump inhibitors, coating agents, and promotility agents; and in severe cases, surgery.
  • Acid reflux can be prevented in some cases by changing the habits that cause the reflux including avoiding alcohol, not smoking, limiting fatty foods and other food triggers, maintaining a healthy body weight, and avoiding large meals within 3 hours of bedtime.
  • The prognosis for acid reflux (GERD) is good in mild to moderate cases. Chronic cases often respond to prescription drugs, and severe cases may require surgery to avoid serious complications.

What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The esophagus or food pipe is the tube stretching from the throat to the stomach. When food is swallowed, it travels down the esophagus.

The stomach produces hydrochloric acid after a meal to aid in the digestion of food.

  • The inner lining of the stomach resists corrosion by this acid. The cells lining the stomach secrete large amounts of protective mucus.
  • The lining of the esophagus does not share these resistant features and stomach acid can damage it.
  • The esophagus lies just behind the heart, so the term "heartburn" was coined to describe the sensation of acid burning the esophagus near where the heart is located.

Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid.

  • This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction.
  • With GERD, however, the sphincter relaxes between swallows, allowing stomach contents (gastric reflux) and corrosive acid to well up and damage the lining of the esophagus.

GERD affects about 20% of the US population. Not only adults are affected; even infants and children can have GERD.

What are Causes of Acid Reflux (GERD)?

There are many factors that influence the symptoms of GERD. The following are contributing factors that weaken or relax the lower esophageal sphincter, making gastric reflux worse:

  • Lifestyle: Use of alcohol or cigarettes, obesity, poor posture (slouching)
  • Medications: Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines
  • Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
  • Eating habits: Eating large meals, eating quickly or soon before bedtime
  • Other medical conditions: Hiatal hernia, pregnancy, diabetes, rapid weight gain

Hiatal hernia is a condition where the upper part of the stomach protrudes through the opening in the diaphragm where the esophagus passes through to its connection with the stomach. In this case, the upper part of the stomach is up above the diaphragm (the strong muscle that separates the organs of the chest from those of the abdomen).

  • Normally, the diaphragm acts as an additional barrier, helping the lower esophageal sphincter keep acid from backing up into the esophagus.
  • The cause of hiatal hernias is not clear, but it is possible that it can occur because of persistent coughing, vomiting, straining, or sudden physical exertion. Obesity and pregnancy can make the condition worse.
  • A hiatal hernia makes it easier for the acid to back up.
  • Hiatal hernia is very common in people older than 50 years of age and often is not associated with GERD.
  • Hiatal hernia usually requires no treatment. In rare cases when the hernia is large or becomes twisted, surgery may be required.

GERD (Acid Reflux) Treatment

GERD and Heartburn Medical Treatment

The medical treatment options are used to prevent complications and reduce morbidity associated with GERD, and they include antacids, H2 receptor antagonists, proton pump inhibitors, coating, and promotility agents. In addition to medications, the following lifestyle modifications below are recommended:

  • Instead of eating large meals, eat small meals more frequently.
  • Avoid caffeine-containing foods and beverages (for example, coffee, tea, soft drinks, chocolate)...

17 Symptoms of Acid Reflux (GERD)

Persistent heartburn is the most common symptom of GERD.

  • Heartburn is a burning pain in the center of the chest, behind the breastbone. It often starts in the upper abdomen and spreads up into the neck or throat.
  • The pain can last as long as 2 hours.
  • Heartburn is usually worse after eating.
  • Lying down or bending over can bring on heartburn or make it worse.
  • The pain usually does not start or get worse with physical activity.
  • Heartburn is sometimes referred to as acid indigestion.
  • Not everyone with GERD has heartburn.

Other symptoms of GERD include:

  • Regurgitation of bitter acid up into the throat while sleeping or bending over
  • Bitter taste in the mouth
  • Persistent dry cough
  • Hoarseness (especially in the morning)
  • Feeling of tightness in the throat, as if a piece of food is stuck there
  • Trouble swallowing
  • Sore throat
  • Wheezing
  • Nausea
  • Post-meal pain in the abdomen

The most common symptoms in children and infants are repeated vomiting, coughing, and other respiratory problems.

What Does Acid Reflux (GERD) Feel Like?

Acid reflux usually feels like a painful or burning sensation in your stomach, upper abdomen behind the breastbone, esophagus, and even up into your throat. You may have the feeling of a hot, acidic, or sour tasting fluid at the back of the throat or a sore throat.

It may feel like it's difficult to swallow or feel a tightness in the throat when you have heartburn, and it may feel as if food is stuck in your throat or esophagus.

You may have chest pain when lying down, bending over, or after eating. (See your doctor for any undiagnosed chest pain – do not assume you are experiencing heartburn until a doctor diagnoses it.)

What Does Acid Reflux (GERD) Look Like?

Heartburn occurs when stomach acid backs up into the esophagus.

Picture of Acid Reflux (GERD)
Picture of Acid Reflux (GERD)

Which Types of Doctors Treat Acid Reflux? When Should I See One?

Although many people can relieve their reflux disease symptoms by changes in their habits, diet, and lifestyle, others need to consult their health-care professional.

You can start with your family or general practitioner (primary care provider). You may be referred to a gastroenterologist, a specialist in disorders of the gastrointestinal (GI) tract. If your symptoms are severe and require surgery, you will be referred to a general surgeon. Certain diagnostic tests for GERD are done by a radiologist.

  • Call your health-care professional when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, are associated with respiratory problems, or are not relieved by self-care measures alone.
  • Make your health-care professional aware that you are using self-care measures or over-the-counter medications so that they can monitor how well they work and how often you need to use them.

If you have any of the following, go immediately to the emergency department where you will be seen by an emergency medical specialist:

  • Severe chest pain or pressure, especially if it radiates to your arm, neck, or back
  • Vomiting followed by severe chest pain
  • Vomiting blood
  • Dark, tarry stools
  • Difficulty swallowing
  • Shortness of breath

How is Acid Reflux (GERD) Diagnosed?

Your doctor usually can diagnose reflux disease by the symptoms you report.

  • Diet and lifestyle changes may be recommended first, and perhaps an over-the-counter antacid.
  • If symptoms continue more than 4 weeks despite this therapy the person may be referred to a gastroenterologist, which is a doctor who specializes in the gastrointestinal (GI) tract.

The gastroenterologist may perform an upper GI series.

  • This is a series of X-rays of the esophagus, stomach, and upper part of the intestine.
  • It is taken after you drink a contrast liquid that makes certain features show up better on the X-rays.
  • This series is sometimes called a barium swallow for one type of contrast liquid that is used and when the examination is limited to the esophagus.
  • This test gives less information than an upper GI endoscopy but is ordered to rule out other conditions such as ulcers or blockage of the esophagus. The upper GI series is sometimes skipped altogether.

The gastroenterologist may perform an upper GI endoscopy, also called esophagogastroduodenoscopy or EGD, a procedure that can be done as an outpatient.

  • You receive sedation then a flexible probe with a tiny camera on the end is passed down your throat. The camera allows the doctor to see damage to the esophagus, how severe the GERD is, and to rule out serious complications of GERD or unexpected diseases.
  • Your esophagus may appear normal if you have mild GERD.
  • This procedure allows the specialist to make diagnoses, assess damage, take biopsies if necessary, and even treat certain conditions on the spot.

Esophageal manometry is a test that measures the function of the lower esophageal sphincter and the motor function of the esophagus. A tube is passed down your throat until it reaches the esophagus. It is often performed along with 24-hour pH probe study.

In a 24-hour pH probe study, a thin tube is placed down into your esophagus for 24 hours. The tube monitors episodes of acid reflux over the day and while you sleep.

What Home Remedies Treat and Soothe Acid Reflux (GERD)?

For some people, acid reflux symptoms may be relieved by changing habits, diet, and lifestyle. The following steps may reduce reflux.

  • Don't eat within 3 hours of bedtime. This allows your stomach to empty and acid production to decrease.
  • Don't lie down right after eating at any time of day.
  • Elevate the head of your bed 6 inches with blocks. Gravity helps prevent reflux.
  • Don't eat large meals. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day.
  • Avoid fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomato-based foods. These foods decrease the competence of the lower esophageal sphincter (LES).
  • Avoid drinking alcohol. Alcohol increases the likelihood that acid from your stomach will back up.
  • Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux.
  • Lose excess weight. Overweight and obese people are much more likely to have bothersome reflux than people of healthy weight.
  • Stand upright or sit up straight, maintain good posture. This helps food and acid pass through the stomach instead of backing up into the esophagus.
  • Talk to your health-care professional about taking over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin), or medicines for osteoporosis. These can aggravate reflux in some people.

Talk to your health-care professional if you need tips on losing weight or quitting smoking.

Is There a Diet for Acid Reflux?

The diet for acid reflux (GERD) is one of elimination. People with GERD should avoid the following foods that may aggravate acid reflux

  • alcohol,
  • fatty or greasy foods,
  • chocolate,
  • onions and garlic,
  • caffeine,
  • mints or mint-flavored foods,
  • spicy foods,
  • citrus, and tomato-based foods, or
  • any foods that aggravate the symptoms.

In addition, being overweight can aggravate symptoms of acid reflux. Losing even 5 or 10 pounds may help relieve some of your GERD symptoms. Talk to your doctor about a diet plan to help you lose weight.

What Foods Aggravate Acid Reflux?

Certain foods may stimulate the production of stomach acid and may irritate the esophagus. Common foods that may cause heartburn include:

  • Onions and garlic
  • Chocolate
  • Alcohol
  • Fatty foods
  • Coffee (caffeinated and decaffeinated), tea, cola, energy drinks
  • Spicy foods
  • Tomato and citrus juices

Different people have different triggers. Your doctor may suggest you keep a food journal to find out what aggravates your acid reflux symptoms.

What Nonprescription (Over-The-Counter, OTC ) Medications Treat Acid Reflux?

Over-the-counter medications also may help relieve your symptoms. Check with your health-care professional before trying any of these.

Antacids (Gaviscon, Maalox, Mylanta, and Tums): These are effective when taken 1 hour after meals and at bedtime because they neutralize acid already present.

  • Some are combined with a foaming agent. Foam in the stomach helps prevent acid from backing up into the esophagus.
  • These agents are safe to use every day over a few weeks, but if taken over a longer period can cause side effects:
    • Diarrhea
    • Impaired metabolism of calcium in the body
    • Build-up of magnesium in the body, which can damage the kidneys
  • If you use these daily for more than 3 weeks, inform your health-care professional.

Histamine-2 receptor blockers (H2-blockers) prevent acid production.

If self-care and treatment with nonprescription medication does not work, your health-care professional likely will prescribe one of a class of stronger antacids. This therapy may be needed only for a short time or over a longer period while you make gradual changes in your lifestyle.

What Prescription Medications Treat Acid Reflux (GERD)?

These drugs use different mechanisms to reduce reflux.

Proton pump inhibitors (PPIs)

Coating agents

Sucralfate (Carafate) coats mucous membranes and sores to provide an additional protective barrier against stomach acid.

Promotility agents

  • Promotility agents include metoclopramide (Reglan, Clopra, Maxolon) and bethanechol (Duvoid, Urabeth, Urecholine).
  • They help tighten the lower esophageal sphincter and promote faster emptying of the stomach.
  • Health-care professionals often are reluctant to prescribe these medications because they have fairly significant side effects.
  • Promotility agents also do not work as well as PPIs for most people.
  • One of these agents, cisapride (Propulsid), has been removed from the U.S. market because of safety concerns related to drug interactions that could cause lethal cardiac conditions.

For best results, follow the advice of your health-care professional concerning medication and lifestyle.

Let your doctor what you are doing about your reflux disease and how well it is working.

Keep follow-up appointments. Your doctor may adjust your treatment at preset intervals of time or decide to refer you to a specialist if initial therapy fails.

Is There Surgery to Treat Acid Reflux (GERD)?

Surgery is never the first option for treating GERD. Changes in lifestyle, diet, and habits, nonprescription antacids, and prescription medications all must be tried before resorting to surgery. Only if all else fails is surgery recommended. Because lifestyle changes and medications work well in most people, surgery is done on only a small number of people.

The operation used most often for GERD is called fundoplication.

  • Fundoplication works by increasing pressure in the lower esophagus to keep acid from backing up.
  • The surgeon wraps part of your stomach around your esophagus like a collar and tacks it down to provide more of a one-way valve effect.
  • This procedure now can be done laparoscopically. The surgeon makes a couple of very small cuts in your belly and inserts long narrow instruments and a fiberoptic camera (laparoscope) through the slits. This method leaves little scarring and can produce a much faster recovery.
  • A newer procedure, the LINX procedure, works by placing a ring around the lower esophageal sphincter and is less invasive than a fundoplication.
  • Like all surgical procedures, fundoplication does not always work and can have complications.

Can Acid Reflux (GERD) be Prevented?

The best and safest way to prevent reflux disease from occurring is to change the things that cause reflux.

  • Maintain a healthy body weight.
  • Avoid large meals and eating within 3 hours of bedtime.
  • Limit fatty or greasy foods, chocolate, caffeine, and other irritating foods.
  • Avoid alcohol.
  • Stop smoking.
  • Maintain good posture, especially while seated.
  • Avoid working out, bending, or stooping on a full stomach.

What is the Prognosis for a Person with Acid Reflux (GERD)?

Reflux disease (GERD) is treatable, but relapses are common, especially if you do not change your lifestyle.

  • For people with mild-to-moderate disease, home care and H2-blockers are generally effective.
  • Severe esophagitis usually requires PPI therapy.
  • If relapses occur, long-term therapy or surgery will be necessary to avoid complications.

Complications of acid reflux can include any of the following. Most of these are rare, but GERD can be the first step toward any of them. The best treatment for any of these is prevention.

  • Esophagitis and esophageal ulcers: Inflammation, irritation of the lining of the esophagus
  • Laryngopharyngeal reflux: When acid from the stomach gets into the throat, the voice becomes hoarse.
  • Bleeding: Due to ulcers in the damaged esophageal lining
  • Strictures: Narrowing of the esophagus due to chronic scarring
  • Swallowing problems: Due to strictures
  • Respiratory problems including asthma: When acid from the stomach gets into the breathing passages
  • Barrett's esophagus: Changes in the cells lining the esophagus, a precancerous condition
  • Cancer of the esophagus: Has a very low incidence rate
Reviewed on 1/25/2018

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

NIH. Digestive Diseases Statistics for the United States. Nov 2014.
<https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases>

Patti, MG, MD. "Gastroesophageal Reflux Disease." Medscape. Updated: Oct 17, 2017.
<https://emedicine.medscape.com/article/176595-overview>

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