GERD, in which stomach acid moves into the esophagus, causes discomfort and may lead to precancerous changes in the lining of the esophagus.
Gastroesophageal reflux disease (GERD) occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.
Many people experience acid reflux from time to time. However, when acid reflux happens repeatedly over time, it can cause GERD.
Most people are able to manage the discomfort of GERD with lifestyle changes and medications. And though it's uncommon, some may need surgery to ease symptoms.
Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. Frequent or constant reflux can lead to GERD.
Common signs and symptoms of GERD include:
If you have nighttime acid reflux, you might also experience:
Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.
Make an appointment with your doctor if you:
GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach.
When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.
If the sphincter does not relax as it should or it weakens, stomach acid can flow back into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.
Conditions that can increase your risk of GERD include:
Factors that can aggravate acid reflux include:
A hiatal hernia occurs when the upper part of your stomach bulges through your diaphragm into your chest cavity.
Over time, chronic inflammation in your esophagus can cause:
Your health care provider might be able to diagnose GERD based on a history of your signs and symptoms and a physical examination.
To confirm a diagnosis of GERD, or to check for complications, your doctor might recommend:
Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope helps your provider see inside your esophagus and stomach. Test results may not show problems when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications.
An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett esophagus. In some instances, if a narrowing is seen in the esophagus, it can be stretched or dilated during this procedure. This is done to improve trouble swallowing (dysphagia).
Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder.
The monitor might be a thin, flexible tube (catheter) that's threaded through your nose into your esophagus. Or it might be a clip that's placed in your esophagus during an endoscopy. The clip passes into your stool after about two days.
X-ray of the upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus and stomach. This is particularly useful for people who are having trouble swallowing.
You may also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.
An upper endoscopy procedure involves inserting a long, flexible tube called an endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope allows views of your esophagus, stomach and the beginning of your small intestine, called the duodenum.
Your doctor is likely to recommend that you first try lifestyle changes and nonprescription medications. If you don't experience relief within a few weeks, your doctor might recommend prescription medication and additional testing.
If you start taking a nonprescription medication for GERD, be sure to inform your doctor.
Prescription-strength treatments for GERD include:
Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
Although generally well tolerated, these medications might cause diarrhea, headaches, nausea, or in rare instances, low vitamin B-12 or magnesium levels.
GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend:
Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth by using an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance.
If you have a large hiatal hernia, TIF alone is not an option. However, TIF may be possible if it is combined with laparoscopic hiatal hernia repair.
Because obesity can be a risk factor for GERD, your health care provider could suggest weight-loss surgery as an option for treatment. Talk with your provider to find out if you're a candidate for this type of surgery.
Surgery for GERD may involve a procedure to reinforce the lower esophageal sphincter. The procedure is called Nissen fundoplication. In this procedure, the surgeon wraps the top of the stomach around the lower esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus.
Lifestyle changes may help reduce the frequency of acid reflux. Try to:
Some complementary and alternative therapies, such as ginger, chamomile and slippery elm, may be recommended to treat GERD. However, none have been proved to treat GERD or reverse damage to the esophagus. Talk to your health care provider if you're considering taking alternative therapies to treat GERD.
You may be referred to a doctor who specializes in the digestive system (gastroenterologist).
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime you don't understand something.
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked: