Gastroesophageal Reflux Disease (GERD) and Acid Reflux Overview

Gastroesophageal Reflux Disease (GERD) and Acid Reflux Overview

What Is GERD? What Is Acid Reflux?

Gastroesophageal reflux or acid reflux is the flow of stomach contents back into your esophagus. Occasional reflux is common, but with gastroesophageal reflux disease (GERD), it lasts longer and irritates your esophagus.

A person with gastroesophageal reflux disease (GERD) has a problem with the connection between the esophagus and stomach. It includes a poorly functioning lower esophageal sphincter, the circular muscle between the esophagus and the stomach. The changes allow stomach content to move into the esophagus causing heartburn and regurgitation.

Relaxation of the esophageal sphincter is a normal part of digestion. It occurs when your stomach is full and allows for burping or belching. However, continued relaxation of the sphincter causes GERD symptoms.

Another contributor to GERD is a sliding hiatal hernia - when the top part of the stomach slides into the chest cavity through a weakened diaphragm.

What Are The Risk Factors?

Two of the most common risk factors for GERD are extra body weight and smoking. Having family members with a history of GERD is another risk factor.

Although certain foods and alcohol may worsen your GERD symptoms, neither actually increases the chance of developing GERD.

What Are The Symptoms?

The main symptoms of GERD are ongoing heartburn and regurgitation.

  • Heartburn is described as pain or burning in the chest, particularly under the breastbone (sternum).

  • Regurgitation is characterized by a sour taste in the mouth and a feeling of food or fluid moving up and down in the esophagus.

Additional symptoms may include upper abdominal pain, chest pain, nausea, bloating, sore throat, cough, and hoarse voice.

Symptoms often worsen when you’re lying down, especially after eating.

How Is It Diagnosed?

Your doctor will most likely make a diagnosis of GERD based on your prolonged heartburn and regurgitation symptoms, but first, they might exclude heart-related causes of chest pain.

Your doctor may try a course of medicine to relieve your GERD symptoms - if your symptoms improve, it helps to confirm the diagnosis.

Except in certain circumstances (e.g. symptoms don’t go away with usual treatment), diagnostic tests are not usually needed.

How Is It Treated?

GERD treatment includes lifestyle changes, medicines, supplements, and rarely surgery.

Lifestyle Changes

Lifestyle changes include managing your weight, stopping tobacco use, elevating your upper body while sleeping, and waiting at least 2 to 3 hours after eating before going to bed. You may also make changes to your diet by determining and avoiding foods that worsen your symptoms.

Medicines

Proton pump inhibitors (PPIs)

PPIs are the first choice of treatment for GERD. PPIs decrease secretion of stomach (gastric) acid and are approved for the short-term treatment of GERD. There are both prescription and over-the-counter (OTC) PPIs.

  • OTC PPIs: omeprazole (Prilosec OTC), esomeprazole (Nexium), lansoprazole (Prevacid)

  • Prescription PPIs: rabeprazole (Aciphex) and pantoprazole (Protonix)

Histamine Type-2 Receptor Antagonists (H2 Blockers)

H2 blockers also decrease secretion of stomach acid and are used to treat GERD. They take effect more quickly and work well for some people. They are ideal for use before meals at high risk of causing heartburn. PPIs are the preferred choice for long-term use.

  • H2 blockers include cimetidine (Tagamet HB) and famotidine (Pepcid).

Antacids

Antacids suppress and neutralize gastric acids. They don’t prevent GERD symptoms, however, they do relieve symptoms in some people. The different antacids are combinations of various compounds and salts of calcium, magnesium, and aluminum.

  • Examples of antacids include: magnesium hydroxide (Milk of Magnesia), aluminum hydroxide/magnesium trisilicate (Gaviscon), aluminum hydroxide/magnesium hydroxide (Maalox).

Supplements

Some herbal supplements and teas provide relief from GERD symptoms. Examples are:

  • Iberogast/STW 5, a product that is a combination of nine herbs.

  • D. Licorice (glycyrrhiza glabra)

  • Marshmallow (althaea officinalis)

  • Another is chamomile tea which helps lessen many gastrointestinal symptoms.

Surgery

Surgical treatment is recommended only in certain individuals with chronic GERD/GORD. You can discuss this and other treatment options with your doctor.

When Should You See Your Doctor?

You should contact your doctor if your GERD symptoms worsen or don’t go away. You should also see your doctor if you have any of the following with your GERD symptoms:

  • Long-term GERD that is not responding to treatment

  • Trouble (difficulty) or pain with swallowing

  • Recurrent vomiting

  • Weight loss

  • Gastrointestinal bleeding (e.g. blood in stool, black stool)

  • Iron deficiency anemia without known cause

For More Information

American Gastroenterological Association (2020). Gastroesophageal Reflux Disease (GERD). Retrieved 3-12-2021 from https://gastro.org/practice-guidance/gi-patient-center/topic/gastroesophageal-reflux-disease-gerd/ National Institute of Diabetes and Digestive and Kidney Disease (2020). Acid Reflux (GER & GERD) in Adults. Retrieved 3-12-2021 from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults