Gastroesophageal Reflux Disease (GERD): What is it?
Many people have a little heartburn now and then, but if it happens often and is paired with regurgitation, you may have gastroesophageal reflux disease (GERD). GERD is a chronic disorder of the digestive system caused by the lower esophageal sphincter (LES) not closing properly, allowing stomach acid into your esophagus, causing inflammation and in some cases, tooth erosion.
In some cases, GERD may be a result of another issue, such as a hiatal hernia or a tumor. Around 20 percent of people living in the United States are estimated to be affected by GERD and it can affect people of all ages. Thankfully, most people are able to control their symptoms with lifestyle changes and/or medications.
The chief symptom of GERD is heartburn, a burning sensation located beneath the breastbone, often radiating up toward the throat. Not everyone with GERD has heartburn. Regurgitation is a more severe form in which stomach acid reaches the back of the throat, producing a sour, acidic taste. These symptoms may sometimes be accompanied by nausea. Heartburn and regurgitation are usually much worse right after a meal and are made more severe while lying flat or bending over.
Other symptoms of GERD include a persistent sore throat, hoarseness, chronic cough, wheezing, bad breath, chest pain, and feeling like there is a lump in your throat.2 These symptoms are more common when you don’t have heartburn. GERD may also cause stomach acid to stimulate nerves in your esophagus or cause damage to its lining that can result in discomfort.
Sometimes, GERD can cause complications that can lead to some very serious problems.
The most frequent complications of GERD include Barrett’s esophagus (a precursor to esophageal cancer), erosive esophagitis, and esophageal stricture.
In addition to esophageal concerns, GERD can lead to other complications involving the head, neck, and airways such as asthma, chronic laryngitis, narrowing of the airways around your larynx (voice box), dental cavities, and chronic sinus infections.
GERD is caused by the reflux of gastric contents into the esophagus. Normally, reflux is prevented by the lower esophageal sphincter (LES), a ring of muscle located at the junction of the esophagus and the stomach. Most of the time, the LES is contracted in order to close the opening and to form a barrier between the stomach and esophagus. The LES transiently relaxes when you swallow to allow food to pass into the stomach. It also relaxes when you belch to allow gas to escape.
In most cases of GERD, the LES transiently relaxes when it’s not supposed to, thus allowing a brief interval of time in which the stomach contents can enter the esophagus.2 It is not clear why so many people develop frequent, transient relaxations of the LES.
Less commonly, GERD can be produced when the LES becomes chronically flaccid, allowing reflux to occur at almost any time. LES pressure can be reduced—and reflux encouraged—by gastric distention (a full stomach), smoking, numerous medications, drinking alcohol, caffeine, and several kinds of food, especially fatty foods and chocolate.
Other factors that can contribute to GERD include having a hiatal hernia, being overweight or obese, and pregnancy.
In most cases, GERD is a clinical diagnosis. That is, the symptoms of GERD are often so classic that doctors usually can make a confident diagnosis based on them alone.
Diagnostic testing is usually done only when you fail to respond to therapy or if your doctor suspects that one of the more serious complications of GERD may have occurred. Tests often used in diagnosing GERD may include endoscopy, 24-hour pH monitoring, esophageal manometry, and barium swallow X-rays.
If you have GERD, the good news is that it is likely that you’ll be able to control your symptoms if you adopt appropriate lifestyle changes. These include:
- Weight loss
- Elevating the head of the bed
- Avoiding trigger foods
- Refraining from eating three hours or so before bedtime
- Avoiding tight-fitting clothing
In general, if you have only mild symptoms, your doctor will recommend such modifications and perhaps suggest an over-the-counter (OTC) medication. Antacids don’t prevent or improve GERD, but they can be taken for occasional symptom relief. Commonly used antacids include Gaviscon, Maalox, Mylanta, Rolaids, and Tums.
Standard treatment of GERD generally involves prescription medication that decreases acid levels in the stomach and allows for healing of the stomach lining. The two most commonly used options, which also have OTC counterparts, are:
- Histamine-2 blockers (H2 blockers): H2 blockers help limit the production of stomach acid, so that stomach contents cause fewer symptoms when they reflux into the esophagus. H2 blockers begin working within an hour, becoming the most effective between one and three hours after taking a dose, and their effectiveness persists for up to 12 hours, They’re more useful when they’re taken regularly for a 2- to 4-week course of therapy. H2 blockers include Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine).
- Proton pump inhibitors (PPIs): PPIs work by inhibiting the pump in gastric cells that produce stomach acid. They are the most potent acid inhibitors and are more effective than H2 blockers at eliminating symptoms and healing esophagitis. However, they tend to cause more adverse effects, so most doctors will try an H2 blocker first. The PPIs include Prevacid (pantoprazole), Nexium (esomeprazole), and Prilosec (omeprazole) .
If your symptoms don’t improve with lifestyle changes and prescription medications, your doctor may recommend surgery, though that is rare.
The most common type is fundoplication, which is when the upper part of your stomach is wrapped around the LES in order to strengthen it and prevent reflux. Endoscopic techniques and implantation of a ring of magnetic beads called a LINX device, may also be considered.
If you are caring for someone with GERD, there are ways you can help your loved one deal with his or her symptoms at home. You can talk about and help her avoid foods that may trigger heartburn, encourage him to wear loose clothing, use medication as needed, encourage her to exercise, and keep his head elevated at night.
GERD is a common gastrointestinal disorder that is usually reasonably mild, but it can cause serious complications if it’s left untreated. If you have symptoms of GERD, you should work with your doctor to make sure you have the correct diagnosis and to make sure you receive a treatment regimen that will get rid of your problem before it worsens. Fortunately, with appropriate lifestyle modifications and the medications available today, the large majority of people with GERD can be successfully treated before an annoying problem becomes a dangerous one.
- National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for GER & GERD
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of GER & GERD
- National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of GER & GERD
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for GER & GERD
- Kahrilas PJ, Shaheen NJ, Vaezi MF, American Gastroenterological Association Institute, Clinical Practice and Quality Management Committee. American Gastroenterological Association Institute Technical Review on the Management of Gastroesophageal Reflux Disease. Gastroenterology. October 2008;135(4):1392-1413,1413.e1-5. doi:10.1053/j.gastro.2008.08.044.
- Katz PO, Gerson LB, Vela MF. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American Journal of Gastroenterology. March 2013;108(3):308-29. doi:10.1038/ajg.2012.444.
- Mikami DJ, Murayama KM. Physiology and Pathogenesis of Gastroesophageal Reflux Disease. The Surgical Clinics of North America. June 2015;95(3):515-25. doi:10.1016/j.suc.2015.02.006.
- Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Weight Loss and Reduction in Gastroesophageal Reflux. A Prospective Population-Based Cohort Study: the HUNT Study. The American Journal of Gastroenterology. March 2013;108(3):376-82. doi:10.1038/ajg.2012.466.