What is gerd?

Gastroesophageal reflux disease (GERD) is the backward flow of stomach acid into the esophagus. The esophagus is the tube that leads from your throat to your stomach. A one-way valve prevents the stomach acid from backing up into this tube. But when you have GERD, this valve does not close tightly enough. This can also cause pain and swelling in your esophagus. (This is called esophagitis.)

If you have mild GERD symptoms including heartburn, you may be able to control the problem with antacids or over-the-counter medicine. You can also make lifestyle changes to help reduce your symptoms. These include changing your diet and eating habits, such as not eating late at night and losing weight.

GERD may cause irritation or inflammation in the esophagus. Advanced GERD can cause problems like ulcers, wearing away or narrowing of the esophagus, and Barrett's esophagus. It can also cause a cough that doesn't go away or pneumonia, and speeding up of tooth decay. Some people may be at risk for cancer of the esophagus.

The main symptoms of GERD are:

• Ongoing (persistent) heartburn. Heartburn is an uncomfortable feeling or burning pain behind the breastbone. It may occur after you eat, soon after you lie down, or when you bend forward. Some people have GERD without heartburn.
• A sour or bitter taste in the mouth. This is caused by the backflow of stomach acid and juices into the esophagus.

Other symptoms may include:

• Chest pain. If you have pain in your chest, it is important to make sure that it isn't caused by a problem with your heart.
  • The pain caused by GERD usually happens after you eat. It may occur with heartburn.
  • Pain from the heart usually feels like heaviness, tightness, discomfort, or a dull ache. It occurs most often after you are active.
• Hoarseness.
• Trouble swallowing (more common with advanced GERD).
• A feeling that something is stuck in your throat.
• A cough.
• Having extra saliva.
• Nausea.

Treatment aims to reduce reflux, prevent damage to your esophagus, and prevent problems caused by GERD.

For mild symptoms, try over-the-counter medicines such as:

• Antacids (like Tums).
• H2 blockers (like Pepcid).
• Proton pump inhibitors (like Prilosec).

Lifestyle changes are important. You can:

• Eat several small meals instead of three large meals.
• Wait 2 to 3 hours after eating before lying down.
• Avoid foods that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
• Raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) .
• Lose weight if needed. Losing just 5 lb (2 kg) to 10 lb (5 kg) can help.

If symptoms persist, possible next steps include a change in medicine or testing. Your doctor may recommend surgery to strengthen the valve between your esophagus and stomach.

You may be able to prevent GERD with lifestyle changes, such as eating a healthy diet, not smoking, and staying at a healthy weight.

Some medicines may cause GERD as a side effect. If any medicines you take seem to be the cause of your heartburn, talk with your doctor. Don't stop taking a prescription medicine until you talk with your doctor.

To find out if you have GERD, your doctor will do a physical exam and ask you questions about your health. Your doctor may ask about your symptoms, such as whether you often have heartburn. If you do have heartburn often, your doctor may suggest a medicine that reduces or blocks stomach acid.

If your heartburn goes away after you take the medicine, your doctor will probably diagnose GERD. You may or may not need any tests.

If medicines don't help, you may have tests. These tests may include:

• An upper gastrointestinal endoscopy.
• Esophageal tests.
• An upper-gastrointestinal X-ray series.

Antacids, H2 blockers, and proton pump inhibitors (PPIs) are usually tried first to treat GERD and its symptoms. These can be either prescription or over-the-counter.

Medicines can:

• Relieve symptoms (heartburn, sour taste, or pain).
• Allow the esophagus to heal.
• Prevent problems caused by GERD.

You may take:

• Antacids. These include Mylanta and Tums. Antacids neutralize stomach acid and relieve heartburn. If you want to take medicine only when your symptoms bother you, antacids are a good choice.
• Acid reducers, such as:
  • H2 blockers. These include cimetidine (Tagamet) and famotidine (Pepcid). H2 blockers reduce the amount of acid in the stomach. Most are sold in both over-the-counter and prescription strength.
  • PPIs. These include lansoprazole (Prevacid) and omeprazole (Prilosec). PPIs reduce the amount of acid in the stomach. Some are available over-the-counter.

If your daily medicine doesn't control your GERD symptoms, talk with your doctor. You may need to try a different medicine.

Take your medicines as directed. These may include prescription or over-the-counter medicines. Eat several small meals a day. Avoid foods that make your GERD worse, like chocolate, mint, and spicy foods. After eating, wait 2 to 3 hours before lying down. For night-time symptoms, raise the head of your bed 6 to 8 inches.

Surgery may be used to treat GERD symptoms that haven't been controlled well by medicines.

The most common surgery used to treat GERD is fundoplication. It strengthens the valve (lower esophageal sphincter) between the esophagus and stomach. This helps keep acid from backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus.

It may be done in one of two ways.

• A partial fundoplication. With this, the stomach is wrapped only partway around the esophagus.
• A full fundoplication. With this, the stomach is wrapped all the way around the esophagus.

Gastropexy is another type of surgery for GERD. With this, the stomach is attached to the diaphragm. It is done so that the stomach can't move through the opening in the diaphragm into the chest.

Surgery for GERD can cause problems with swallowing, burping, and extra gas. You may need other procedures to fix these problems.

Things that increase your risk for symptoms of gastroesophageal reflux disease (GERD) include your lifestyle and certain health conditions.

Lifestyle

• Being overweight.
• Smoking.
• Eating certain foods. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.

Health conditions

• Being pregnant. GERD is a common problem during pregnancy. Most of the time, symptoms get better after the baby is born.
• Having a hiatal hernia.
• Taking certain medicines. If you think that a medicine you take may be causing your GERD symptoms, talk to your doctor.

Normally when you swallow food, it travels down the esophagus. A valve opens to let the food pass into the stomach, and then the valve closes. With GERD, the valve doesn't close tightly enough. Stomach acid and juices from the stomach flow back up (reflux) into the esophagus.

When you have GERD, stomach acids and juices back up into the esophagus. This can irritate and wear away the lining of the esophagus and cause sores. These sores are called ulcers.