Gastroesophageal reflux disease
Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This can irritate the esophagus and cause heartburn and other symptoms.
Causes
When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter (LES).
When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus.
The risk factors for reflux include:
- Use of alcohol (possibly)
- Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
- Obesity
- Pregnancy
-
Scleroderma
Scleroderma
Scleroderma is a disease that involves the buildup of scar-like tissue in the skin and elsewhere in the body. It also damages the cells that line th...
- Smoking
Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:
- Anticholinergics (for example, seasickness medicine)
- Bronchodilators for asthma
- Calcium channel blockers for high blood pressure
-
Dopamine-active drugs for
Parkinson disease
Parkinson disease
Parkinson disease causes certain brain cells to die. These are the cells that help control movement and coordination. The disease leads to shaking ...
- Progestin for abnormal menstrual bleeding or birth control
- Sedatives for insomnia or anxiety
- Tricyclic antidepressants
Talk to your health care provider if you think one of your medicines may be causing heartburn. Never change or stop taking a medicine without first talking to your provider.
Symptoms
Common symptoms of GERD include:
- Feeling that food is stuck behind the breastbone
-
Heartburn
or a burning pain in the chest
Heartburn
Heartburn is a painful burning feeling just below or behind the breastbone. Most of the time it comes from the esophagus. The pain often rises in y...
- Nausea after eating
Less common symptoms are:
- Bringing food back up (regurgitation)
- Cough or wheezing
- Difficulty swallowing
- Hiccups
-
Hoarseness
or change in voice
Hoarseness
Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or qualit...
- Sore throat
Symptoms may get worse when you bend over or lie down, or after you eat. Symptoms may also be worse at night.
Exams and Tests
You may not need any tests if your symptoms are mild.
If your symptoms are severe or they come back after you have been treated, your doctor may perform a test called an upper endoscopy (EGD).
Upper endoscopy
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine.
- This is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine.
- It is done with a small camera (flexible endoscope) that is inserted down the throat.
You may also need 1 or more of the following tests:
- A test that measures how often stomach acid enters the tube that leads from the mouth to the stomach (called the esophagus)
-
A test to measure the pressure inside the lower part of the esophagus (
esophageal manometry
)
Esophageal manometry
Esophageal manometry is a test to measure how well the esophagus is working.
A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.
Stool occult blood test
The stool guaiac test looks for hidden (occult) blood in a stool sample. It can find blood even if you cannot see it yourself. It is the most commo...
Treatment
You can make many lifestyle changes to help treat your symptoms.
Lifestyle changes
Peptic esophagitis - discharge; Reflux esophagitis - discharge; GERD - discharge; Heartburn - chronic - discharge
Other tips include:
- If you are overweight or obese, in many cases, losing weight can help.
- Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.
- Take all of your medicines with plenty of water. When your doctor gives you a new medicine, ask whether it will make your heartburn worse.
You may use over-the-counter antacids after meals and at bedtime, although the relief may not last very long. Common side effects of antacids include diarrhea or constipation.
Over-the-counter antacids
Heartburn - antacids; Reflux - antacids; GERD - antacids
Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.
- Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
- H2 blockers also lower the amount of acid released in the stomach
Anti-reflux surgery may be an option for people whose symptoms do not go away with lifestyle changes and medicines. Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn.
There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).
Outlook (Prognosis)
Most people respond to lifestyle changes and medicines. However, many people need to continue taking medicines to control their symptoms.
Possible Complications
Complications may include:
-
Worsening of
asthma
Asthma
Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughi...
-
A change in the lining of the esophagus that can increase the risk of cancer (
Barrett esophagus
)
Barrett esophagus
Barrett esophagus (BE) is a disorder in which the lining of the esophagus is damaged by stomach acid. The esophagus is also called the food pipe or ...
- Bronchospasm (irritation and spasm of the airways due to acid)
- Chronic cough or hoarseness
- Dental problems
-
Ulcer
in the esophagus
Ulcer
Erosion is a breakdown of the outer layers of the skin, usually because of a: CutScrapeInflammation
- Stricture (a narrowing of the esophagus due to scarring)
When to Contact a Medical Professional
Call your health care provider if symptoms do not improve with lifestyle changes or medicine.
Also call if you have:
- Bleeding
- Choking (coughing, shortness of breath)
- Feeling filled up quickly when eating
- Frequent vomiting
- Hoarseness
- Loss of appetite
- Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
- Weight loss
Prevention
Following heartburn prevention techniques may help prevent symptoms. Obesity is linked to GERD, so maintaining a healthy body weight may help prevent the condition.
Heartburn prevention techniques
Heartburn is a painful burning feeling just below or behind the breastbone. Most of the time it comes from the esophagus. The pain often rises in y...
References
ASGE Standards of Practice Committee, Muthusamy VR, Lightdale JR, et al. The role of endoscopy in the management of GERD. Gastrointest Endosc . 2015;81(6):1305-1310. PMID: 25863867 www.ncbi.nlm.nih.gov/pubmed/25863867 .
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.
Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial. JAMA . 2011;305:1969-1977. PMID: 21586712 www.ncbi.nlm.nih.gov/pubmed/21586712 .
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol . 2013;108:308-28. PMID: 23419381 www.ncbi.nlm.nih.gov/pubmed/23419381 .
Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.
Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol . 2008;103(3):788-797. PMID: 18341497 www.ncbi.nlm.nih.gov/pubmed/18341497 .
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Heartburn
Animation
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Gastroesophageal reflux disease - illustration
A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.
Gastroesophageal reflux disease
illustration
-
Gastroesophageal reflux - Series
Presentation
-
Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
-
Gastroesophageal reflux disease - illustration
A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.
Gastroesophageal reflux disease
illustration
-
Gastroesophageal reflux - Series
Presentation
-
Gastroesophageal reflux disease
(Alt. Medicine)
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Gastroesophageal reflux disease and heartburn
(In-Depth)
Review Date: 1/28/2016
Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.