Digestive Disorders

Gastroesophageal Reflux Disease (GERD) / Heartburn

What is GERD?
Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

Heartburn may mimic other, more serious conditions:

Heartburn pain can be mistaken for the pain associated with heart disease or a heart attack. Seek immediate medical care if:

You suffer sudden, severe chest pain, or
Pain is accompanied by sweating, light-headedness, and nausea.

Severe heartburn may be due to a serious medical condition, such as a ruptured abdominal organ or heart attack. See a physician when ...

Heartburn persists, and
An over-the-counter antacid or acid-reducer does not relieve the burning feeling within a short amount of time (from a few seconds to five minutes).

What are the symptoms of GERD?
The following is the most common symptom of GERD. However, each individual may experience symptoms differently.

Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn.

Heartburn pain is less likely to be associated with physical activity.

The symptoms of GERD may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What causes GERD?
GERD is believed to be the result of condition called hiatal hernia, which affects the lower esophageal sphincter (LES). The typical cause of heartburn is when acid from the stomach backs up into the esophagus. The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.

Other lifestyle contributors to GERD may include the following:

being overweight
overeating
consuming certain foods, such as citrus, peppermint, chocolate, fatty, and spicy foods
caffeine
alcohol
smoking
use of nonsteroidal anti-inflammatory (NSAIDs) drugs such as aspirin and ibuprofen

Other medical causes of heartburn may include the following:

gastritis - an inflammation of the stomach lining.
ulcer disease

How is GERD diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for GERD may include the following:

upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
esophagogastroduodenoscopy (Also called EGD or upper endoscopy.)
An EGD (upper endoscopy) is a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
Bernstein test - a test that helps to confirm that the symptoms are a result of acid in the esophagus. The test is performed by dripping a mild acid through a tube placed in the esophagus.
esophageal manometry - this test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.
pH monitoring - measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin, plastic tube is placed into a nostril, guided down the throat, and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 12 to 24 hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing. The pH readings are evaluated and compared to the patient's activity for that time period.

Treatment for GERD:
Specific treatment for GERD will be determined by your physician based on:

your age, overall health, and medical history
extent of the condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your physician. Some ways to manage heartburn include the following:

Monitor the medications you are taking - some may irritate the lining of the stomach or esophagus.

Quit smoking.

Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products.

Eat smaller portions.

Avoid overeating.

Watch consumption of alcohol.

Do not lay down or go to bed right after a meal. Instead, wait a couple of hours.

Lose weight, if necessary.

Elevate the head of the bed 6 inches.

Take an antacid, as directed by your physician.

Ask your physician about use of over-the-counter medicines called "H2-blockers." Formerly available only by prescription, these drugs can be taken before eating to prevent heartburn from occurring.

Occasionally, a surgical procedure called fundoplication may be performed to increase pressure on the esophagus.

This page was last updated on: May 25, 2006.

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