GERD (Gastroesophageal Reflux Disease)
Chances are good that you’ve experienced symptoms of gastroesophageal reflux at some point in your life. Maybe you’ve had heartburn or experienced a sour or bitter backwash in your throat, especially after eating a large meal. It happens to most of us sometimes. But when it occurs frequently or is associated with damage, it can indicate gastroesophageal reflux disease, or GERD.
GERD is one of the most common gastrointestinal disorders in the United States. It can affect people of any age, and it is estimated that approximately 20% of people in the U.S. have it. GERD occurs when stomach contents—gastric secretions with or without food—regurgitate into your esophagus, resulting in a bad taste and burning sensation in the chest and throat.
Over time, and left untreated, repeated exposure of the esophagus to stomach acid can cause esophageal ulcers, difficulty swallowing, and even cancer. Fortunately, GERD can be effectively managed by lifestyle modifications, over-the-counter or prescription medications, and in more severe cases, surgery.
“Reflux symptoms such as burning in the chest and regurgitation of stomach contents to the throat are common, especially when a person overeats or lies down soon after eating. However, if symptoms occur frequently, are more severe, and interfere with a person’s quality of life, they may have GERD,” says Yale Medicine gastroenterologist William Ravich, MD. “They should discuss these symptoms with their primary care physician and may need a consultation with a gastroenterologist.”
What is GERD?
GERD is a digestive disorder that occurs when the lower esophageal sphincter, a ring-shaped muscle at the lower end of the esophagus, malfunctions. When it is working normally, this muscle relaxes and opens to allow food to pass into the stomach and contracts, or closes, to prevent stomach contents from flowing back into the esophagus. When the lower esophageal sphincter is too relaxed, stomach acid can splash up into the esophagus. This backward flowing of stomach contents is called gastroesophageal reflux, or sometimes acid reflux.
The stomach has a special lining that protects it from being damaged by gastric acid, but the esophagus does not. As a result, when the esophagus is exposed to stomach acid, it becomes irritated and inflamed. This results in heartburn, a painful burning sensation in the chest or in the throat.
Acid reflux happens to just about everyone from time to time and usually causes only mild symptoms. But GERD occurs when acid reflux is chronic and repeatedly causes heartburn or other symptoms or complications.
What are the symptoms of GERD?
The most common symptom of GERD is heartburn, which may last for several hours. It usually occurs after eating a meal or while lying down.
Other symptoms may include:
- Regurgitation of stomach contents into the throat or mouth
- Bitter or sour taste
- Chest pain
- Nausea and/or vomiting
- Difficult or painful swallowing
- Hoarseness (sometimes laryngitis)
- Sensation of a lump in the throat
Most people with GERD only experience mild to moderate symptoms. But those who have more severe symptoms or those whose symptoms persist in spite of treatment are at risk of long-term damage to the esophagus. This may lead to such problems as:
- Esophagitis. Long-term inflammation of the esophagus that can cause ulcers.
- Esophageal stricture. Narrowing of the esophagus that may lead to problems with swallowing.
- Barrett’s esophagus. Development of abnormal cells in the esophagus that may result in esophageal cancer.
What are the risk factors of GERD?
Several factors can increase the risk of developing GERD, including:
- Weight gain, being overweight or obese
- Family history of GERD
- Hiatal hernia (condition in which the top of the stomach at the esophageal junction bulges into the chest)
- Smoking or inhaling secondhand smoke
- Eating fatty foods
- Drinking alcohol, coffee, or carbonated beverages
- Lying down within 3 hours of eating
- Taking certain medications including some antidepressants, calcium channel blockers (high blood pressure medications), sedatives, and some medications used to treat asthma.
How is GERD diagnosed?
In most cases, your doctor can diagnose GERD based on your symptoms. He or she will ask about risk factors for GERD, such as what kinds of foods you typically eat. Your doctor will also ask whether you take any medications, because some drugs can stimulate acid reflux.
If your doctor suspects you have GERD after the initial exam, he or she may ask you to begin taking a medication. A few different types of medications can help relieve symptoms, including proton pump inhibitors (PPIs), H2 blockers, and histamine-2 receptor antagonists (H2Ras). Not only can these help alleviate your discomfort, they also aid in the diagnosis of GERD; If your symptoms improve after taking the medication, it can confirm your doctor’s initial diagnosis.
If your symptoms are severe or do not improve with medication or if you show signs of more serious complications, your doctor may run the following diagnostic tests:
- Upper endoscopy. In this procedure, a thin tube equipped with a tiny camera and light is passed into the esophagus and down into the stomach. The camera allows doctors to visually examine the esophagus and stomach. In some cases, the doctor will take a biopsy (a small piece of tissue) of the esophagus to rule out other medical conditions that may be causing your symptoms.
- pH monitoring. This procedure monitors the amount of stomach acid that reaches the esophagus and how often reflux occurs. A doctor inserts a small tube with a pH sensor into the nose or mouth and passes it into the esophagus. (Sometimes, a doctor will instead insert a wireless capsule equipped with a pH sensor.) You go about your routine daily activities with the tube or capsule in place and wear a small electronic monitor that records data from the pH sensor. Over the course of the test, you may need to keep a food diary and keep track of symptoms.
How is GERD treated?
Treatment for GERD typically involves lifestyle modification, medications, and in rare cases, surgery.
Lifestyle Modification. A number of lifestyle and dietary changes may help relieve symptoms. These include:
- Losing weight
- Elevating the head of your bed
- Avoiding overeating
- Avoiding lying down within 3 hours of eating
- Quitting smoking and avoiding exposure to secondhand smoke
- Avoiding foods and beverages that can trigger reflux, including chocolate, peppermint, fatty or spicy foods, citrus fruits, tomatoes, coffee, tea, alcohol, and carbonated drinks
Medications. Three classes of medications, all of which work by reducing acid levels in the stomach, may alleviate symptoms caused by GERD.
- Antacids. These drugs neutralize stomach acid so, even if it regurgitates into the esophagus, its harmful effects will be lessened. Antacids are available over-the-counter.
- H2 Blockers. These medications work by reducing the stomach’s production of acid. They are available by prescription or over-the-counter.
- Proton pump inhibitors (PPIs). These medications also reduce the stomach’s production of acid. They are available by prescription or over-the-counter.
Surgery. If symptoms persist in spite of other treatments, or if patients cannot tolerate medications or do not wish to use medications over the long-term, a doctor may recommend surgery. The goals of surgery may be to strengthen the lower esophageal sphincter or correct hiatal hernia.
What is the outlook for people who have GERD?
GERD can be treated effectively. Medications and lifestyle changes are usually helpful in controlling symptoms; however, because GERD tends to recur, long-term use of medications may be necessary. For those people whose condition does not respond well to medication or lifestyle modification, surgical treatments typically have excellent outcomes.
What makes Yale Medicine's approach to GERD unique?
“GERD can be a serious condition. It is important to distinguish between those with symptoms alone and those in whom symptoms are associated with complications,” says Dr. Ravich. “For those who don’t respond to initial treatment or who have complications of reflux, it is important to see a gastroenterologist who specializes in reflux disease, who knows what diagnostic tests are available—and how they are best used and interpreted—and who has experience in the long-term management of reflux disease and its complications.”