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Gastroesophageal Reflux Disease—Overview

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Definition

Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. The pain is often worse after eating, in the evening, or when lying down or bending over.

Heartburn that occurs often and gets in the way of day-to-day life may be gastroesophageal reflux disease (GERD). It can damage your esophagus. GERD can also cause Barretts esophagus, a change in the cells that can lead to cancer.

Gastroesophageal Reflux Disease
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Causes

A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:

  • Problems with the nerves that control the muscles of the ring
  • Problems with muscle tone of the ring
  • Muscles that move food down into the stomach are weak
  • Abnormal pressure on the area
  • Increased relaxation of the muscles
  • Increased pressure within the abdomen—pushes up against the stomach
Heartburn
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Risk Factors

Factors that may increase your chance of heartburn or GERD include:

  • Obesity
  • Smoking
  • Alcohol use
  • Exercising or strenuous activity immediately after eating
  • Lying down, bending over, or straining after eating
  • Pregnancy
  • Prior surgery for heartburn
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube

Foods and drinks that are more likely to cause symptoms include:

  • Caffeinated products
  • Carbonated drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
  • Large or fatty meals

Medications and supplements that cause symptoms may include:

  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates

Symptoms

Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat—most common symptom
  • Regurgitation—a feeling that food is coming back up
  • Sour or bitter taste in the throat
  • Burping
  • Bloating

The repeated, regular episodes can lead to other symptoms such as:

  • Sore throat
  • Hoarseness
  • Chronic laryngitis
  • Chronic cough
  • Feeling of a lump in the throat
  • Waking up with a sensation of choking
  • Difficulty swallowing

Long-term complications of GERD may include:

  • Inflammation and scarring of the esophagus—esophagitis
  • Bleeding and ulcers in the esophagus
  • Narrowing of the esophagus— esophageal stricture
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel
  • Asthma attacks
  • Vomiting blood
  • Black or tarry stools
  • Precancerous condition that can lead to esophageal cancer— Barrett esophagus
  • Esophageal cancer

When Should I Call My Doctor?

Make an appointment to see your doctor if you have heartburn 2 or more times a week, every week.

Diagnosis

The doctor will ask about symptoms and past health. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.

Further testing is not always needed. Your doctor may order the following to better plan treatment:

  • Upper GI series
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
  • Manometry to test muscle strength in the lower esophagus

Treatment

Treatment will depend the cause of the heartburn. The goal is to prevent further symptoms and heal any damage.

Lifestyle Changes

Tracking food can help to learn what may be causing the most problems. Avoiding foods can help avoid heartburn. It can also help to lower pressure on stomach by:

  • Eating smaller portions.
  • Not lying down or exercising for at least 2 to 3 hours after a meal.
  • Avoid tight belts and clothing.

Other steps that may ease heartburn include:

  • If you are overweight, talk to your doctor about a plan to lose weight .
  • If you smoke, look for ways to help you quit .
  • Elevate head of bed 6 to 8 inches. It may relieve heartburn at night.

Medication

Medicine may help relieve symptoms. Some can also help to repair damage. They can treat heartburn that has started or may help stop heartburn from starting. Many heartburn medicines are available over-the-counter such as:

  • Proton-pump inhibitors
  • H2 blockers
  • Antacids

Talk to your doctor about which ones may be best for you. Some should only be used for short periods of time.

Surgery

Heartburn that is severe or does not respond to treatment may need surgery. Options include:

Fundoplication

The most common surgery for GERD is fundoplication . The doctor wraps the stomach around the esophagus. This helps to keep the opening to the stomach closed.

Endoscopic Antireflux Procedures

There are a number of procedures that can be done with an endoscope. The scope passes through the mouth to the stomach to complete procedures. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach. It will help to tighten the opening to the stomach.

LINX Reflux Management System

LINX is a small band with magnetic beads. A surgeon places the band around the end of the esophagus where it meets the stomach. The magnets pull together to help close the opening. Swallowed food or drink push apart the beads so that it can move into the stomach.

Some people will be able to stop or reduce medicine after surgery.

Some people will be able to stop or reduce medicine after surgery.

Prevention

There are no current guidelines to prevent GERD.

Resources

American Gastroenterological Association
http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

Canadian Resources

Canadian Association of Gastroenterology
https://www.cag-acg.org

Canadian Digestive Health Foundation
http://www.cdhf.ca

References

Acid reflux (GER & GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults. Accessed January 26, 2021.

Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Accessed January 26, 2021.

Heartburn. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/heartburn/. Accessed January 26, 2021.

Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack%5FUCM%5F002039%5FArticle.jsp#.WsUYIy7wZQJ. Accessed January 26, 2021.

4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.