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Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a disease that persistently causes acid reflux where the contents of your stomach (acids and food) rise up into the esophagus. Occasional acid reflux is common. However, if you experience acid reflux more than twice a week you may have GERD. The most common symptom with GERD is heartburn from stomach acid making contact with your esophagus. Smoking, being overweight, and a hiatal hernia can lead to GERD while eating highly acidic foods like citrus fruits or chocolate can worsen the symptoms. While the cause for GERD is unknown, Dr. Cofrancesco and Dr. Quijano can diagnose the disease, provide medication to combat the symptoms, and educate you on lifestyle changes that will lessen the severity of your GERD.

Scroll down to learn more about GERD and its causes.

  • What is GERD?
  • What are the symptoms of GERD?
  • What causes GERD?
  • How is GERD treated?
  • What if GERD symptoms persist?
  • What are the long-term complications of GERD?
  • Points to Remember

What is GERD?

Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.

What are the symptoms of GERD?

The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

What causes GERD?

Other factors that may contribute to GERD include

  • obesity
  • pregnancy
  • smoking

Common foods that can worsen reflux symptoms include

  • citrus fruits
  • chocolate
  • drinks with caffeine or alcohol
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

How is GERD treated?

See Dr. Cofrancesco or Dr. Quijano if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes

  • If you smoke, stop.
  • Avoid foods and beverages that worsen symptoms.
  • Lose weight if needed.
  • Eat small, frequent meals.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.

Medications

Dr. Cofrancesco or Dr. Quijano may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see Dr. Cofrancesco or Dr. Quijano before starting or adding a medication.

Antacids Antacids such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts— magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids CCA such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitorsPPIs include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.

Prokinetics Prokinetics help strengthen the LES and make the stomach empty faster. This group includes metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness— fatigue, sleepiness, depression, anxiety, and problems with physical movement.

Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Dr. Cofrancesco or Dr. Quijano is the best source of information about how to use medications for GERD.

What if GERD symptoms persist?

If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.

Barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.

Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. Dr. Cofrancesco or Dr. Quijano may spray your throat to numb it and then, , will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows Dr. Cofrancesco and Dr. Quijano to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.Dr. Cofrancesco or Dr. Quijano also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow Dr. Cofrancesco and Dr. Quijano to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.

pH monitoring examination involves Dr. Cofrancesco or Dr. Quijano either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary— recording when, what, and amounts you eats—which allows the Dr. Cofrancesco and Dr. Quijano to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.

Surgery

Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication is the standard surgical treatment for GERD. Usually a specific type of this procedure, called Nissen fundoplication, is performed. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.

The Nissen fundoplication may be performed using a laparoscope, an instrument that is inserted through tiny incisions in the abdomen. A surgeon then uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants. The procedure is reported to have the same results as the standard fundoplication, and people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

What are the long-term complications of GERD?

Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures— narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its complications should be monitored closely by a Dr. Confrancesco or Dr. Quijano.

Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.

Points to Remember

  • Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults. Anyone experiencing heartburn twice a week or more may have GERD.
  • You can have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.
  • If you have been using antacids for more than 2 weeks, it is time to see Dr. Cofrancesco or Dr. Quijano.
  • Dr. Cofrancesco and Dr. Quijano usually recommends lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medication. Surgery may be considered as a treatment option.

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