Overview
Gastroesophageal reflux disease (GERD) is a chronic digestive disorder caused by stomach acid backing up into the esophagus. About 1 in 4-5 people experience symptoms weekly.
Normally, the valve (lower esophageal sphincter) between the stomach and esophagus prevents acid reflux. When this valve relaxes or weakens, acid escapes into the esophagus and causes burning.
Symptoms
Typical symptoms:
- Heartburn (burning sensation behind the breastbone)
- Regurgitation of bitter or sour fluid into the mouth
- Chest pain (especially when lying down or after meals)
- Difficulty or painful swallowing
- Lump sensation in the throat
Atypical symptoms:
- Chronic cough
- Hoarseness (especially in the morning)
- Wheezing, asthma-like symptoms
- Tooth enamel erosion
- Recurrent pharyngitis, laryngitis
- Bad breath
- Nausea
Symptoms worsen when lying down, bending over, and after meals.
Causes
- Weakening or relaxation of the lower esophageal sphincter
- Hiatal hernia
- Slow gastric emptying
- Excessive acid production
- Anatomical abnormalities of the esophagus
Risk Factors
- Obesity and excess weight
- Pregnancy
- Hiatal hernia
- Smoking
- Connective tissue disorders (scleroderma)
- Eating late at night
- Overeating
- Tight clothing
- Some foods and drinks: Chocolate, caffeine, mint, spicy and fatty foods, carbonated drinks, alcohol
- Some medications: Aspirin, NSAIDs, some blood pressure medications
Complications
- Esophagitis: Inflammation of the esophagus
- Esophageal stricture (narrowing)
- Barrett's esophagus: Cellular change; precursor to cancer
- Esophageal cancer (long-term)
- Dental enamel erosion
- Pulmonary problems: Aspiration pneumonia, asthma exacerbation
- Sleep disturbance
When to See a Doctor
- If you have heartburn more than twice a week
- If symptoms persist despite over-the-counter medications
- If you have difficulty swallowing
- Unexplained weight loss
- Loss of appetite, vomiting, bloody vomiting
- Black or bloody stools
- New onset of symptoms after age 50
Diagnosis and Treatment
Diagnosis:
- Upper endoscopy (gastroscopy)
- 24-hour esophageal pH monitoring
- Manometry
- Barium esophagram
Treatment:
Medications:
- Proton pump inhibitors (PPIs): Omeprazole, pantoprazole, lansoprazole — most effective
- H2 receptor blockers: Famotidine
- Antacids: Quick temporary relief
- Prokinetics: Speed up stomach emptying
Surgery (in resistant cases):
- Nissen fundoplication
- LINX device
Prevention and Lifestyle
- Lose weight (most effective recommendation)
- Eat at least 3 hours before lying down
- Raise the head of the bed by 15-20 cm
- Eat smaller, more frequent meals
- Avoid trigger foods
- Quit smoking
- Limit alcohol
- Do not wear tight clothing
- Manage stress
- Do not bend over right after eating