Gastroesophageal Reflux Disease (GERD)/Heartburn

Gastroesophageal reflux disease, or GERD, is a digestive disorder that occurs when gastric acid from the stomach flows back up into the food pipe or esophagus. Heartburn is the most common symptom of GERD.

A muscle at the bottom of the esophagus opens to let food in and closes to keep food in the stomach. This muscle is called the lower esophageal sphincter (LES). When the LES relaxes too often or too long, acid backs up into the esophagus and causes heartburn.

Causes

Some lifestyle choices may cause GERD:

  • Overeating
  • Eating citrus, chocolate, or foods that are fatty or spicy
  • Consuming caffeine
  • Drinking alcohol
  • Smoking
  • Using aspirin and over-the-counter pain/fever medication (nonsteroidal anti-inflammatory drugs or NSAIDs) 

Some health conditions may cause GERD:

  • Being overweight
  • Gastritis, a redness or swelling (inflammation) of the stomach lining
  • Ulcers, painful sores on the stomach lining, esophagus or the first part of small intestine (duodenum)
  • Hiatal hernia
  • Weak lower esophageal sphincter 
  • Pregnancy

Symptoms

Heartburn, also called acid indigestion or acid reflux, is the most common symptom of GERD. Heartburn is a burning chest pain that starts behind the breastbone and moves up into the neck and throat, lasting as long as two hours. It often feels worse after eating. Lying down or bending over can also cause heartburn.


Another common symptom of GERD is regurgitation. Some people have trouble swallowing.


Heartburn is not a GERD symptom for most children younger than 12 and for some adults. Instead, they may experience dry coughing, asthmatic symptoms or trouble swallowing.

Diagnosing GERD

Your provider will perform a physical exam and ask about your medical history. Some people with typical symptoms may be treated without further testing. 


Other tests for GERD may include the following.

  • Upper GI (gastrointestinal) series, also called a barium swallow: This test looks at the organs of the top part of the digestive system. After you swallow a metallic fluid called barium, which coats the organs so they can be seen on an X-ray, a provider checks the food pipe (esophagus), stomach and first part of the small intestine (duodenum). 
  • Upper endoscopy or EGD (esophagogastroduodenoscopy): This test looks at the lining or inside of the esophagus, stomach and duodenum. The test is performed with an endoscope, a thin, lighted tube with a camera on the end. The endoscope is inserted into the mouth and throat. Then it goes into the esophagus, stomach and duodenum. A provider can see inside these organs and take a small tissue sample (biopsy) if needed.
  • Bernstein test: This test helps examine if symptoms are caused by acid in the esophagus. The test is performed by dripping a mild acid through a tube placed in the esophagus.
  • Esophageal manometry: This test checks the strength of esophagus muscles and looks for problems with backward flow of fluid (reflux) or swallowing. A small tube is inserted into the nostril, then down the throat and into the esophagus. The tube checks how much pressure esophageal muscles make during rest.
  • pH monitoring: This test checks the pH or acid level in the esophagus. A thin, plastic tube that measures pH level is placed into the nostril, down the throat and into the esophagus. The other end of the tube outside the body is attached to a small monitor that records pH levels for 24 to 48 hours. During this time, you can go home and conduct normal activities. You will need to keep a diary of symptoms and food consumed. The pH readings are checked and compared to activity during that time period.

Treatments

A care plan is based on many factors including:

  • Age, overall health and past health
  • Severity of the condition 
  • Tolerance to certain medications, treatments or therapies
  • Whether the condition is expected to worsen
  • Personal preference

In many cases, diet and lifestyle modifications can help reduce GERD symptoms. Always check with your health provider before making any changes.


Limiting the following food and drink can help:

  • Fried and fatty foods
  • Peppermint
  • Chocolate
  • Alcohol
  • Citrus fruit and juices
  • Tomato products
  • Caffeinated drinks, such as coffee, soda and energy drinks

Try these other lifestyle tips:

  • Eating smaller portions
  • Not overeating
  • Quitting smoking
  • Not drinking too much alcohol
  • Waiting a few hours after eating before lying down or going to bed
  • Losing weight, if needed
  • Raising the head of the bed six inches (with bricks, cinderblocks or risers)
  • Checking all medications, as some may cause problems with the lining of the stomach or esophagus

These medications may help alleviate GERD:

  • Antacids that reduce stomach acid
  • H2-blockers and protein pump inhibitors (taken before eating) that may prevent heartburn
  • Promotility medications that help to empty food from the stomach require a prescription. However, these medications are rarely used to treat reflux disease unless there are other health problems, too.

Surgery called fundoplication is sometimes performed to help keep the esophagus in the right place and to stop the backward flow of fluid (reflux).