Gastroesophageal reflux - discharge
Peptic esophagitis - discharge; Reflux esophagitis - discharge; GERD - discharge; Heartburn - chronic - discharge
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This article tells you what you need to do to manage your condition.
A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.
Do you feel a burning in your chest not long after you eat or lie down? If so, you may have Gastroesophageal reflux disease, or GERD. When we swallow food, it travels down our esophagus into the stomach, where it's greeted by a rush of Hydrochloric acid in the stomach to begin digestion. This acid is so powerful, it could eat the paint right off your car! Fortunately, there's a band of muscle between the stomach and the esophagus - called the Lower Esophageal Sphincter or L-E-S, that clamps down to prevent the stomach contents from moving or refluxing upward and burning the lining of the esophagus. If that band of muscle does not adequately clamp down, this backwash causes the irritation and burning that's known as heartburn or GERD. Maintaining good tight L-E-S muscle tone is the key to preventing this condition. Causes of GERD include being overweight, smoking, and drinking too much alcohol. Certain foods, like chocolate and peppermint and if you're a woman, pregnancy can bring on GERD. To determine if you have GERD, your doctor may request an upper endoscopy exam to look into your esophagus and stomach to diagnose reflux. Other tests can measure the acid and amount of pressure in your esophagus, or if you have blood in your stool. If you do have GERD, lifestyle changes can help. First, avoid foods that cause problems for you and avoid eating large meals. If you're a little on the heavy side, try to lose some weight. Since most GERD symptoms are experienced lying down in bed, let gravity help. Elevating the head of your bed 4 to 6 inches using blocks of wood may help. If symptoms continue, see your doctor or a Gastroenterologist for evaluation and an upper endoscopy exam. Your doctor may suggest you take over-the-counter antacids or may prescribe stronger medications. Call your doctor if you are bleeding, feel like you are choking, have trouble-swallowing, or experience sudden weight loss. The good news is most people who have GERD do not need surgery. For the worst cases, surgeons may perform a laparoscopic procedure to tighten a weak L-E-S muscle. If you have occasional heartburn, antacid tablets can be used as needed. However! If you're having heartburn more than 3 to 4 times a week, see your doctor & take the prescribed medication to prevent this condition.
Self-care
You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you.
- Do not drink alcohol.
- Avoid drinks and foods that have caffeine, such as soda, coffee, tea, and chocolate.
- Avoid decaffeinated coffee. It also increases the level of acid in your stomach.
- Avoid high-acid fruits and vegetables, such as citrus fruits, pineapple, tomatoes, or tomato-based dishes (pizza, chili, and spaghetti) if you find that they cause heartburn.
- Avoid items with spearmint or peppermint.
Other lifestyle tips that may make your symptoms better are:
- Eat smaller meals, and eat more often.
- Lose weight, if you need to.
- If you smoke or chew tobacco, try to quit. Your health care provider can help.
- Exercise, but not right after eating.
- Reduce your stress and watch for stressful, tense times. Stress can bother your reflux problem.
- Bend at the knees, not your waist, to pick things up.
- Avoid wearing clothes that put pressure on your waist or stomach.
- Do not lie down for 3 to 4 hours after eating.
Avoid medicines such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain. Take any of your medicines with plenty of water. When you start a new medicine, remember to ask if it will make your heartburn worse.
Try these tips before going to sleep:
- Do not skip meals or eat a large meal for dinner to make up for missed meals.
- Avoid late night snacks.
- Do not lie down right after you eat. Remain upright for 3 to 4 hours after your last meal before you go to bed.
- Raise your bed 4 to 6 inches (10 to 15 centimeters) at the head of your bed, using blocks. You can also use a wedge support that raises the top half of your body when you are in bed. (Extra pillows that raise only your head may not help.)
Drug Treatment
Antacids can help neutralize your stomach acid. They do not help to treat the irritation in your esophagus. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter drugs and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your provider can tell you how to take these drugs. There are two different types of these drugs:
- H2 antagonists: famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid)
- Proton pump inhibitors (PPI): omeprazole (Prilosec or Zegarid), esomeprazole (Nexium), lansoprazole (Prevacid), dexlansoprazole (Dexilant), rabeprazole (AcipHex), and pantoprazole (Protonix)
Follow-up
You will have follow-up visits with your provider to check your esophagus. You may also need to have dental check-ups. GERD can cause the enamel on your teeth to wear away.
When to Call the Doctor
Contact your provider if you have:
- Problems or pain with swallowing
- Choking
- A full feeling after eating a small meal portion
- Weight loss that cannot be explained
- Vomiting
- Loss of appetite
- Chest pain
- Bleeding, blood in your stools, or dark, tarry looking stools
- Hoarseness
References
Abdul-Hussein M, Castell DO. Gastroesophageal reflux disease (GERD). In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier 2023:220-222.
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 129.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-328. PMID: 23419381
Richter JE,Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 46.
Version Info
Last reviewed on: 10/31/2022
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
