Gastroesophageal reflux disease
Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). Food travels from your mouth to the stomach through your esophagus. GERD can irritate the food pipe and cause heartburn and other symptoms.
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.
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Eating spicy foods, such as pizza, may cause a person to feel heartburn. Although the name may imply the heart, heartburn has nothing to do with the heart itself. Heartburn is pain felt in the chest by a burning sensation in the esophagus. Here, you can see the pizza passing from the mouth to the esophagus and on to the stomach. At the junction between the stomach and esophagus is the lower esophageal sphincter. This muscular sphincter acts as a valve that normally keeps food and stomach acid in the stomach, and prevents the stomach’s contents from regurgitating back into the esophagus. However, certain foods may affect the lower esophageal sphincter, making it less effective. That’s how heartburn begins. The stomach produces hydrochloric acid to digest food. The stomach has a mucous lining that protects it from hydrochloric acid, but the esophagus does not. So, when food and stomach acid regurgitate back into the esophagus, a burning feeling is felt near the heart. This feeling is known as heartburn. Antacids may be used to relieve heartburn by making stomach juices less acidic, thereby reducing the burning feeling felt in the esophagus. If heartburn becomes frequent or prolonged, medical intervention may be necessary to correct the problem.
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.
The esophagus is a narrow, muscular tube that leads from the mouth to the stomach. The esophagus carries food from the mouth to the stomach. A sphincter at the junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into the esophagus.
You've just finished eating a double chili dog, when it hits. That burning, belching feeling, like your dinner has taken a detour back up your throat. You've got heartburn, also known as gastroesophageal reflux disease or GERD, for short. When heartburn becomes a frequent, unwelcome visitor and you're tired of taking medicine to treat it, your doctor may recommend surgery. Normally when you eat, food passes down this tube, called the esophagus. It crosses your diaphragm and enters your stomach through a hole. Sometimes the muscles where your esophagus and stomach meet don't close tightly enough, and this weakness allows acids from your stomach to back up into your esophagus, causing heartburn. The hole in your diaphragm may also be too big, letting part of your stomach slip into an opening in your chest. That's called a hiatal hernia, and it can make your heartburn symptoms even worse. If you don't want to take heartburn medicine anymore, or if you're dealing with complications like ulcers or bleeding in your esophagus, your doctor may recommend surgery to fix your hiatal hernia. Usually the surgery you'll have is called fundoplication. Fundoplication is done while you're under general anesthesia, which means that you'll be asleep and you won't feel any pain. Before your surgery, your doctor will ask you to stop taking drugs like aspirin or warfarin, which makes it harder for your blood to clot. Also, you shouldn't eat or drink anything after midnight the night before your surgery. If you have open surgery, the surgeon will make one large cut in your belly area. With laparoscopic surgery, there are more cuts, but they're much smaller. The surgeon will use a thin tube with a camera attached to see through these tiny holes and perform the surgery. A newer form of the procedure passes a special camera down your mouth into your esophagus. Whatever way the surgery is done, the goal is to close your hiatal hernia with stitches and tighten the opening in your diaphragm to keep your stomach from poking through. The surgeon will also wrap the upper part of your stomach around the end of your esophagus so that acids from your stomach can't back up into your esophagus. Just like any procedure, hiatal hernia surgery can have risks. You might have bleeding, an infection, breathing problems, bloating, or pain when you swallow. Call your doctor for any symptoms that bother you or don't go away. Expect to stay in the hospital for about 4 to 6 days, and then spend a month to 6 weeks recovering at home with the open surgical procedure. Laparoscopic surgery will shorten your hospital stay to 1 to 3 days, and you'll be back on your feet and at work in just 2 to 3 weeks. Anti-reflux surgery is safe, and it works. After your surgery, you should have fewer problems with heartburn. But if that burning feeling creeps back up again, you might need to have a repeat surgery. To avoid another procedure, take your heartburn medicine if you need it. Oh, and take it easy on those chili dogs!
Causes
When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter (LES).
When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus.
The risk factors for reflux include:
- Use of alcohol (possibly)
- Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
- Obesity
- Pregnancy
- Scleroderma
- Smoking or tobacco use
- Lying down within 3 hours after eating
Heartburn and gastroesophageal reflux can be caused by or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:
- Anticholinergics (for example, sea sickness medicine)
- Beta-blockers for high blood pressure or heart disease
- Bronchodilators for asthma or other lung diseases
- Calcium channel blockers for high blood pressure
- Dopamine-active drugs for Parkinson disease
- Progestin for abnormal menstrual bleeding or birth control
- Sedatives for insomnia or anxiety
- Theophylline (for asthma or other lung diseases)
- Tricyclic antidepressants
Talk to your health care provider if you think one of your medicines may be causing heartburn. Never change or stop taking a medicine without first talking to your provider.
Symptoms
Common symptoms of GERD include:
- Feeling that food is stuck behind the breastbone
- Heartburn or a burning pain in the chest
- Nausea after eating
Less common symptoms are:
- Bringing food back up (regurgitation)
- Cough or wheezing
- Difficulty swallowing
- Hiccups
- Hoarseness or change in voice
- Sore throat
Symptoms may get worse when you bend over or lie down, or after you eat. Symptoms may also be worse at night.
Exams and Tests
You may not need any tests if your symptoms are mild.
If your symptoms are severe or they come back after you have been treated, your provider may recommend a test called an upper endoscopy (EGD).
- This is a test to examine the lining of the esophagus, stomach, and first part of the small intestine.
- It is done with a small camera (flexible endoscope) that is inserted down the throat.
You may also be recommended to have one or more of the following tests:
- A test that measures how often stomach acid enters the esophagus
- A test to measure the pressure inside the lower part of the esophagus (esophageal manometry)
A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.
Treatment
You can make many lifestyle changes to help treat your symptoms such as avoiding tobacco, alcohol, or foods that cause your symptoms.
Other tips include:
- If you are overweight or obese, in many cases, losing weight can help.
- Raise the head of the bed if your symptoms get worse at night.
- Have your dinner 2 to 3 hours before going to sleep.
- Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.
- Take all of your medicines with plenty of water. When your provider gives you a new medicine, ask whether it will make your heartburn worse.
You may use over-the-counter antacids after meals and at bedtime, although the relief may not last very long. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter and prescription medicines can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, provider, or nurse can tell you how to take these medicines.
- Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach.
- H2 blockers also lower the amount of acid released in the stomach.
Anti-reflux surgery may be an option for people whose symptoms do not go away with lifestyle changes and medicines. Heartburn and other symptoms should improve after surgery. But you may still need to take medicines for your heartburn.
There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).
Outlook (Prognosis)
Most people respond to lifestyle changes and medicines. However, many people need to continue taking medicines to control their symptoms.
Possible Complications
Complications may include:
- Worsening of asthma
- A change in the lining of the esophagus that can increase the risk of cancer (Barrett esophagus)
- Bronchospasm (irritation and spasm of the airways due to acid)
- Long-term (chronic) cough or hoarseness
- Dental problems
- Ulcer in the esophagus
- Stricture (a narrowing of the esophagus due to scarring from chronic irritation)
When to Contact a Medical Professional
Contact your provider if symptoms do not improve with lifestyle changes or medicine.
Also contact if you have:
- Bleeding
- Choking (coughing, shortness of breath)
- Feeling filled up quickly when eating
- Frequent vomiting
- Hoarseness
- Loss of appetite
- Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
- Weight loss
- A feeling like food or pills are sticking behind the breast bone
Prevention
Avoiding factors that cause heartburn may help prevent symptoms. Obesity is linked to GERD. Maintaining a healthy body weight may help prevent the condition.
References
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 124.
Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the diagnosis and management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56. PMID: 34807007
National Institute of Diabetes and Digestive and Kidney Diseases website. Acid reflux (GER & GERD) in adults.
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: 1/30/2023
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Internal review and update on 02/10/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
