Gastroesophageal reflux disease

medical animation:





Alternative names

Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic
Definition Return to top

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Causes, incidence, and risk factors

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

Symptoms

Heartburn
Involves a burning pain in the chest (under the breastbone)
Increased by bending, stooping, lying down, or eating
Relieved by antacids
More frequent or worse at night
Belching
Regurgitation of food
Nausea and vomiting
Vomiting blood
Hoarseness or change in voice
Sore throat
Difficulty swallowing
Cough or wheezing
Signs and tests

A positive stool guaiac
Continuous esophageal pH monitoring showing reflux
Endoscopy showing ulceration or inflammation of the esophagus
Esophageal manometry showing abnormal sphincter pressure
A barium swallow showing reflux
A positive Bernstein test for gastric acid reflux
Treatment

General measures include:

Weight reduction
Avoiding lying down after meals
Sleeping with the head of the bed elevated
Taking medication with plenty of water
Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
Avoiding alcohol and tobacco
Medications that alleviate symptoms include:
Antacids after meals and at bedtime
Histamine H2 receptor blockers
Promotility agents
Proton pump inhibitors
Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.
Expectations (prognosis)

The majority of people respond to nonsurgical measures with behavioral modification and medications.

Complications
Inflammation of the esophagus
Stricture
Esophageal ulcer
Hoarseness, bronchospasm
Chronic pulmonary disease
Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Calling your health care provider

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Prevention

Avoid foods and activities that worsen symptoms. Maintain a healthy weight.


After basketball practice, Ella looks forward to hanging out with her teammates and sharing a large pizza with extra cheese and a pitcher of soda — a well-deserved reward after hours of shooting free throws and running laps.

Lately, though, Ella hasn't been enjoying her post-practice treat like she used to. After eating, she feels an odd burning sensation in her chest and sometimes in her throat. It's that uncomfortable feeling people call "heartburn."

Frequent, strong heartburn is one of the signs of gastroesophageal reflux disease, more commonly known as GERD or acid reflux. GERD doesn't just affect older people who eat too much while watching TV. Active, healthy teens can have GERD, too.

What Is GERD?
Gastroesophageal (pronounced: gas-tro-ih-sah-fuh-jee-ul) reflux disease is a disorder that results from stomach acid moving backward from the stomach into the esophagus. GERD usually happens because the lower esophageal sphincter (LES) — the muscular valve where the esophagus joins the stomach — is weak or does not close properly.

When the stomach contents move backward into the esophagus, this is known as gastroesophageal reflux. (Because the stomach makes acid to help a person digest food, gastroesophageal reflux is also known as acid reflux). Almost everyone has this type of reflux at some time. Often a person isn't even aware that it is happening.

Sometimes reflux causes the burning sensation of heartburn that most of us occasionally feel. But although lots of people have heartburn from time to time, that doesn't mean that they have GERD. When a person has GERD, heartburn or other symptoms happen much more often and cause serious discomfort.

GERD can be a problem if it's not treated because, over time, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. In adults, long-lasting, untreated GERD can lead to permanent damage of the esophagus and sometimes even cancer.

What Causes GERD?
No one knows for sure why people get GERD. Although lots of different things may contribute to the condition, doctors believe that the way a person's LES works is the main reason why people have gastroesophageal reflux.

The LES is a muscular ring at the bottom of the esophagus where it joins the stomach. As a person swallows, muscles in the esophagus move the food down into the stomach. The LES relaxes just enough to allow food and liquids into the stomach, but then the powerful muscles in the LES contract (tighten) to stop food and liquids from moving back up the esophagus. In other words, the job of the LES is to prevent reflux.

Sometimes, though, the LES may not be able to do its job for various reasons. In some people, the LES is too weak to tighten properly. In other cases, the LES may not close quickly enough, allowing stomach contents to wash back up.

If a person has eaten way too much, the stomach may be so stretched full that the LES can't do its job properly.

In some people who have GERD, a hiatal hernia (pronounced: high-ay-tull her-nee-ah) is to blame. A hiatal hernia is an opening in the diaphragm (the muscle that separates the abdomen and chest) where the esophagus joins the stomach. The hernia can allow the uppermost part of the stomach to bulge through the diaphragm into the chest area, interfering with how the LES works. Most teens who have GERD do not have a hiatal hernia.

Doctors do know that some things can make GERD worse, including obesity, drinking alcohol, and pregnancy. Certain foods and medications can also worsen GERD symptoms; for example:

citrus fruits
chocolate
drinks or foods with caffeine
fatty and fried foods
garlic and onions
mint flavorings
spicy foods
tomato-based foods, like spaghetti sauce, chili, and pizza
How Do People Know They Have GERD?
Often, people who have GERD notice that they regularly have the pain of heartburn in the chest or stomach — and their heartburn can last up to a couple of hours. Lots of people who have GERD notice their heartburn is worse after eating.

Regurgitation is also a sign that a person may have GERD, although, like heartburn, occasional regurgitation is common for everyone. (Regurgitation is when food and liquid containing stomach acid comes back up into the throat or mouth.)

Other symptoms of GERD include:

a sore, raw throat or hoarse voice
a frequent sour taste of acid, especially when lying down
a feeling of burping acid into the mouth
trouble swallowing
a feeling that food is stuck in the throat
a feeling of choking that may wake them up
a dry cough
bad breath
You should talk to your parents and visit your doctor if you've had heartburn that doesn't seem to go away or any other symptoms of GERD for a while.

How Doctors Diagnose GERD
If a doctor thinks you might have GERD, he or she will do a physical examination. Your doctor will also ask about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.


If your doctor suspects you might have GERD, he or she may refer you to a pediatric gastroenterologist, a doctor who treats kids and teens who have diseases of the gastrointestinal system (the esophagus, stomach, intestines, and other organs that aid in digestion).

Doctors sometimes run the following tests to diagnose GERD or rule out other possible problems:

A special X-ray called a barium swallow radiograph can help doctors see whether liquid is refluxing into the esophagus. It can also show whether the esophagus is irritated or whether there are other abnormalities in the esophagus. With this test, the person drinks a special solution (barium, a kind of chalky liquid); this liquid then shows up on the X-rays.
An upper endoscopy (pronounced: en-das-ko-pee) allows the doctor to look at the esophagus, stomach, and part of the small intestines using a tiny camera. For this test, the doctor first gives the patient a medicine to help him or her relax, then sprays the throat to numb it. The doctor then slides a thin, flexible plastic tube called an endoscope down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. During the endoscopy, the doctor also may use small tweezers (forceps) to remove a piece of tissue for biopsy. A biopsy can reveal damage caused by acid reflux or infection and help rule out other problems.
In another kind of test, called a 24-hour pH-probe study, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. The tube is connected to a device that monitors the acid levels in the esophagus as the person goes about normal daily activities. This test is useful for diagnosing people who have symptoms of GERD but no damage to the esophagus. It also can detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing.
How Can GERD Be Treated?
Treatment for GERD depends on how severe a person's symptoms are. For some people, treatment may just include lifestyle changes, such as changing what they eat or drink. Others will need to take medications. In very rare cases, when GERD is particularly severe, a doctor will recommend surgery.

The following lifestyle changes can help the symptoms of GERD or even prevent the condition:

quitting smoking
avoiding alcohol
losing weight if you are overweight
eating small meals
wearing loose-fitting clothes
avoiding caffeine
avoiding foods that trigger reflux
It can also help to not lie down for 3 hours after a meal and not eat 2 to 3 hours before going to bed. Doctors sometimes also recommend raising the head of the bed about 6 to 8 inches (15 to 20 centimeters). Before you start a major bedroom makeover, though, talk to your doctor and your parents about the best sleeping position for you.

A doctor may also recommend different medications to relieve symptoms. Over-the-counter antacids, such as Alka-Seltzer or Maalox, work by neutralizing stomach acid and can help with mild symptoms. Other medications called H2 blockers are available over the counter and by prescription and help by blocking the production of stomach acid. If your doctor thinks you should take these, he or she will recommend certain over-the-counter medications or write you a prescription.

More powerful prescription drugs called proton pump inhibitors also reduce the amount of acid the stomach produces. Doctors often prescribe these for people with more severe or persistent GERD.

For some teens, doctors advise combining medications to control different symptoms. For example, people who get heartburn after eating can try taking both antacids and H2 blockers. The antacid goes to work first to neutralize the acid in the stomach, while the H2 blocker acts on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.

Surgery is a last resort for people with GERD and is rarely needed in healthy teens. The typical surgical treatment for GERD is called fundoplication (pronounced: fun-doh-plih-kay-shun). During the surgery, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent reflux. Fundoplication has been used in people of all ages, even babies with severe GERD.

Living With GERD
The key to living with GERD is to not ignore it. Early diagnosis and treatment can help reduce or even eliminate uncomfortable symptoms. Left untreated, however, GERD can cause permanent damage to the esophagus.

One possible long-term effect of GERD is something called Barrett's esophagus. In this condition, the cells in the esophagus change and become precancerous because they have been irritated by stomach acid for so long. Eventually, it may lead to cancer of the esophagus. Barrett's esophagus is mostly found in adults who have had GERD for many years. But you can help avoid it by dealing with your GERD now.

You'll probably find that one of the simplest ways to make living with GERD easier is to avoid the things that trigger your symptoms. Some people will have to limit certain foods; others may have to give them up entirely. It all depends on your individual symptoms.

It can be hard to give up sodas or favorite foods at first. But after a while, lots of people discover that they feel so much better that they don't miss the problem foods as much as they thought they would.

GERD

Almost 30 to 40% of the population experiences occasional heartburn. Many believe that these are just bothersome symptoms.

But frequent heartburn may indicate a disease called GERD, Gastro Esophageal Reflux Disease.

The gastro intestinal system includes: esophagus, the lower esophageal sphincter, stomach containing gastric juice, pyloric sphincter, and duodenum.

The food swallowed enters through the esophagus into the stomach where it is digested by acid secretions present in the gastric juices.

The lower esophageal sphincter prevents the return of the gastric juice back to the esophagus.

Abnormal functioning of lower esophageal sphincter causes GERD. This results in backflow of the gastric contents to the esophagus and damages it.

Symptoms of GERD are

* Heartburn
* Regurgitation
* Feeling of lump in throat.