Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into the esophagus.

Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus.

Stomach acid that touches the lining of your esophagus can cause heartburn, also called acid indigestion.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER.

Without treatment, GERD can sometimes cause serious complications over time, such as
  • Esophagitis: Esophagitis is inflammation in the esophagus. Adults who have chronic esophagitis over many years are more likely to develop precancerous changes in the esophagus.
  • Esophageal stricture: An esophageal stricture happens when your esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.
  • Respiratory problems: With GERD you might breathe stomach acid into your lungs. The stomach acid can then irritate your throat and lungs, causing respiratory problems, such as:
    • asthma —a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
    • chest congestion, or extra fluid in your lungs
    • a dry, long-lasting cough or a sore throat
    • hoarseness—the partial loss of your voice
    • laryngitis—the swelling of your voice box that can lead to a short-term loss of your voice
    • pneumonia—an infection in one or both of your lungs—that keeps coming back
    • wheezing—a high-pitched whistling sound when you breathe
  • Barrett’s esophagus: GERD can sometimes cause Barrett’s esophagus. A small number of people with Barrett’s esophagus develop a rare yet often deadly type of cancer of the esophagus.
Anyone can develop GERD, some for unknown reasons. You are more likely to have GERD if you are:
  • overweight or obese
  • a pregnant woman
  • taking certain medicines
  • a smoker or regularly exposed to secondhand smoke
GER and GERD happen when your lower esophageal sphincter becomes weak or relaxes when it shouldn’t, causing stomach contents to rise up into the esophagus. The lower esophageal sphincter becomes weak or relaxes due to certain things, such as:
  • increased pressure on your abdomen from being overweight, obese, or pregnant
  • certain medicines, including
    • those that doctors use to treat asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
    • calcium channel blockers—medicines that treat high blood pressure
    • antihistamines—medicines that treat allergy symptoms
    • painkillers
    • sedatives—medicines that help put you to sleep
    • antidepressants—medicines that treat depression
  • smoking, or inhaling secondhand smoke

A hiatal hernia can also cause GERD. Hiatal hernia is a condition in which the opening in your diaphragm lets the upper part of the stomach move up into your chest, which lowers the pressure in the esophageal sphincter.

If you have gastroesophageal reflux (GER), you may taste food or stomach acid in the back of your mouth.

The most common symptom of gastroesophageal reflux disease (GERD) is regular heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, and in the middle of your abdomen. Not all adults with GERD have heartburn.

Other common GERD symptoms include
  • bad breath
  • nausea
  • pain in your chest or the upper part of your abdomen
  • problems swallowing or painful swallowing
  • respiratory problems
  • vomiting
  • the wearing away of your teeth

Some symptoms of GERD come from its complications, including those that affect your lungs.

If your GER symptoms don’t improve, if they come back frequently, or if you have trouble swallowing, your doctor may recommend testing you for gastroesophageal reflux disease (GERD).

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

Several tests can help a doctor diagnose GERD. Your doctor may order more than one test to make a diagnosis.
  • Upper gastrointestinal (GI) endoscopy and biopsy
  • Upper GI series
  • Esophageal pH and impedance monitoring
  • Bravo wireless esophageal pH monitoring
  • Esophageal manometry

Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medicines, surgery, or a combination.

You may be able to control gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by:
  • not eating or drinking items that may cause GER, such as greasy or spicy foods and alcoholic drinks
  • not overeating
  • not eating 2 to 3 hours before bedtime
  • losing weight if you’re overweight or obese
  • quitting smoking and avoiding secondhand smoke
  • taking over-the-counter medicines
Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes or medicines. You’re more likely to develop complications from surgery than from medicines.
  • Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control. A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of your stomach around your esophagus to add pressure to the lower end of your esophagus and reduce reflux. The surgeon performs the operation at a hospital. You receive general anesthesia and can leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks.
  • Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten your sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten your sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and you receive general anesthesia.

The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques often.