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Gastroesophageal Reflux Disease (GERD)

This information describes the causes, symptoms, and treatment of gastroesophageal reflux disease (GERD). 

GERD is the backflow of stomach contents into the esophagus. It is commonly called reflux. It may cause inflammation of the esophagus. (See illustration.) The lower esophagus has a sphincter. This sphincter blocks contents from the stomach from backing up into the esophagus. During swallowing, the sphincter opens to allow food into the stomach.

Causes of GERD 

Reflux occurs if:

  • The sphincter pressure is not strong enough.
  • The pressure within the stomach is greater than the pressure from the sphincter.

Factors that can lead to increased reflux are:

  • Eating or drinking large amounts of:
    • Fat
    • Whole milk
    • Citrus fruits
    • Chocolate
    • Mints
    • Tomatoes
    • Caffeinated drinks (coffee, tea, cola soft drinks)
  • Cigarette smoking
  • Drinking alcohol
  • Lying down, especially after meals
  • Having large meals
  • A hiatal hernia
  • Pregnancy
  • Obesity
  • Exercise after a meal
  • Pressure from the abdomen. This can occur if you strain to move your bowels due to constipation. It may also occur during coughing, bending, or lifting.

Signs and Symptoms

GERD may or may not cause symptoms. When symptoms are present, the most common is heartburn. It usually occurs 30 to 60 minutes after eating. Heartburn may become more severe during exercise or while lying down. Symptoms of GERD that occur when someone is lying down may include:

  • Coughing
  • Choking
  • A burning sensation in the throat
  • Wheezing
  • Hoarseness

If you have reflux while lying down, your stomach fluids can get into your airway.

Antacids or sitting upright may relieve heartburn.

Reflux can cause painful spasms in the chest area. Reflux that does not go away may lead to esophagitis. This is inflammation of the lining of the esophagus. If it is not treated, it can cause ulcers, narrowing, and bleeding of the esophagus. It may also increase the risk for esophageal cancer.

Treatment

The goal of treatment is to reduce reflux. This can be done by:

  • Gravity (sitting up after meals)
  • Strengthening the sphincter with drugs
  • Making stomach contents neutral instead of acidic
  • Reducing abdominal pressure

The following suggestions may help relieve GERD and its symptoms:

  • Do not eat large meals. Rather, eat small, frequent meals.
  • Do not lie down until at least two to three hours after eating.
  • Avoid late night snacks.
  • Avoid:
    • Acidic juices
    • Alcohol
    • Peppermint
    • Caffeinated drinks (coffee, tea, cola soft drinks)
    • Fatty foods
  • Do not smoke cigarettes or use other tobacco products.
  • Sleep with the head of your bed raised 45 degrees.
  • Avoid things that increase abdominal pressure.
    • Limit bending and vigorous exercise.
    • Use cough medicine if you are coughing a lot.
    • Prevent constipation.
    • Lose weight if you are overweight.
  • Take the medicine your doctor prescribes. Take it the way your doctor tells you to.

Follow-Up

Most patients improve with medicine and a change in lifestyle. Let your doctor know if your symptoms do not improve. Also call if you have trouble swallowing. Your doctor may want to examine your esophagus and stomach. Your doctor may recommend an upper endoscopy.