Gastroesophageal reflux disease (GERD) is a chronic condition that involves a backflow of stomach contents into the esophagus. This can happen when the sphincter muscle that separates the esophagus from the stomach does not function properly, or when pressure within the stomach is greater than that exerted by the sphincter.
Over the course of months and years, exposure to stomach acids and bile can cause inflammation, ulceration, and changes in the lining of the lower part of the esophagus. This can turn into a condition called Barrett’s esophagus.
Chronic backflow of stomach contents into the esophagus due to GERD can cause heartburn, a burning feeling in the throat or chest. For many people this sensation occurs 30 to 60 minutes after eating and becomes more severe during exercise or when lying down. It can also lead to sudden fits of coughing at night during sleep. Other symptoms include regurgitation; “water brash,” a sour taste in the mouth that usually occurs after waking up; and sometimes even difficulty swallowing.
Some people with GERD have only a sore throat, chronic cough, or hoarseness. Others have no symptoms at all.
Several lifestyle and dietary habits can make gastroesophageal reflux disease continue or worsen. These include smoking, lying down after eating, and eating large amounts of fatty foods, whole milk, citrus fruits, chocolate, mints, or alcohol. Weight gain can also cause or worsen the symptoms of GERD.
GERD often occurs in people who have a hiatal hernia, a condition that allows a part of the stomach to move up into the chest.
If you have had GERD for more than ten years, we may recommend that you get screened for Barrett’s esophagus, especially if your reflux disease started when you were very young, you are a white male over 50, you have a hiatal hernia, or you are overweight.
One of the benefits of getting treatment for GERD at Memorial Sloan Kettering is that each member of our team, who together have decades of experience in different areas, can help you decide which treatment may be best for you.
To reduce the symptoms and discomfort of GERD, and to prevent further irritation of the esophagus, we may recommend medications that reduce stomach acid.
Many people get relief from heartburn and other symptoms with medications. We often also recommend these lifestyle changes:
- Lose weight if you are overweight or obese.
- Sit up after meals.
- Eat small, frequent meals instead of large meals.
- Avoid late-night snacking, acidic juices, carbonated beverages, caffeinated drinks, fatty foods, and alcohol.
- Stop smoking or chewing tobacco.
- Stop drinking caffeinated and alcoholic beverages.
- Sleep with the head of your bed elevated 45 degrees.
- Prevent constipation.
- Minimize or treat coughing.
Many people with chronic gastroesophageal reflux disease take medications. These often help, but we may recommend surgery if your medicines stop working, if your symptoms are severe, or if you don’t want to take medication for the rest of your life.
The most common surgery for GERD is called Nissen fundoplication. A surgeon tightens the sphincter — the valve between the esophagus and the stomach — by wrapping or folding the stomach. It often helps with symptoms and can be done with minimally invasive techniques.
Many people with GERD have a hiatal hernia. This means that a section of the stomach is pushed up through the diaphragm into the chest. Our surgeons can repair this type of hernia while doing the fundoplication surgery, putting the stomach back in its correct place and fixing the diaphragm.
Surgery is usually recommended to fix very large hiatal hernias, especially in people who have chest pain with eating, difficulty swallowing, regurgitation after eating, inhalation of food or liquid into the lungs, bleeding, or a feeling of fullness soon after eating.