Gastroesophageal Reflux Disease (GERD)

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This topic is about gastroesophageal reflux disease (GERD) in adults. For information on reflux in babies and children, see Gastroesophageal Reflux in Babies and Children.

What is gastroesophageal reflux disease (GERD)?

Reflux means that stomach acid and juices flow from the stomach back up into the tube that leads from the throat to the stomach (esophagus). This causes heartburn. When you have heartburn at least 2 times a week, it is called gastroesophageal reflux disease, or GERD.

Eating too much or bending forward after eating sometimes causes heartburn and a sour taste in the mouth. But having heartburn from time to time doesn't mean you have GERD. With GERD, the reflux—and heartburn—last longer and come more often. If this happens to you, it is important to treat it, because GERD can cause ulcers and damage to the esophagus.

See a picture of the esophagus.

What causes GERD?

Normally when you swallow your food, it travels down the food pipe (esophagus) to a valve that opens to let the food pass into the stomach and then closes. With GERD, the valve doesn't close tightly enough. Stomach acid and juices flow from the stomach and back up (reflux) into the esophagus.

What are the symptoms?

The main symptom of GERD is heartburn. It may feel like a burning, warmth, or pain just behind the breastbone. It is common to have symptoms at night when you are trying to sleep.

If you have pain behind your breastbone, it is important to make sure it is not caused by a problem with your heart. The burning sensation caused by GERD usually occurs after you eat. Pain from the heart usually feels like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull ache. It occurs most often after you are active.

How is GERD diagnosed?

First, your doctor will do a physical exam and ask you questions about your health. You may or may not need further tests. Your doctor may just treat your symptoms by prescribing medicines that reduce or block stomach acid. These include H2 blockers (for example, Pepcid) or proton pump inhibitors (for example, Prilosec). If your heartburn goes away after you take the medicine, your doctor will likely diagnose GERD.

In some cases doctors do tests to be sure that you have GERD or to look for other problems.

• Endoscopy is a test that lets the doctor look at the inside of your esophagus and stomach through a tiny camera in a thin, flexible, lighted tube (endoscope).
• Esophagus testing is a group of tests that check the condition of the esophagus and how well it works.
• An upper gastrointestinal series helps your doctor examine the upper part of your digestive system. These X-rays can show other health problems that may be causing your symptoms.

How is it treated?

For mild symptoms of GERD, you can try over-the-counter medicines. These include antacids (for example, Tums), H2 blockers (for example, Pepcid), or proton pump inhibitors (for example, Prilosec OTC). Changing your diet, losing weight if needed, and making other lifestyle changes can also help. If you still have symptoms after trying lifestyle changes and over-the-counter medicines, talk to your doctor.

Your doctor may recommend surgery if medicine doesn't work or if you can't take medicine because of the side effects. For example, fundoplication surgery strengthens the valve between the esophagus and stomach. But many people continue to need some medicine even after surgery.

GERD is common in pregnant women. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. Most of the time, symptoms get better after the baby is born.

How can you manage GERD?

Many people with GERD have it for the rest of their lives. You may need to take medicine for many years to help control the symptoms. But making certain lifestyle changes can also help. Here are some tips that may help your symptoms:

• Quit smoking or using tobacco.
• After eating, wait 2 to 3 hours before you lie down.
• Raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting blocks under the frame or a foam wedge under the head of the mattress.
• If you are overweight, lose weight. Even losing a small amount of weight can help.
• Wear loose-fitting clothes around your waist and midsection. This puts less pressure on the stomach.
• Try to eat smaller meals more often, and avoid any foods that make you feel worse.
• Use chewing gum or hard candies to increase the amount of saliva your mouth produces. Saliva washes stomach juices out of the esophagus into the stomach and can control stomach acid.

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