GERD & Acid Reflux
What is Acid Reflux?
Acid reflux, or gastroesophageal reflux, is when the liquids in the stomach flow back into the esophagus.
When you eat, food flows through the esophagus and into the stomach. In between the esophagus and stomach is a circular muscle called the lower esophageal sphincter (LES). During normal function, the LES relaxes to let food through and then contracts to prevent backflow into the esophagus.
Even in healthy people, stomach acid may occasionally wash back into the esophagus. These are normally brief periods without symptoms.
What is GERD?
Acid Reflux/GER becomes GERD (gastroesophageal reflux disease) when it causes injury to the esophagus or bothersome symptoms. Damage to the esophagus is more likely when acid reflux is frequent, happening 2 or more times per week.
- Heartburn – a burning sensation in your chest, most often after eating. Heartburn may be worse at night when you lay down.
- Chest pain
- Trouble swallowing
- Regurgitating food or sour liquid
- Feeling like there is a lump in your throat
Acid reflux at night may cause:
- Sleep disruption
When to see a doctor: If you have chest pain, shortness of breath, or pain in your jaw or arm – seek immediate care. These could be signs of a heart attack.
Schedule an appointment with a GERD specialist if you:
- Have frequent or severe symptoms of GERD
- Take over-the-counter heartburn medications two or more times per week
Frequent acid reflux causes GERD.
The lower esophageal sphincter (LES) keeps stomach acid from washing back into the esophagus. If the LES is weakened, stretched, or abnormally relaxed, stomach acid can flow back into the esophagus (acid reflux).
The acidic fluid can irritate and damage the lining of the esophagus, often causing inflammation and over time, more serious conditions.
GERD Risk Factors
Conditions that increase the risk of GERD include:
- Hiatal hernia (weakening in the diaphragm, causing the stomach to slip through the diaphragm into the chest)
- Connective tissue disorders (e.g. scleroderma)
- Gastroparesis (delayed stomach emptying)
Lifestyle factors can increase the risk of acid reflux and GERD:
- Eating large meals
- Eating late at night or laying down after eating
- Eating fatty or fried foods
- Drinking alcohol or coffee
- Taking certain medications (e.g. aspirin)
Your doctor may be able to diagnose GERD or acid reflux by examining your medical history, discussing your signs and symptoms, and performing a physical exam.
It’s important to rule out other conditions or complications while confirming the diagnosis of GERD.
To do this, your doctor may recommend:
- Upper Endoscopy – This is a common procedure used to inspect and evaluate the esophagus. A small, flexible tube with a light and camera are passed through the esophagus, stomach, and small intestine. This allows your doctor to evaluate any damage to the esophagus caused by acid reflux or GERD. Your doctor may remove a small tissue sample (biopsy) for further testing.
Complications of GERD and Acid Reflux
Ulcers – Stomach acid in the esophagus can cause ulcers. These ulcers have the potential to bleed. To check for bleeding ulcers, your doctor may recommend a stool sample test called hemocult.
Stricture – Damage caused by acid reflux can cause the esophagus to scar and narrow. This is called stricture. Over time, stricture could cause a blockage of food and require treatment. The scar tissue is a result of ulcers that occur and heal over time.
Lung and throat problems – Acid reflux in the throat could lead to irritation or inflammation of the vocal cords or a sore throat. If the acid is inhaled into the lungs, it could cause aspiration pneumonia or symptoms of asthma. If the acid reflux is chronic, it could eventually cause permanent lung damage including pulmonary fibrosis or bronchiectasis.
Barrett’s esophagus – Barrett’s esophagus occurs when the cells in the lower esophagus transform. The transformation is usually caused by damage to the esophageal lining, most often from chronic acid reflux or GERD. There is a small chance these cells may develop into cancer. Patients with Barrett’s esophagus should have an upper endoscopy done periodically to look for early signs of cancer.
Esophageal cancer – Barrett’s esophagus is a major risk factor for developing esophageal cancer. The rate of esophageal cancer is on the rise, but relatively few people with GERD develop Barrett’s esophagus and even fewer people with Barrett’s esophagus develop esophageal cancer.
Reducing acid in the esophagus is the goal of treatment for GERD and acid reflux. Your doctor will likely recommend lifestyle changes and over the counter medications at first. If these do not work, your doctor may recommend prescription medications or surgery for GERD.
Antacids may provide short-term relief from acid reflux. They are available over the counter and include products like Tums®, Maalox®, and Mylanta®.
Histamine antagonists reduce acid production in the stomach, but may not be as effective as proton pump inhibitors.
Histamine antagonists available in the US include ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).
Changes in diet and lifestyle may be effective for some people. You may decide to try these before seeking medical treatment for mild symptoms of acid reflux. If you have severe symptoms, you should be evaluated by a doctor for treatment.
Lose weight – Those who are overweight may see a reduction in acid reflux by losing weight. Weight loss has numerous other health benefits, including a reduced risk of diabetes and heart disease.
Raise the head of your bed 6-8 inches – Some people who experience nighttime acid reflux may benefit from elevating the head of their bed 6 to 8 inches. This may help keep stomach acid from entering the esophagus.
Avoid Smoking – Saliva helps neutralize stomach acid, but smoking can impact saliva production and the chemical balance. Smoking can also cause a pressure reduction in the muscle that stops stomach acid from entering the esophagus. This muscle is called the Lower Esophageal Sphincter, or LES.
Chew gum or use oral lozenges – These may help increase saliva production which may help clear the esophagus of stomach acid.
Avoid Fatty Foods – Fatty foods take longer to digest in your stomach and cause additional acid production. You can still enjoy lean meats, fish, poultry, etc.
Avoid Caffeine – Too much caffeine can relax the LES that keeps stomach acid from entering the esophagus.
Avoid Chocolate – The acidity in cocoa powder, caffeine content, and ingredients that may cause loosening of the LES make chocolate a triple threat. Many people may not see symptoms from eating chocolate in moderation. Chocolate may be more likely to cause issues when combined with other possible triggers like eating right before bed.
Avoid Peppermint – Peppermint candies, oil, and teas get much of their distinct flavor from their menthol content. The numbing/soothing effect of menthol can relax the LES and cause acid reflux. Try spearmint as an alternative, which has significantly less menthol content.
Avoid Overeating – When you’re stomach is overly full, your LES may have trouble closing completely, which could cause acid reflux.
Avoid Eating Before Bed – Eating while lying down or going to bed soon after eating can increase acid reflux. When upright, your body has gravity’s help to keep stomach acid from entering the esophagus. Lying down makes it easier for stomach acid to flow into the esophagus causing acid reflux. Try to eat two or three hours prior to bedtime.
Avoid Tight-Fitting Clothes – Tight clothing may cause acid reflux by constricting the stomach and forcing acid into the esophagus. Examples include belts, tight pants, shapewear (e.g. Spanx), or other constraining clothing.
Avoid Heavy-Lifting – Strenuous exercises that constrain the abdomen, including heavy lifting or stomach crunches, can cause acid reflux. In general, exercise and weight loss are good for controlling GERD and acid reflux. Your doctor can help recommend the best exercise routine for your goals.
Proton pump inhibitors
Most people with moderate to severe acid reflux are treated with proton pump inhibitors (PPIs). PPIs include omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®), dexlansoprazole (Kapidex®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
A typical PPI treatment lasts 8 weeks. Using the lowest possible dose of these medications that manage symptoms or prevents complications is the best strategy.
If your symptoms are not managed by a PPI, your doctor may recommend a different PPI or using a stronger dose. Additional testing may be necessary to determine the next course of treatment.
Surgery for GERD is often not necessary due to advances in medical therapy. However, if your condition does not respond to other therapies, your doctor may recommend a surgical option.
Typically, the goal of GERD surgery is repairing the hiatus hernia or strengthening the lower esophageal sphincter.
Laparoscopic Nissen fundoplication is the most common surgical treatment for GERD. This procedure wraps the lower part of the stomach around the lower end of the esophagus.
Your doctor will discuss the risks and complications of GERD surgery, which include a sense of bloating/gas, difficulty swallowing, and diarrhea.