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Gastroesophageal reflux disease

Definition

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This can irritate the esophagus and cause heartburn and other symptoms.

Alternative Names

Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD

Causes

When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter, or LES.

When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus.

The risk factors for reflux include:

Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:

Talk to your doctor if you think one of your medicines may be causing heartburn. Never change or stop taking a medicine without first talking to your doctor.

Symptoms

Common symptoms of GERD include:

Less common symptoms are:

Symptoms may get worse when you bend over or lie down, or when you eat. Symptoms may also be worse at night.

Exams and Tests

You may not need any tests if your symptoms are mild.

If your symptoms are severe or they come back after you have been treated, your doctor may perform a test called an upper endoscopy (EGD)

You may also need one or more of the following tests:

A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.

Treatment

You can make many lifestyle changes to help treat your symptoms.

Other tips include:

You may use over-the-counter antacids after meals and at bedtime, although the relief may not last very long. Common side effects of antacids include diarrhea or constipation.

Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.

Anti-reflux surgery may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn.

There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).

Outlook (Prognosis)

Most people respond to lifestyle changes and medicines. However, many patients need to continue taking drugs to control their symptoms.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if symptoms do not improve with lifestyle changes or medicine.

Also call if you have:

Prevention

Following heartburn prevention techniques may help prevent symptoms. Obesity is linked to GERD, so maintaining a healthy body weight may help prevent the condition.

References

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308-328.

Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 43.

Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-797.

Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial. JAMA. 2011;305:1969-1977.



Review Date: 7/18/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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