Gastroesophageal reflux disease (GERD) is a chronic condition that occurs when gastric juice, bile, or stomach acid reflux from the stomach up into the esophagus. This irritates the esophagus lining, which produces the symptoms you feel.
A sphincter (group of muscles) at the bottom of the esophagus (lower esophageal sphincter) usually prevents the reflux of fluid back into the esophagus. Sometimes that sphincter is very loose (hiatal hernia), and sometimes it occasionally relaxes (transient relaxation of the lower esophageal sphincter). Either of these conditions can allow gastric contents to make their way into the esophagus.
If left untreated long-term, reflux can cause the following complications:
Esophagitis (ulcers or acid burn)
Strictures (bands of scar tissue)
Barrett’s esophagus (a precancerous change to the lining of the esophagus)
Acid Reflux or Heartburn
Acid reflux refers to the backflow of stomach contents into the esophagus. This can lead to a painful burning sensation in the chest, known as heartburn.
Heartburn is the most common symptom of acid reflux. You can’t experience heartburn without acid reflux. But you can have acid reflux that doesn’t cause heartburn.
When acid reflux occurs more frequently, it becomes a disease. GERD is a condition that involves at least two episodes of acid reflux weekly. This is a more severe form of acid reflux that can cause a range of symptoms.
Symptoms of GERD
The symptoms of GERD vary widely from person to person. Factors such as diet, medications, and lifestyle choices can either worsen or improve your symptoms.
Many factors can increase your risk of GERD. Some of these factors are outside your control. Whereas others are modifiable.
Common risk factors for GERD include:
Slow stomach emptying
H. Pylori infection
When to See a Doctor for GERD
Most people experience esophageal reflux at some point in their lives. If it’s just a few symptoms that come and go and are easily controlled with diet changes or over-the-counter medications, it’s unlikely that you need to seek medical care.
If your symptoms persist longer than a couple of weeks or don’t improve with over-the-counter medications, then I recommend evaluation by a doctor. It’s also best to see a doctor if you experience any swallowing problems, bleeding, weight loss, or loss of appetite with your reflux symptoms. People who are overweight and who smoke or drink excessive alcohol are also at increased risk for long-term damage from reflux and should be evaluated by a doctor.
The main thing I worry about in my patients with long-term reflux is the progression to Barrett’s esophagus or esophageal cancer. The best way to prevent that from happening is to see a doctor and get your acid reflux under tighter control.
Your doctor can often diagnose GERD based on your symptoms, medical history, and physical examination. In some cases, your doctor may need to confirm a diagnosis of GERD with medical tests. Your doctor may recommend testing if your symptoms are a sign of a medical complication or another condition. Testing may also be necessary if medication doesn’t improve your GERD symptoms.
The following tests can help diagnose GERD:
Upper endoscopy. This test examines the inside of your esophagus with an endoscope. It can detect signs of damage, such as inflammation, scar tissue, and ulcers. During this test, your doctor can biopsy abnormal tissue and treat any medical problems.
Esophageal pH monitoring. This test tracks when stomach acid flows into the esophagus and how long it stays there. Esophageal pH monitoring is the gold standard for GERD diagnosis and can determine if acid reflux is the cause of your symptoms.
Esophageal manometry. This test measures the muscle contractions in the esophagus. It can detect weakness in the lower esophageal sphincter (LES), which connects the esophagus and stomach. Your doctor may recommend this test if you have trouble swallowing.
GERD Treatment Options
GERD treatment options focus on keeping the LES closed and reducing stomach acid production. This can prevent stomach acid from flowing into the esophagus. Depending on the severity of your symptoms, treatment with diet changes, medication, or surgery may help.
Making dietary changes is often the first step in the treatment of GERD. Avoiding trigger foods like acidic and fatty foods can prevent the LES from relaxing.
Common trigger foods for GERD include:
Citrus fruits such as oranges and grapefruit
Tomatoes and tomato-based products
Coffee or tea
If you have symptoms of GERD, adding more alkaline foods to your diet may provide some relief. These are foods that have a high pH, such as root vegetables, bananas, and oatmeal. Alkaline foods can offset the acidity in your stomach and neutralize stomach acid.
Eating high-fiber foods like whole grains, fruit (not citrus fruits), and vegetables can also improve acid reflux symptoms. Fiber helps you feel full and can stop you from overeating. This can prevent the stomach contents from pressing against the LES and leaking into the esophagus.
What’s more, foods high in fiber absorb liquids like stomach acid, which can make it less likely for reflux to occur. Consuming a fiber-rich diet can reduce the frequency of acid reflux and heartburn.
Your doctor may prescribe medication if symptoms of GERD aren’t controlled by diet or lifestyle changes. Certain medications can decrease stomach acid levels and improve upper gastrointestinal motility.
The most common medications for GERD treatment are:
Antacids. This medication can treat mild GERD or infrequent acid reflux by neutralizing stomach acid. But you shouldn’t take this too often. If you take antacids frequently, your stomach can start to produce even more stomach acid.
Histamine blockers. This type of medication reduces acid secretion in the stomach. It can relieve symptoms of GERD for 3-15 hours.
Proton pump inhibitors (PPIs). This is the most effective medication for GERD. PPIs lower stomach acid production for up to 24 hours. Depending on the severity of GERD, your symptoms may improve within 1-3 days of starting PPIs.
Foaming agents. This type of medication covers the stomach in foam to prevent stomach acid from entering the esophagus. Foaming agents may also coat the esophagus and protect it from GERD damage.
Prokinetic agents. This medication improves muscular contractions in the upper gastrointestinal tract to speed up stomach emptying. Reducing the time that food sits in the stomach can decrease stomach acid production.
Your doctor may recommend surgery if medication doesn’t relieve your symptoms or if you’re concerned about the side effects of long-term medication use. Surgery may be the best treatment option for severe cases of GERD.
GERD surgical treatment options include:
Nissen fundoplication. This is a laparoscopic procedure that strengthens the LES by tying the upper part of the stomach around it. If a hiatal hernia is the cause of your reflux, your doctor can repair it during this procedure.
LINX. This procedure inserts a titanium ring around the lower esophagus. The ring reinforces the LES and prevents it from spontaneously relaxing due to stomach pressure like reflux.
Stretta. This procedure uses radiofrequency energy to heat the esophageal muscles, thickening the esophagus and stomach barrier.
Transoral incisionless fundoplication (TIF). This endoscopic procedure reconstructs the LES by wrapping the stomach around it. Like the Nissen fundoplication, TIF prevents acid reflux by strengthening the LES.
Surgery for GERD is relatively safe, but all procedures pose certain risks. The most common risks of surgery include the following:
GERD is a chronic condition that affects millions of people worldwide. It can cause lasting damage if left untreated. If you experience acid reflux or heartburn more than twice a week, you may have GERD. Fortunately, many treatments can keep your symptoms under control and prevent medical complications.
Avoiding trigger foods and eating a high-fiber diet can lower your risk of acid reflux. Eating high-pH foods can also reduce your discomfort by neutralizing stomach acid. Treatment with medication such as acid reducers may also be an effective option for managing GERD.
You should see a gastroenterologist if your symptoms don’t improve with diet changes and over-the-counter medication. An evaluation with medical testing can find the root cause of your problem. In severe cases, your doctor may recommend surgery for GERD. No matter the treatment option, managing your condition with help from your doctor can improve your health and quality of life.
If you want to find relief from your symptoms or learn more about GERD treatment options, you can request an appointment online or call our office at 210-615-8308.