What is GERD? GERD (gastroesophageal reflux disease) is frequent and chronic backflow of stomach acid into the esophagus. Other names for it are acid indigestion and acid reflux, or just reflux. It happens when the lower esophageal sphincter (LES) doesn’t close properly. This ring of muscle normally keeps stomach acid in the stomach and out of the esophagus. When it doesn’t work the way it should, acid irritates the esophageal lining causing heartburn and other symptoms. GERD is more than just occasional heartburn. Almost everyone experiences heartburn now and then. People with GERD have long-term heartburn two or more times a week. They can have other symptoms as well, such as bad breath or nausea. GERD is a common condition, affecting about 20% of Americans. Being obese or pregnant increases the chances of developing GERD. This is likely due to increased pressure in the abdomen with these conditions. Eventually, GERD causes complications and may worsen other medical conditions, such as asthma. So, it’s important to see your doctor if you treat heartburn with over-the-counter (OTC) medicines twice a week or more. You should also visit the doctor if symptoms persist despite using OTC medicines and making dietary changes. Call your doctor right away or seek medical care if you have concerning symptoms such as: Difficulty breathing after vomiting Pain when you eat or swallow Projectile vomiting Trouble swallowing Vomiting large amounts or bloody or dark contents Sometimes, GERD causes chest pain that can mimic a heart attack. Seek immediate medical care (call 911) if you have chest pain that may also involve the jaw, neck, shoulder or arm. Chest pain needs immediate evaluation to find the cause. It is better to err on the side of safety than to ignore it and assume it is heartburn. What are the symptoms of GERD? Frequent heartburn is the most common symptom of GERD. The pain, burning or discomfort typically occurs in the chest behind the breastbone. It usually happens after eating and can last for a few hours. It may also get worse at night. However, some people with GERD do not get heartburn. There are also other GERD symptoms. Other GERD symptoms can include: Bad breath, chronic cough, hoarseness, or laryngitis Nausea New or worsening asthma or breathing problems Tasting stomach contents or sour liquid in the back of the throat or mouth Swallowing problems, throat tightness, choking, or feeling like there is a lump in the throat Wearing away of tooth enamel or cavities If you have any of these symptoms on a regular basis, see your doctor for an evaluation. You should also see your doctor if you need over-the-counter medicines to treat heartburn twice a week or more. Left untreated, GERD can cause complications, such as Barrett’s esophagus and esophageal cancer. The risk of complications goes up with longer duration of chronic heartburn. Seeing your doctor early can help prevent future problems. Your doctor may also be able to identify a physical cause for GERD that can be corrected, such as hiatal hernia. What causes acid reflux and GERD? GERD is the result of stomach juices refluxing up into the esophagus. Normally, the lower esophageal sphincter keeps stomach contents from entering the esophagus. In GERD, the LES is no longer able to provide this protection. It may be too weak or it may relax when it shouldn’t. As a result, the lining of the esophagus becomes irritated from contact with stomach juices. What are the risk factors for GERD? A number of factors contribute to the development of GERD. Risk factors for GERD include: Being overweight, obese or pregnant Having a hiatal hernia or a connective tissue disorder, such as scleroderma Smoking Taking certain medications including antihistamines, antidepressants, aspirin, asthma meds, calcium channel blockers, painkillers, and sedatives Certain foods, beverages, and eating habits can aggravate GERD. This includes eating too much food at once and eating too close to bedtime. Eating acidic, fatty, fried, minty or spicy foods can be especially problematic for people with GERD. Foods including chocolate, citrus, garlic, onions, and tomato-based sauces often trigger heartburn. Drinks can also aggravate symptoms if they contain alcohol or caffeine. Reducing your risk of GERD Experts do not know exactly why some people develop GERD and some do not. So it isn’t always possible to prevent GERD. But you may be able to reduce your symptoms through lifestyle changes. These changes are often part of GERD treatment as well. They include: Avoiding or limiting alcohol, caffeine, and foods that trigger symptoms Eating small meals and remaining upright for 2 to 3 hours afterwards Elevating the head of your bed 6 to 8 inches with blocks under the feet, a wedge between the mattress and box springs, or with an adjustable bed Losing weight if necessary and maintaining a healthy body weight Stopping smoking Wearing loose-fitting clothing around your abdomen If you continue to have problems despite making these changes, see your doctor. You may need medication to control GERD. How is GERD treated? Along with lifestyle changes, GERD treatment can also involve medicines and surgery. Many GERD medicines are available without a prescription. It’s fine to try them, but if your symptoms persist, you need to see your doctor. You may need to combine different classes of medicines or use prescription medicines. Talk with your doctor about these GERD medications and what they do: Antacids neutralize stomach acid right away. They don’t require a prescription and often work well for mild symptoms. However, frequent use can cause side effects, such as diarrhea or constipation. Examples include Maalox, Mylanta, Rolaids and Tums. H2 blockers reduce acid production. They come in both OTC and prescription strengths. You can use them with antacids as necessary for symptoms. They can also control symptoms for a period of time. Examples include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). PPIs (proton pump inhibitors) block acid production better than H2 blockers. They can help heal the lining of the esophagus in nearly everyone, so they are often part of a long-term GERD treatment plan. There are both prescription and OTC products. But you should talk with your doctor about taking them even if you use an OTC version. PPIs can cause problems in some people who use them for long periods of time. This can include vitamin deficiencies and bone fractures. Examples include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and rabeprazole (Aciphex). Prokinetics or promotility agents help your stomach empty faster and increase LES tone or pressure. This prevents reflux. They are prescription drugs that can have potentially serious side effects. Doctors usually reserve them for people who don’t respond to other treatments. Examples include bethanechol (Urecholine), erythromycin (various brands), and metocloprapmide (Reglan). Surgery may be an option if medical treatment fails to control your symptoms. Your doctor may also consider surgery if you have long-term side effects from medicines. The most common type of GERD surgery is a fundoplication, commonly called acid reflux surgery. It involves wrapping the top of the stomach around the LES. This tightens it and adds pressure to prevent reflux. Most people have successful long-term reflux control with fundoplication. What are the potential complications of GERD? Without proper treatment, GERD can eventually lead to poor quality of life and medical complications. Some of these can be serious and even life threatening. Complications of GERD can include: Esophageal ulcer due to irritation, inflammation and damage to the esophageal lining. These open sores can bleed and be painful, making eating and swallowing difficult. Esophageal stricture or narrowing of the esophagus due to scarring from chronic damage. People may actually notice less heartburn when this happens because of the narrowing. But it can make swallowing difficult because the space for food to pass is restricted. Barrett’s esophagus is a change in the tissue lining the lower end of the esophagus. The cells look like the lining of the intestine instead of normal esophageal cells. About 10 to 15% of people with GERD will develop this complication. In a small number of these people, the change is a precancerous sign of esophageal cancer. Esophageal cancer is a cancer that is currently very difficult to successfully treat. The risk of getting it increases the longer you go without treating GERD. The good news is these complications are highly avoidable with treatment. So don’t ignore heartburn and other GERD symptoms. See your doctor to work out a strategy for controlling your symptoms and preventing esophageal damage.