Your stomach is filled with acid. Its purpose is to help digest the food you eat. Believe it or not, this acid is the same acidity as battery acid. Your stomach is built to handle the acid it produces. However, your esophagus isn’t. So when acid backs up into your esophagus, it can cause the burning sensation known as heartburn.

Almost everyone has occasional heartburn. But if these symptoms occur two or more days a week for at least three months, you may have GERD, or acid reflux disease. Acid reflux occurs when the lower esophageal sphincter (the valve separating the esophagus and stomach) does not close properly, allowing acid to back up into the esophagus.

GERD is a chronic condition and may lead to more serious medical conditions, but is treatable. In this section, you’ll learn about the causes and common symptoms of GERD, a disease that is more common than you might think.

What Causes GERD?

GERD and Your Digestive System

To understand what causes GERD, you must first understand your digestive system. The upper digestive, or upper gastrointestinal system, is made up of:

• The mouth
• The space behind the mouth, called the pharynx
• The esophagus, a tube that runs from the pharynx to the stomach
• The stomach
• The duodenum, the first part of the small intestine

The esophagus connects the mouth to the stomach. The place where the esophagus and stomach meet is surrounded by a ring of muscle. This ring is called the lower esophageal sphincter , or LES. Normally, when you’re not eating, the LES muscle is squeezing shut so that the stomach is closed off from the esophagus. When you eat, the muscle relaxes and the LES opens, allowing food to enter the stomach. Then the muscle squeezes the LES shut again, keeping whatever is in the stomach from backing up into the esophagus.

The LES plays an important role in digestion. The stomach makes acid to aid in the digestion of food. While the stomach has a special lining to protect it from acid damage, the esophagus does not have a protective lining and is more easily injured by stomach acid.

With GERD, the LES may open more often than it should or it may open at the wrong times, allowing stomach acid to back up into the esophagus. This can be extremely painful. If this continues for a long time, a portion of the esophagus can become “raw.” This is called erosive esophagitis and it can lead to serious medical problems including scarring, bleeding and ulcers. Chronic GERD could lead to a condition called Barrett’s esophagus. In Barrett’s esophagus, the lining of the esophagus is abnormal. Patients with Barrett’s esophagus have an increased risk of one type of esophageal cancer which can lead to an increased risk of cancer of the esophagus.

What triggers acid reflux?

Your lifestyle doesn’t cause GERD, but it may make your symptoms worse. Triggers for acid reflux include:

• Certain foods or drinks
• Smoking
• Being overweight
• Eating too much
• Bending over after eating
• Lying down less than 3 hours after meals

Lifestyle changes may help to relieve the symptoms of GERD. Most medical treatments for GERD are aimed at decreasing the acidity of the stomach’s contents.

GERD Symptoms

The most common symptom of GERD is heartburn, a burning pain that rises from the stomach or lower part of the chest towards the neck. Regurgitation occurs when stomach acid washes into the esophagus and up into the mouth, causing a bitter or sour taste, is another symptom of GERD. Another common symptom is difficulty swallowing, also called dysphagia.

GERD has other, less common symptoms. Water brash is the sudden appearance in the mouth of slightly sour or salty fluid that happens when the salivary glands are stimulated by acid reflux. GERD has been associated with non-cardiac chest pain, asthma, hoarseness, and chronic cough.

Symptoms of GERD:

• Heartburn
• Regurgitation
• Difficulty swallowing
• Water brash

How common is GERD?

Some people who have GERD may not experience any symptoms. This may happen because these people are not very sensitive to the acid and do not experience pain even though they are having reflux.

From time to time everyone has stomach acid that backs up into the esophagus. This flow is called gastroesophageal reflux, or acid reflux. It can cause a number of sensations. The most common of these is heartburn. Some acid reflux is common and normal.⁴ When this process occurs frequently and chronically, it is called gastroesophageal reflux disease (GERD). With GERD, acid reflux can become painful and may cause damage to the lining of the esophagus.

If you have persistent heartburn two or more days in the week, despite treatment and diet change, you may have GERD. Heartburn that does not go away can, over time, wear away the lining of your esophagus. This is true even if the heartburn is mild. Talking with your doctor about your symptoms can help your doctor determine if you have GERD.

GERD is a chronic, but treatable condition, and it is extremely common. Studies estimate that approximately 19 million people in the United States may have GERD. In fact, approximately 4.6 million doctor visits each year are made to discuss GERD symptoms. GERD can lead to serious problems.

How is GERD Treated?

GERD is a treatable medical condition. If you are experiencing symptoms of GERD, you should schedule an appointment with your health care provider to discuss your symptoms and receive an official diagnosis. In order to appropriately diagnose you, your doctor may recommend lifestyle changes, a trial of a specific medical treatment, or diagnostic tests.

Diagnosing GERD

To help decide if you have GERD, your health care provider will ask you to describe the type of symptoms you have, their severity, their frequency (how many times per week), and how long the symptoms last. The most common symptoms of GERD include heartburn and acid regurgitation (reflux), in which stomach acid backs up into the mouth. These symptoms are often made worse by bending over, stooping or lying flat. If you have had partial or temporary relief with over-the-counter medicines, let your doctor know.

Your doctor may begin by suggesting lifestyle modifications and provide a trial of an appropriate medicine for your situation. If your symptoms improve based on treatment, a diagnosis of GERD may be made. If the treatment is effective, your doctor may not order any additional tests.

If you do not get relief from the trial or treatment, your doctor may order testing. Testing is also done for patients who have what are called “alarm symptoms.” Alarm symptoms include weight loss, anemia, bleeding from your gastrointestinal tract (either vomiting blood or having blood in your bowel movements), difficulty swallowing or pain on swallowing.

The test ordered depends on the type and severity of symptoms. Diagnostic tests that might be used include:

• Endoscopy
• Barium Esophagogram(Upper GI)
• Esophageal pH Monitoring Test

Endoscopy tests are performed to see if the esophagus has been damaged. A thin, bendable tube with a video camera is put into the mouth and passed down the esophagus into the stomach. The doctor uses this tool to identify injured areas in the esophagus. Patients are typically sedated during this outpatient treatment.

Barium Esophagram is a test that looks for changes in the shape of the esophagus and may see abnormalities in the lining of the esophagus, as well as reflux of the barium during the test. The shape of the stomach can also be seen using this test. The patient drinks a chalky liquid that contains barium. The barium coats the esophagus and stomach. A doctor can then see the outline of the esophagus and stomach on an x-ray.

Esophageal pH Monitoring is used to find out the severity of acid reflux. It tests for the amount of acid in the esophagus over time. It can also tell how long acid stays in the esophagus. There are two different forms of this test. In the first, a tiny tube is inserted through the nose and down the esophagus. There is a small acid monitor at the end of the tube that measures acid levels for 24 hours. In the second, which requires an endoscopy, a monitor the size of a medicine capsule can be attached to the esophagus during endoscopy. It stays in the esophagus and tests for acid over time. After about 48 hours, the monitor is passed out of the body as if it were a piece of food.

Common Treatment Options

Once you have been diagnosed with GERD, your doctor can offer you a number of medical treatment options, as well as suggest lifestyle changes that can help manage the symptoms of GERD.

When treating GERD, physicians are trying to achieve the following goals:

• Manage GERD symptoms
• Heal the lining of the esophagus in patients who have been diagnosed with erosive esophagitis
• Prevent more damage to the esophagus

To achieve these goals, your doctor may recommend an over-the- counter or prescription medicine. Only your doctor can decide which treatments are right for you.

There are four common treatment options for GERD. They each work in a unique way within the body:

1. Antacids neutralize stomach acid
2. Mucosal protective agents protect the lining of the esophagus
3. Promotility agents cause the stomach to empty faster
4. Acid-suppressive agents reduce the amount of acid the stomach makes

Antacids—Antacids help to counteract the acid created by the stomach. They help control symptoms of mild to moderate heartburn. Antacids are available without a prescription.

Mucosal protective agents—There are two types of mucosal protective agents: sucralfate suspension and alginic acid.

Sucralfate suspension, or gel, acts as a protective barrier and blocks the juices the stomach creates (a combination of stomach acid and a digestive enzyme called pepsin) from making contact with the esophagus. Sulcrafate can be used for moderate to severe GERD. It can also be used to treat erosive esophagitis. It is available only with a prescription.

Alginic acid is thick and floats on top of the pool of stomach juices. It blocks contact between the stomach juices and the esophagus. Sometimes alginic acid is mixed with an antacid. Alginic acid can be used for mild to moderate GERD symptoms. It is available without a prescription.

Promotility agents—Medicines that make the stomach empty more quickly are called promotility agents or prokinetic agents. These medicines work to improve GERD symptoms and heal esophagitis. Metoclopramide is the only one of these medicines available in the United States. A prescription is needed to buy metoclopramide.

Acid-suppressive agents—Two types of medicines reduce the amount of acid the stomach makes: H₂-receptor antagonists and proton pump inhibitors.

H₂-receptor antagonists, “H₂-blockers,” reduce acid production from the stomach. They do this by blocking one of the paths that stimulate acid production, reducing the acid that is produced in the stomach . H₂-blockers are generally well tolerated and are available without a prescription in some dosages. These are useful to treat mild or occasional heartburn.

Proton pump inhibitors, or PPIs, block the final step in making stomach acid. The short- and long-term safety of PPIs has been confirmed in many large studies. They are available in an OTC dose for treatment of frequent heartburn. The most common side effects are headache and diarrhea.

Lifestyle Changes

Medical treatment is not the only option for managing GERD symptoms. Changes in diet, nutrition, and routines can be used alone, or combined with a medical treatment, to gain relief from the pain associated with GERD.

The following lifestyle changes have been shown to have a positive effect on symptoms associated with GERD in some patients:

• Losing weight
• Quitting smoking
• Wearing loose-fitting clothing
• Eating smaller meals
• Raising the head of the bed when sleeping
• Waiting at least 3 hours before lying down after eating
• Avoiding certain foods and drinks, including:
• Chocolate
• Peppermint
• Alcoholic drinks
• Caffeinated beverages
• Citrus drinks
• Tomato-based foods
• High fat and/or fried foods

What Can I Do?

If you are concerned that you may have GERD, you should arrange to visit your doctor as soon as possible. GERD is a chronic medical condition that may lead to more serious problems, but it is treatable, and can be effectively managed through diet and lifestyle changes along with medical treatments. In this section, you will find advice that will assist you before, during, and after your doctor visit.