Do I have GERD? - Gastroesophageal Reflux Disease

Most people, young and old, will experience some form of acid reflux in their lifetime. In most cases, it remains nothing more than an occasional nuisance. Acid reflux occurs when food and acid inside the stomach flow in the wrong direction. Also known as heartburn, it may be uncomfortable, but it is rarely a cause for concern. However, in some cases, acid reflux can be more than a minor irritation after over-indulging in a large meal. Acid reflux can progress into persistent discomfort that negatively impacts your life and requires treatment.

If you experience frequent acid reflux, you may have a condition called Gastroesophageal Reflux Disease, or GERD. You might have GERD if you experience symptoms of acid reflux at least twice per week.¹ In some cases, more severe symptoms less than twice per week will warrant treatment. GERD is diagnosed in approximately 20% of adults, making it one of the most common gastrointestinal disorders in the United States.² It is seen in patients of all ages, from infancy into the geriatric population, and can be mild to severe.

Symptoms of GERD vary between individuals. Someone with GERD may complain of one or two symptoms, while others may suffer from a majority of them. Because signs of GERD may be present in other conditions, it is essential to consult your doctor for a correct diagnosis. If you frequently encounter any of the following symptoms or often take over-the-counter medications for them, you should make an appointment with a doctor.

• Difficulty swallowing
• Nausea or vomiting
• Feeling as though there is a lump in your throat
• Regurgitation of food or stomach acids
• Frequent burping accompanied by a burning sensation
• Chronic cough or laryngitis
• New or worsening asthma symptoms
• Chest pain

Obtain immediate medical attention if you have chest pain. It may indicate a heart attack.

Are there any complications?

GERD is relatively easy to diagnose and treat, with most patients reporting an improvement in symptoms soon after treatment is initiated. If left untreated, the persistent backflow of stomach acid can affect your quality of life and lead to complications.⁴ It is important if you experience recurrent symptoms of acid reflux to schedule an appointment with a healthcare provider.

Esophageal Stricture

Esophageal stricture, or narrowing of the esophagus, results from scarring caused by persistent injury to the esophagus. Long-term GERD is the most common cause of esophageal stricture. Patients with esophageal stricture may not have any symptoms or could experience extreme discomfort depending on the severity of narrowing.

If patients have symptoms, they may feel as though food is stuck in their throat, chest, or upper abdomen. They can also experience painful swallowing, regurgitation, and unintentional weight loss. Esophageal stricture can become so severe that it is difficult for the patient to consume liquids. It is commonly treated by dilating the esophagus as well as treating the underlying cause, which is often GERD.

Esophagitis

Esophagitis is inflammation of the esophagus. Continuous exposure to acidic gastric contents irritates the esophagus lining, resulting in inflammation. When left untreated, esophagitis can lead to esophageal ulcers. Symptoms of esophagitis are similar to esophageal stricture. If esophagitis progresses to esophageal ulcers, patients may vomit blood in addition to the symptoms of esophagitis. Treating GERD will usually resolve symptoms.

Barrett's Esophagus

Barrett's esophagus is a condition in which the tissue lining the esophagus is replaced by tissue similar to that which lines the intestine. In a small number of patients, this can lead to a type of esophageal cancer called esophageal adenocarcinoma.

Barrett's esophagus doesn't cause symptoms, but patients with this condition often have GERD and the associated symptoms. Although not all patients with Barrett's esophagus have GERD, long-standing GERD is the principal risk factor. The primary treatment is to control the acid reflux. In some cases, your doctor may recommend procedures to remove the abnormal tissue.

Your esophagus is a hollow tube that connects your mouth to your stomach. It is closed off at the top, and the bottom by muscles called sphincters that act as one-way valves. After swallowing food, your muscles take over in a process called peristalsis. Peristalsis is the involuntary contraction of muscles that create a wave-like motion to move contents, such as food, in the right direction. During peristalsis of your esophagus, the sphincter muscles relax, allowing food to pass through the esophagus and into the stomach, but not the other way.

In some people, the lower esophageal sphincter (LES) that separates the bottom of the esophagus from the stomach becomes weakened or intermittently relaxed. When this muscle relaxes, it no longer acts as a one-way valve, and acidic stomach contents flow up into the esophagus, causing acid reflux symptoms. Additionally, sometimes the pressure inside the stomach is greater than the pressure on the other side of the LES. When this occurs, gastric contents are driven into the esophagus.

Although it is not known why some people develop GERD while others do not, several risk factors have been identified. ³

• Alcohol use
• Pregnancy
• Obesity
• Smoking
• Hiatal hernia
• Certain medications
• Pregnancy

Some people will not have any of the risk factors listed above but encounter acid reflux severe enough to obtain a GERD diagnosis. Schedule an appointment with a physician if you have concerns about your risk factors.

A doctor can easily diagnose GERD by reviewing your symptoms and medical history. If you are experiencing heartburn more than twice per week, intense heartburn less than twice per week, or have any concerns about the severity or frequency of your symptoms, you should schedule a doctor's appointment. Diagnosing GERD rarely requires further medical testing or procedures beyond evaluating symptoms. If your symptoms do not improve with treatment or your doctor suspects you have a complication of GERD, you may need diagnostic testing.

Upper gastrointestinal (GI) endoscopy

During an upper gastrointestinal (GI) endoscopy, your doctor will insert a long flexible line with a camera attached to the end through your mouth and into your stomach. Depending on the level of sedation, you may not be awake during the procedure. Images from the camera are delivered to a screen for your doctor to see.

The doctor can look at the internal structures from your throat down into your stomach. They can see if you have any esophageal damage or other complications of GERD. They can also take tissue samples, dilate a narrow area, or treat bleeding. After an upper GI endoscopy, you can return home.

Esophageal pH monitoring

Esophageal pH monitoring measures how often stomach acid enters your esophagus and for how long it stays there. During the procedure, your doctor inserts a thin tube through your nose and into your esophagus. You will be given a small monitor, about the size of a cell phone, attached to the tube.

The monitor will continuously measure the pH of your esophagus and record the data for 24 hours. You will have a journal to document when you have acid reflux symptoms, eat, or lie down. At the end of the 24-hour period, your doctor will remove the tube and collect the equipment and journal for evaluation.

Manometry

Manometry is a procedure where your doctor threads a long, thin tube through your nose, down your esophagus, and into your stomach. The tube is sensitive to pressure and provides crucial information to your doctor about the muscles in your esophagus. Some patients feel discomfort during the tube's insertion, which lasts about a minute. After data is collected, your doctor removes the line, and you are free to go home. A manometry takes around 40 minutes to complete, and you will be asked not to eat for several hours before the procedure.

X-rays

Upper gastrointestinal (GI) tract x-ray is a non-invasive diagnostic test used to gather information about your upper GI tract. You will be asked to drink a chalky substance that creates contrast during the x-ray. This substance is called barium and is safe to drink while under the guidance of a doctor. Barium coats the inside of your throat, esophagus, stomach, and upper GI tract giving your provider a better x-ray image. The x-rays will require your stomach to be empty, so you will need to fast for several hours before your appointment.

What if your baby has GERD?

As with adults, GERD is one of the most diagnosed gastrointestinal conditions in the pediatric population. However, there are fundamental differences between how GERD presents in adults and how it presents in children. Infants have the most difference in symptoms. As infants age into toddlers and teens, symptoms present closer and closer to that of their adult counterparts.

If your infant has GERD, they may arch their back, choke, gag, vomit, or have problems with swallowing. Your infant could also wheeze or develop a frequent cough. Additionally, they may refuse to eat or exhibit poor weight gain. Some infants spit up often without discomfort or cause for concern, but an infant with GERD may exhibit irritability accompanied by regurgitation. If your infant has any of these symptoms, a pediatrician should evaluate them to rule out other potential health concerns before treating for GERD.

Most infants will not require medication for GERD. Symptoms usually clear on their own as the infant grows into toddlerhood. For most pediatric patients, conservative treatment is indicated and should be the first line of defense against your child's reflux symptoms.¹⁰ Your doctor may recommend that you:

• Feed your child in an upright position
• Avoid laying your infant down for 20 to 30 minutes after eating
• Burp your infant often
• Adjust the infant's diet, or your diet if you are breastfeeding

Medication may be necessary for infants with a severe presentation of GERD. Infants refusing to eat, have poor weight gain, or show evidence of esophagitis may need a temporary course of acid-reducing medication.

Once you are diagnosed with GERD, your doctor will develop a treatment plan for you. GERD may improve with lifestyle changes, medications, or a combination of the two. In rare cases, surgery may be necessary.

Lifestyle Modifications

Patients may see improvement in symptoms of GERD by decreasing their risk factors. In one study of 332 overweight adults who participated in a weight loss program, 81% reported improvement in their symptoms while 65% no longer had symptoms by the study's end.⁵ Weight loss has many health benefits and should be part of your treatment plan if you are overweight and suffering from GERD. Acid-reducing medications can help manage symptoms while you're supported during a proper weight loss plan.

Many patients and their doctors report that smoking, alcohol, and certain foods aggravate GERD. If you or your doctor suspect diet could be exacerbating your symptoms, you might consider maintaining a food journal to try and identify triggers, if any. With a food journal, you will document all food and drink consumption alongside your symptoms and the time they occurred. You and your doctor can review your data for patterns. Smaller meals more often can also be beneficial.

If your symptoms appear primarily at night, you may have nocturnal gastroesophageal reflux. In one study, 13% of respondents from a phone interview reported acid reflux symptoms only during the night.⁶ Reducing food intake several hours before sleeping and adjusting sleep positions may benefit patients with this kind of reflux. Elevating the head and torso enlists gravity's help and could improve nocturnal gastroesophageal reflux symptoms.

Medications

Stomach acid is vital to aid in digestion and keep bacteria under control. However, some people have to regulate their stomach acid to manage their GERD. There are three types of medications used to prevent gastric acid and treat reflux symptoms. They are PPIs, H2RAs (H2 blockers), or antacids. Each drug has a different profile and offers distinct benefits.

The proper medication for you will depend on the duration and severity of your symptoms and requires a review of your health history. You should meet with a doctor before starting any medication for GERD to ensure your symptoms are caused by acid reflux disease. Your doctor can help you determine the best course of action for your situation.

The most common class of medications used to treat GERD are proton pump inhibitors or PPIs.⁷ They improve esophageal healing with fewer relapses of symptoms compared to other medicines. As the name implies, proton pump inhibitors inhibit specialized stomach cells from pumping acid into the stomach, decreasing overall acidity. The reduction in acid improves reflux symptoms and promotes esophageal healing. Scientists designed PPIs to work as a preventative medication and require daily use for maximum benefits. They do not work as well when taken on demand for acute reflux.

Medications like H2 blockers and antacids work better for acute treatment. H2 Receptor Antagonist, or H2 blockers, reduce the amount of acid in your stomach by interrupting a chemical signal that tells the acid-producing cells in your stomach to create more acid. Like PPIs, doctors also prescribe H2 blockers to treat symptoms and complications of GERD.

Lastly, antacids are an effective option to relieve symptoms of heartburn that occur occasionally. Antacids work by neutralizing stomach acid. If you find yourself taking over-the-counter antacids often, you may need a stronger medication like a PPI or H2 blocker.

Surgery

Your doctor may recommend surgery if lifestyle changes and medications do not reduce your symptoms to satisfactory levels.⁸ In some cases, your doctor may also support surgical intervention for GERD if you want to discontinue long-term GERD medication use.

Fundoplication is the most common surgery used to manage GERD. It irreversibly modifies the structures of the stomach and esophagus to prevent gastric contents from entering the esophagus. During the surgery, your doctor folds the upper part of your stomach around the esophagus and sews it into place. The surgery is effective at reducing acid reflux and offers durable symptom relief.

Can you prevent GERD?

Prevention for GERD primarily focuses on the same lifestyle changes used to treat GERD. Remember, the esophageal sphincters act as one-way valves. Many ways to prevent GERD are based on reducing pressure to the lower esophageal sphincter (LES). The LES muscle can become overwhelmed by pressure, especially in patients prone to reflux. Relieving that pressure reduces your chances of experiencing chronic heartburn.

Maintain a Healthy Weight

Maintaining a healthy weight by making good food choices and staying active will decrease your chances of having GERD. The added weight of obesity puts pressure on your stomach, which can push stomach acid back up into the esophagus.

Alter Your Eating Habits

Alter your eating habits to include several smaller meals instead of three big ones. Large meals fill your stomach enough to apply upward pressure against the LES muscle. The additional pressure can be enough that the LES can no longer prevent gastric contents from entering the esophagus.

Don't Eat Before Bed

Plan your dinner earlier to avoid bedtime with a full stomach. Skipping bedtime snacks means less food in your stomach at bedtime, decreasing the chances of food finding its way into the esophagus after lying down. Less food also puts less pressure against the LES, which helps diminish the likelihood of experiencing reflux in the night.

Avoid Tight Clothing

Just like a full stomach and extra body weight, tight clothing applies pressure to the LES, increasing the chances of retrograde flow of stomach contents. Choosing clothes with loose waistbands and avoiding sinching your belt too tight may reduce your chances of acid reflux.

Smoking

Smoking has been shown to contribute to acid reflux by promoting the LES's relaxation and decreasing saliva production.⁹ Once the LES relaxes and reflux occurs, saliva can help clear stomach acid from the esophagus by flushing it back into the stomach. Saliva also contributes to neutralizing acidic gastric contents.

Schedule a Doctor's Appointment Today

Although acid reflux is common, it is not normal and needs attention if you have frequent or severe heartburn. Delaying treatment can increase your chances of encountering a complication of GERD. Contacting a doctor is the first step to obtaining relief and promoting healing of your esophagus. Most of the time your doctor can make a quick diagnosis after evaluating your symptoms and medical history. After a diagnosis, you can take immediate action to improve your reflux. Many patients report a reduction in their heartburn within the first few days after visiting their doctor.

Some lifestyle changes that improve reflux are within your control, but GERD requires a diagnosis and treatment plan to prevent complications and improve healing outcomes. Chronic acid reflux symptoms can be distressing and interfere with your daily activities. The right doctor can help you take a proactive approach to improve your symptoms while supporting you through pharmaceutical treatment if necessary. You don't have to live with chronic acid reflux. Meet with a doctor to find the treatment plan that works for you.