Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is an irritation of the esophagus caused by the chronic or repeated reflux (back-up) of undigested stomach contents, such as bile or stomach acid. The esophagus (food pipe) is part of your digestive tract. It allows food to enter the stomach and is located in the chest just behind the trachea (windpipe). At the lower end of your esophagus is a ring of muscular tissue called a sphincter, which relaxes to allow food to enter the stomach and closes to keep acid from returning to the esophagus.

GERD is sometimes called heartburn or acid indigestion. It is very common and affects approximately 30% of American adults occasionally and 10% report daily symptoms.

Symptoms of GERD

There are both common and uncommon symptoms with GERD and not everyone who has GERD will have all the symptoms but your symptoms will be determined by the severity of your condition. The more common symptoms include:

  • Heartburn
  • Sour or bitter taste in the mouth
  • Regurgitation or bringing up undigested stomach material
  • Belching

Less common symptoms include:

  • Asthma
  • Chronic hoarseness or loss of voice
  • Chest pain not related to heart disease
  • Painful or difficulty in swallowing
  • Sore throat or constant clearing of the throat
  • Sneezing and nasal congestion

While chronic cough is the most common sign, the condition can also be clinically silent.

Diagnosing GERD

GERD is usually diagnosed based on a report of the symptoms. Rarely are laboratory tests or x-rays needed. We or your referring doctor will order appropriate tests, if this is necessary. With early diagnosis and treatment of GERD, some researchers feel this will lead to better asthma control.

Treatment

The first steps in treatment are lifestyle changes.

  • Eat small, frequent meals.
  • Try to avoid fatty foods, tomato products, citrus fruits, alcohol, chocolate, caffeine, and tobacco.
  • Elevate the head of your bed on 6-inch blocks.
  • Avoid eating no later than 4 to 6 hours before bedtime.
  • If you are overweight, try and lose weight.

The following medications can worsen symptoms of GERD. We will discuss with your primary care physician if you are on any of these medications whether it is possible to avoid taking them:

  • Estrogen and progesterone products
  • Calcium channel blockers
  • Diazepam
  • Barbiturates
  • Quinidine
  • Nonsteroidal anti-inflammatory medications (NSAIDs)

We may recommend GERD medication. For milder infrequent problems we may consider the use of antacids. For more severe or frequent symptoms, other medications may be prescribed. The classes of medications most often used for GERD include:

  • H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75)
  • Proton pump inhibitorssuch as omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium)
  • Prokinetics, such as bethanechol (Urecholine) and metoclopramide (Reglan).

If medical treatment is not effective, a surgical procedure may be considered. The most common procedure is called Nissen fundoplication. During this procedure, the upper part of the stomach is wrapped around the muscular sphincter, where the esophagus meets the stomach. This procedure strengthens the sphincter and prevents acid reflux.

National GuidelinesThe symptoms of GERD are common in both children and adults with asthma. Reflux during sleep can contribute to nocturnal asthma. The National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma recommend medical management of GERD for any asthma patient who complains of frequent heartburn, particularly those with frequent episodes of nighttime asthma.

Support Organizations

American Gastroenterology Association 
7910 Woodmont Ave., 7th Floor
Bethesda, MD 20814
301-654-2055 
Fax: 301-652-3890
Web site: www.gastro.org
E-mail: webinfo@gastro.org

International Foundation for Functional Gastrointestinal Disorders 
Coalition Against Acid Reflux Disease
PO Box 17864
Milwaukee, WI 53217
888-964-2001 
Web site: www.iffgd.org

References

Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD). National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. Available at: http://www.niddk.nih.gov/health/digest/pubs/gerd/gerd.htm. Accessed September 3, 2002.

Straight Answers to Your Questions about Heartburn and GERD. The Word on GERD. American College of Gastroenterology. Available at: http://www.acg.gi.org/acg-dev/patientinfo/frame_gerd.html. Accessed September 3, 2002.

The contents of and all materials are used with permission by Protocol Driven Healthcare, Inc. (PDHI), 75 Claremont Road, Suite 201, Bernardsville, NJ 07924-2262, USA.

Date: 2/4/2005

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