Gastroesophageal Reflux Disease (GERD)

Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. Heartburn happen often or every once in a while.

Heartburn that occurs more than 2 times a week for several weeks may be gastroesophageal reflux disease (GERD). It can cause permanent damage over the course of time.

Gastroesophageal Reflux DiseaseCopyright © Nucleus Medical Media, Inc.

Causes

A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:

  • Problems with the nerves that control the muscles of the ring

  • Problems with muscle tone of the ring

  • Muscles that move food down into the stomach are weak

  • Abnormal pressure on the area

  • Increased relaxation of the muscles

  • Increased pressure within the abdomen—pushes up against the stomach

HeartburnCopyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chance of heartburn or GERD include:

  • Obesity

  • Smoking

  • Alcohol use

  • Exercising or strenuous activity immediately after eating

  • Lying down, bending over, or straining after eating

  • Pregnancy

  • Prior surgery for heartburn

  • Diabetes

  • Scleroderma

  • Certain nervous system disorders

  • In-dwelling nasogastric tube

Foods and drinks that are more likely to cause symptoms include:

  • Caffeinated products

  • Carbonated drinks

  • Citrus fruits

  • Chocolate

  • Fried foods

  • Spicy foods

  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce

Medications and supplements that cause symptoms may include:

  • Anticholinergics

  • Calcium channel blockers

  • Theophylline, bronchial inhalers, and other asthma medications

  • Nitrates

  • Sildenafil

  • Bisphosphonates

Symptoms

Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat—most common symptom

  • Regurgitation—a feeling that food is coming back up

  • Sour or bitter taste in the throat

  • Burping

  • Bloating

The repeated, regular episodes can lead to other symptoms such as:

  • Sore throat

  • Hoarseness

  • Chronic laryngitis

  • Chronic cough

  • Feeling of a lump in the throat

  • Waking up with a sensation of choking

  • Difficulty swallowing

Long-term complications of GERD may include:

  • Inflammation and scarring of the esophagus—esophagitis

  • Bleeding and ulcers in the esophagus

  • Narrowing of the esophagus— esophageal stricture

  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel

  • Asthma attacks

  • Vomiting blood

  • Black or tarry stools

  • Precancerous condition that can lead to esophageal cancer— Barrett esophagus

  • Esophageal cancer


When Should You Call A Doctor?

Make an appointment to see your doctor if you have heartburn 2 or more times a week, every week.


Diagnosis

The doctor will ask about your symptoms and medical history. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.

Further testing is not always needed. Your doctor may order the following to look for complications:

  • Upper GI series

  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus

  • Manometry to test muscle strength in the lower esophagus


This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.


RESOURCES

American Gastroenterological Association http://www.gastro.org 

National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov