Gastric reflux (gastroesophageal reflux [GER] and gastroesophageal reflux disease [GERD]) in adults

Definition and facts

What is gastroesophageal reflux?

Gastroesophageal reflux occurs when the contents of the stomach are returned to the esophagus.

Gastric acid that touches the lining of the esophagus can cause heartburn, also known as acid indigestion.

Is gastroesophageal reflux known by another name?

Doctors also refer to GERD as:

  • acid indigestion
  • gastric reflux
  • acid regurgitation
  • acidity
  • Reflux

How common is gastroesophageal reflux?

Having gastroesophageal reflux from time to time is common.

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease is a longer-lasting and more serious form of gastroesophageal reflux.

What is the difference between GERD and GERD?

GERD that occurs more than twice a week for a few weeks could be GERD. Over time, GERD can cause more serious health problems. If a person thinks they have gastroesophageal reflux disease, they should see their doctor.

How common is gastroesophageal reflux disease?

Gastroesophageal reflux disease affects approximately 20 percent of the population in the United States. 1

Who is most likely to develop gastroesophageal reflux disease?

Anyone can develop this disease, some for no apparent reason. A person is more likely to develop gastroesophageal reflux disease if:

What are the complications of gastroesophageal reflux disease?

Sometimes, if left untreated, over time the disease can cause serious complications, such as:

Esophagitis

Esophagitis is an inflammation in the esophagus. Adults who have chronic esophagitis for many years are more likely to develop precancerous changes in the esophagus.

Esophageal stricture

An esophageal stricture occurs when the esophagus becomes too narrow. Esophageal strictures can cause swallowing problems.

Respiratory problems

With gastroesophageal reflux disease, the patient may inhale gastric acid into the lungs. Gastric acid can irritate the throat and lungs, causing breathing problems, such as:

  • asthma – a long-lasting lung disease that makes a person more sensitive to things they are allergic to
  • chest congestion, or excess fluid in the lungs
  • long-lasting, dry cough or sore throat
  • hoarseness: partial loss of voice
  • laryngitis – inflammation of the laryngeal cage that can cause short-term loss of voice
  • pneumonia: infection in one or both lungs, which recurs
  • wheezing: high-pitched wheezing when breathing

Barrett’s esophagus

Sometimes gastroesophageal reflux disease can cause Barrett’s esophagus  . A small number of people with Barrett’s esophagus develop a rare but often fatal type of esophageal cancer.

If you have GERD, you should talk to your doctor about how to prevent or treat long-term problems.

Bibliography

[1] El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–1699.

Symptoms and causes

What are the symptoms of GERD and GERD?

If the person has GERD, they may taste food or stomach acid in the back of their mouth.

The most common symptom of gastroesophageal reflux disease is habitual heartburn, a burning sensation and pain in the middle of the chest, behind the breastbone, and in the middle of the abdomen. Not all adults with gastroesophageal reflux disease have heartburn.

Common symptoms of this disease include:

  • bad breath
  • sickness
  • pain in the chest or upper abdomen
  • trouble swallowing or pain when swallowing
  • respiratory problems
  • threw up
  • tooth wear

Some symptoms of gastroesophageal reflux disease stem from its complications , including those that affect the lungs.

What Causes GERD and GERD?

GERD and GERD occur when the lower esophageal sphincter weakens or relaxes when it shouldn’t, causing stomach contents to move up into the esophagus. The lower esophageal sphincter becomes weak or relaxed due to certain things, such as:

  • increased pressure on the abdomen from being overweight, obese, or pregnant
  • certain medications, including:
    • those used by doctors to treat asthma : a long-lasting lung disease that makes a person more sensitive to things they are allergic to
    • calcium channel blockers: medicines that treat high blood pressure
    • antihistamines – medicines that treat allergy symptoms
    • analgesics
    • sedatives: medicines that help you sleep
    • Antidepressants : medicines to treat depression (in English)
  • smoking or inhaling secondhand smoke

A hiatal hernia can also cause gastroesophageal reflux disease. Hiatal hernia is a condition in which the opening in the diaphragm allows the upper part of the stomach to move towards the chest, decreasing the pressure on the esophageal sphincter.

When should a person see the doctor?

You should see your doctor if you have persistent GERD symptoms that do not improve with over-the-counter medications or diet changes.

You should call your doctor immediately if:

  • vomits large amounts
  • regularly have explosive or loud vomiting
  • vomits liquid: none
    • green or yellow
    • that looks like coffee beans
    • with blood
  • have trouble breathing after vomiting
  • your mouth or throat hurts when eating
  • have trouble swallowing or it hurts to swallow

Diagnosis

How do doctors diagnose gastroesophageal reflux?

In most cases, the doctor diagnoses GERD by reviewing the patient’s symptoms and medical history. If symptoms do not improve with lifestyle changes and medications, the patient may need to be tested.

How do doctors diagnose gastroesophageal reflux disease?

If the patient’s GERD symptoms do not improve, if they recur frequently, or if he or she has trouble swallowing, the doctor may recommend that you get screened for GERD.

The doctor may refer the patient to a gastroenterologist to diagnose and treat gastroesophageal reflux disease.

What tests do doctors use to diagnose gastroesophageal reflux disease?

Several tests can help doctors diagnose this disease. The doctor may order more than one test to make a diagnosis.

Gastrointestinal endoscopy and biopsy

In a gastrointestinal endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to look inside the upper part of the digestive system. This procedure is done in a hospital or outpatient facility.

An intravenous (IV) needle is placed in the patient’s arm to provide sedation. Sedatives help keep the patient relaxed and comfortable during the procedure. In some cases, the procedure can be done without sedation. The patient will be given liquid anesthesia to gargle or an aerosol anesthetic will be applied to the back of the throat. The doctor will carefully pass the endoscope through the esophagus into the stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor, allowing a closer look at the lining of the upper part of the digestive system. The endoscope pumps air into the stomach and duodenum to make them easier to see.

The doctor may do a biopsy with the endoscope by removing a small sample of tissue from the lining of the esophagus. The patient will not feel the biopsy. A pathologist will examine the tissue sample in the laboratory.

In most cases, the procedure only diagnoses gastroesophageal reflux disease if the patient has moderate to severe symptoms.

Learn more about upper gastrointestinal endoscopy .

Transit of the upper part of the digestive system

gastrointestinal transit  looks at the shape of the upper part of the digestive system.

A radiology technologist does this test in a hospital or outpatient facility. A radiologist reads the x-rays and makes a report. The patient does not need anesthesia. A healthcare professional will tell the patient how to prepare for the procedure, including when to stop eating and drinking.

During the procedure, the patient will be asked to stand or sit in front of an X-ray machine and drink a barium liquid to coat the lining of the upper part of the digestive system. The radiology technologist takes several X-rays as the barium travels through the digestive system. Gastrointestinal transit cannot show gastroesophageal reflux disease in the esophagus; rather, the barium shows up on the x-ray and can detect disease-related problems, such as:

The patient may have bloating and nausea for a short time after the procedure. For several days, the patient may have white or light-colored stools due to the barium he took. A healthcare professional will instruct you on eating, drinking, and taking medications after the procedure.

Monitoring of esophageal pH and impedance

This is the most accurate procedure to detect gastric reflux. It measures the amount of acid in the patient’s esophagus while doing routine things, like eating and sleeping.

A gastroenterologist does this procedure in a hospital or outpatient center as part of a gastrointestinal endoscopy. Most of the time, the patient can stay awake during the procedure.

A gastroenterologist will pass a thin tube through your nose or mouth into your stomach. The gastroenterologist will then pull it up into the esophagus and stick it on the patient’s cheek. The end of the tube in the esophagus measures when and how much acid moves up the esophagus. The other end of the probe connects to a monitor attached to the outside of the body that records measurements.

The patient will wear the monitor for the next 24 hours. The patient will return to the hospital or outpatient facility to have the catheter removed.

This procedure is most helpful to the doctor if the patient keeps a diary of when, what and how much food he eats and the symptoms of gastroesophageal reflux disease after eating. The gastroenterologist can see how symptoms, certain foods, and certain times of the day are related to each other. The procedure can also help determine if gastric reflux triggers any respiratory symptoms.

Esophageal pH Monitoring Using the Bravo Wireless System

This type of monitoring also measures and records the pH in the esophagus to determine if the patient has gastroesophageal reflux disease. A doctor temporarily places a small capsule in the wall of the esophagus during an upper endoscopy. The capsule measures the pH concentrations in the esophagus and transmits information to a receptor. The receiver is about the size of a beeper, which the patient wears on the belt or waist.

During the monitoring, which generally lasts 48 hours, the patient will follow his usual daily routine. The receiver has several buttons that the patient will press to record symptoms of GERD, such as heartburn. The healthcare professional will tell you what symptoms to record. The patient will be asked to keep a diary to record certain events, such as when he starts and stops eating and drinking, when he goes to bed, and when he gets up.

To prepare for the test, the patient should consult with the doctor about the medications they are taking. Your doctor will tell you if you can eat or drink before the procedure. After about seven to ten days, the capsule will dislodge from the esophageal lining and will be expelled through the digestive tract.

Esophageal manometry

Esophageal manometry measures muscle contractions in the esophagus. A gastroenterologist may order this procedure if the patient is considering anti-reflux surgery.

The gastroenterologist can do this procedure in the office. A healthcare professional will give the patient aerosol anesthesia to the back of the throat or ask them to gargle with a liquid anesthetic.

The gastroenterologist passes a soft, thin tube through the nose and into the stomach. The patient swallows while the gastroenterologist slowly withdraws the tube into the esophagus. A computer measures and records the pressure of muscle contractions in different parts of the esophagus.

The procedure can show if symptoms are due to a weak sphincter muscle. A doctor can also use the procedure to diagnose other esophagus problems that may have symptoms similar to heartburn. A healthcare professional will instruct the patient about eating, drinking, and taking medications after the procedure.

Treatment

How does the patient manage GERD and GERD?

The patient may be able to control gastroesophageal reflux and gastroesophageal reflux disease if:

  • don’t eat or drink things that can cause GERD, such as fatty or spicy foods and alcoholic beverages
  • don’t eat too much
  • does not eat 2 to 3 hours before bed
  • lose weight if you are overweight or obese
  • quit smoking and avoid secondhand smoke
  • take over-the-counter medications, such as Maalox or Rolaids

How do doctors treat gastroesophageal reflux disease?

Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medications, surgery, or a combination of these.

Changes in lifestyle

Making lifestyle changes can reduce the symptoms of gastroesophageal reflux disease and gastroesophageal reflux disease. The patient must:

  • lose weight , if necessary.
  • wear loose clothing around the abdomen. Tight clothing can compress the stomach area and push acid into the esophagus.
  • stay upright for 3 hours after meals. You should avoid leaning and slouching when sitting.
  • sleep at a slight angle. You should raise the head of the bed 6 to 8 inches by safely placing blocks under the bed posts. Just using extra pillows won’t help.
  • quit smoking and avoid secondhand smoke.

Prescription and over-the-counter drugs

You can buy many medicines for GERD without a prescription. However, if the patient has symptoms that do not go away, he should see the doctor.

All GERD medications work differently. A combination of GERD medications may be needed to control symptoms.

Antacids Doctors often recommend antacids first to relieve heartburn and other mild symptoms of GERD and GERD. Antacids include over-the-counter medications, such as:

Antacids can have side effects, such as diarrhea  and constipation .

H2 blockers. H2 blockers decrease acid production. They provide short-term or when needed relief for many people with symptoms of GERD and GERD. They can also help heal the esophagus, although not as well as other medications. The patient can buy H2 blockers over the counter or the doctor can prescribe them. Types of H2 blockers include:

If the patient has heartburn after eating, the doctor might recommend that they take an antacid and an H2 blocker. The antacid neutralizes gastric acid and the H2 blocker prevents the stomach from producing acid. When the antacid stops working, the H2 blocker has already stopped the acid.

Proton-pump inhibitor. Proton pump inhibitors reduce the amount of acid your stomach makes. These inhibitors are better at treating GERD symptoms than H2 blockers. 2 These can heal the esophageal lining in most people with gastroesophageal reflux disease. Doctors often prescribe proton pump inhibitors for the long-term treatment of gastroesophageal reflux disease.

However, studies show that people who take proton pump inhibitors for a long time or in high doses are more likely to break their hips, wrist, and spine. The patient must take these medications on an empty stomach in order for their stomach acid to make them work.

There are several types of proton pump inhibitors available by prescription, including:

The patient should consult with the doctor about taking omeprazole or low-strength lansoprazole, which are sold without a prescription.

Prokinetics. Prokinetics help the stomach empty faster. Prokinetics that require a prescription include:

Both medications have side effects, such as:

  • sickness
  • diarrhea
  • fatigue or tiredness
  • depression (English)
  • anxiety
  • delayed or abnormal physical movement

Prokinetics can cause problems if they are mixed with other drugs, so the patient should tell the doctor about all the drugs they are taking.

Antibiotics Antibiotics, including erythromycin , can help the stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

Surgery

Your doctor may recommend surgery if GERD symptoms do not improve with lifestyle changes or medications. The patient is more likely to develop complications from surgery than from medications.

The fundoplication is the most common surgery for gastroesophageal reflux disease. In most cases, it results in long-term reflux control.

A surgeon does the fundoplication with a laparoscope, a thin tube with a tiny video camera. During the operation, the surgeon sews the upper part of the stomach around the esophagus to add pressure to the lower end of the esophagus and reduce reflux. The surgeon does the operation in a hospital. The patient receives general anesthesia and will be able to leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks.

The endoscopic techniques , such as endoscopic stitching and radiofrequency, help control gastroesophageal reflux disease in a small number of people. Endoscopic sewing uses small stitches to tighten the sphincter muscle. Radio frequency creates heat injuries, or ulcers, that help tighten the sphincter muscle. A surgeon does both operations with an endoscope in a hospital or outpatient center; the patient receives general anesthesia.

The results of endoscopic techniques may not be as good as those of fundoplication. Doctors do not use endoscopic techniques very often.

Food, diet and nutrition

How can diet help prevent or relieve GERD or GERD?

You can prevent or relieve symptoms of GERD or GERD by changing your diet. Certain foods and drinks that make symptoms worse may need to be avoided. Other dietary changes that can help reduce symptoms include:

  • decrease consumption of fatty foods
  • eat small, frequent portions instead of three large meals

What should the patient avoid eating if they have gastroesophageal reflux disease or gastroesophageal reflux disease?

You should avoid eating or drinking the following things:

  • chocolate
  • café
  • mint
  • greasy or spicy foods
  • tomatoes and tomato products
  • alcoholic drinks

What can the patient eat if they have gastroesophageal reflux or gastroesophageal reflux disease?

Eating healthy and balanced amounts of different types of food is good for your overall health. For additional information on eating a balanced diet, visit My Plate .

If you are overweight or obese, you should talk to your doctor or dietitian about diet changes that can help you lose weight and reduce the symptoms of GERD.

Clinical trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research on many digestive disorders.

What are clinical trials? Are They Right For You?

Clinical trials are part of clinical research and are at the core of all medical advancements. Clinical trials look for new ways to prevent, detect, or treat diseases. Researchers also use clinical trials to look at other aspects of health care, such as improving the quality of life for people with chronic diseases. Find out if clinical trials are right for you .

What clinical trials are open?

At www.ClinicalTrials.gov , you can find clinical trials that are currently open and recruiting participants.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.Syndicated Content Details:

Source Agency: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)