Gastroesophageal reflux disease, or GERD, occurs
when the lower esophageal sphincter (LES) does not close properly and stomach
contents leak back, or reflux, into the esophagus. The LES is a ring of muscle
at the bottom of the esophagus that acts like a valve between the esophagus and
stomach. The esophagus carries food from the mouth to the stomach.
When refluxed stomach acid touches the lining of the esophagus, it causes a
burning sensation in the chest or throat called heartburn. The fluid may even be
tasted in the back of the mouth, and this is called acid indigestion. Occasional
heartburn is common but does not necessarily mean one has GERD. Heartburn that
occurs more than twice a week may be considered GERD, and it can eventually lead
to more serious health problems.
Anyone, including infants, children, and pregnant women, can have GERD.
What are the symptoms of GERD?
The main symptoms are persistent heartburn and acid regurgitation. Some people
have GERD without heartburn. Instead, they experience pain in the chest,
hoarseness in the morning, or trouble swallowing. You may feel like you have
food stuck in your throat or like you are choking or your throat is tight. GERD
can also cause a dry cough and bad breath.
GERD in Children
Studies* show that GERD is common and may be overlooked in infants and children.
It can cause repeated vomiting, coughing, and other respiratory problems.
Children's immature digestive systems are usually to blame, and most infants
grow out of GERD by the time they are 1 year old. Still, you should talk to your
child's doctor if the problem occurs regularly and causes discomfort. Your
doctor may recommend simple strategies for avoiding reflux, like burping the
infant several times during feeding or keeping the infant in an upright position
for 30 minutes after feeding. If your child is older, the doctor may recommend
sodas that contain caffeine
chocolate and peppermint
spicy foods like pizza
acidic foods like oranges and tomatoes
fried and fatty foods
Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend
that the child sleep with head raised. If these changes do not work, the doctor
may prescribe medicine for your child. In rare cases, a child may need surgery.
*Jung AD. Gastroesophageal reflux in infants and children. American Family
What causes GERD?
No one knows why people get GERD. A hiatal hernia may contribute. A hiatal
hernia occurs when the upper part of the stomach is above the diaphragm, the
muscle wall that separates the stomach from the chest. The diaphragm helps the
LES keep acid from coming up into the esophagus. When a hiatal hernia is
present, it is easier for the acid to come up. In this way, a hiatal hernia can
cause reflux. A hiatal hernia can happen in people of any age; many otherwise
healthy people over 50 have a small one.
Other factors that may contribute to GERD include
Also, certain foods can be associated with reflux events, including
drinks with caffeine
fatty and fried foods
garlic and onions
tomato-based foods, like spaghetti sauce, chili, and pizza
How is GERD treated?
If you have had heartburn or any of the other symptoms for a while, you should
see your doctor. You may want to visit an internist, a doctor who specializes in
internal medicine, or a gastroenterologist, a doctor who treats diseases of the
stomach and intestines. Depending on how severe your GERD is, treatment may
involve one or more of the following lifestyle changes and medications or
If you smoke, stop.
Do not drink alcohol.
Lose weight if needed.
Eat small meals.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by putting blocks of wood under the
bedposts—just using extra pillows will not help.
Your doctor may recommend over-the-counter antacids, which you can buy without a
prescription, or medications that stop acid production or help the muscles that
empty your stomach.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and
Riopan, are usually the first drugs recommended to relieve heartburn and other
mild GERD symptoms. Many brands on the market use different combinations of
three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate
ions to neutralize the acid in your stomach. Antacids, however, have side
effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause
constipation. Aluminum and magnesium salts are often combined in a single
product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a
supplemental source of calcium. They can cause constipation as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents with
foam to prevent reflux. These drugs may help those who have no damage to the
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine
(Axid AR), and ranitidine (Zantac 75), impede acid production. They are
available in prescription strength and over the counter. These drugs provide
short-term relief, but over-the-counter H2 blockers should not be used for more
than a few weeks at a time. They are effective for about half of those who have
GERD symptoms. Many people benefit from taking H2 blockers at bedtime in
combination with a proton pump inhibitor.
Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid),
pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which
are all available by prescription. Proton pump inhibitors are more effective
than H2 blockers and can relieve symptoms in almost everyone who has GERD.
Another group of drugs, prokinetics, helps strengthen the sphincter and makes
the stomach empty faster. This group includes bethanechol (Urecholine) and
metoclopramide (Reglan). Metoclopramide also improves muscle action in the
digestive tract, but these drugs have frequent side effects that limit their
Because drugs work in different ways, combinations of drugs may help control
symptoms. People who get heartburn after eating may take both antacids and H2
blockers. The antacids work first to neutralize the acid in the stomach, while
the H2 blockers act on acid production. By the time the antacid stops working,
the H2 blocker will have stopped acid production. Your doctor is the best source
of information on how to use medications for GERD.
What if symptoms persist?
If your heartburn does not improve with lifestyle changes or drugs, you may need
A barium swallow radiograph uses x rays to help spot abnormalities such as a
hiatal hernia and severe inflammation of the esophagus. With this test, you
drink a solution and then x rays are taken. Mild irritation will not appear on
this test, although narrowing of the esophagus—called stricture—ulcers, hiatal
hernia, and other problems will.
Upper endoscopy is more accurate than a barium swallow radiograph and may be
performed in a hospital or a doctor's office. The doctor will spray your throat
to numb it and slide down a thin, flexible plastic tube called an endoscope. A
tiny camera in the endoscope allows the doctor to see the surface of the
esophagus and to search for abnormalities. If you have had moderate to severe
symptoms and this procedure reveals injury to the esophagus, usually no other
tests are needed to confirm GERD.
The doctor may use tiny tweezers (forceps) in the endoscope to remove a small
piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage
caused by acid reflux and rule out other problems if no infecting organisms or
abnormal growths are found.
In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the
esophagus that will stay there for 24 hours. While you go about your normal
activities, it measures when and how much acid comes up into your esophagus.
This test is useful in people with GERD symptoms but no esophageal damage. The
procedure is also helpful in detecting whether respiratory symptoms, including
wheezing and coughing, are triggered by reflux.
Surgery is an option when medicine and lifestyle changes do not work. Surgery
may also be a reasonable alternative to a lifetime of drugs and discomfort.
Fundoplication, usually a specific variation called Nissen fundoplication, is
the standard surgical treatment for GERD. The upper part of the stomach is
wrapped around the LES to strengthen the sphincter and prevent acid reflux and
to repair a hiatal hernia.
This fundoplication procedure may be done using a laparoscope and requires only
tiny incisions in the abdomen. To perform the fundoplication, surgeons use small
instruments that hold a tiny camera. Laparoscopic fundoplication has been used
safely and effectively in people of all ages, even babies. When performed by
experienced surgeons, the procedure is reported to be as good as standard
fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and
return to work in 2 to 3 weeks.
In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic
devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in
the LES to create little pleats that help strengthen the muscle. The Stretta
system uses electrodes to create tiny cuts on the LES. When the cuts heal, the
scar tissue helps toughen the muscle. The long-term effects of these two
procedures are unknown.
Recently the FDA approved an implant that may help people with GERD who wish to
avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES
to keep stomach acid from flowing into the esophagus. It is injected during
endoscopy. The implant is approved for people who have GERD and who require and
respond to proton pump inhibitors. The long-term effects of the implant are
What are the long-term complications of GERD?
Sometimes GERD can cause serious complications. Inflammation of the esophagus
from stomach acid causes bleeding or ulcers. In addition, scars from tissue
damage can narrow the esophagus and make swallowing difficult. Some people
develop Barrett's esophagus, where cells in the esophageal lining take on an
abnormal shape and color, which over time can lead to cancer.
Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may
be aggravated or even caused by GERD.
For information about Barrett's esophagus, please see the Barrett's Esophagus
fact sheet from the National Institute of Diabetes and Digestive and Kidney
Points to Remember
Heartburn, also called acid indigestion, is the most common symptom of GERD.
Anyone experiencing heartburn twice a week or more may have GERD.
You can have GERD without having heartburn. Your symptoms could be excessive
clearing of the throat, problems swallowing, the feeling that food is stuck in
your throat, burning in the mouth, or pain in the chest.
In infants and children, GERD may cause repeated vomiting, coughing, and other
respiratory problems. Most babies grow out of GERD by their first birthday.
If you have been using antacids for more than 2 weeks, it is time to see a
doctor. Most doctors can treat GERD. Or you may want to visit an internist—a
doctor who specializes in internal medicine—or a gastroenterologist—a doctor who
treats diseases of the stomach and intestines.
Doctors usually recommend lifestyle and dietary changes to relieve heartburn.
Many people with GERD also need medication. Surgery may be an option.
Hope Through Research
No one knows why some people who have heartburn develop GERD. Several factors
may be involved, and research is under way on many levels. Risk factors—what
makes some people get GERD but not others—are being explored, as is GERD's role
in other conditions such as asthma and bronchitis.
The role of hiatal hernia in GERD continues to be debated and explored. It is a
complex topic because some people have a hiatal hernia without having reflux,
while others have reflux without having a hernia.
Much research is needed into the role of the bacterium Helicobacter pylori. Our
ability to eliminate H. pylori has been responsible for reduced rates of peptic
ulcer disease and some gastric cancers. At the same time, GERD, Barrett's
esophagus, and cancers of the esophagus have increased. Researchers wonder
whether having H. pylori helps prevent GERD and other diseases. Future treatment
will be greatly affected by the results of this research.
National Institutes of Health (NIH)
Nutritional and Herbal Therapy for GERD
Begin a stress management program: Yoga, Tai Chi, Qigong, Meditation and deep
Diet: Avoid carbonated beverages, chocolate, tomato, peppermint, coffee, acidic
fruit juices, sour, hot spicy, fatty and fried foods and alcohol.
Change your eating habits: Eat slowly and chew well. Avoid
eating big meals. Eat smaller meals. Don’t over eat, only allow your stomach to be moderately
full. Eat 5-6 small meals daily. Eat your dinner at least 3 hours before
bedtime. Sit down in an upright chair and rest 20-30 minutes after eating
prior to any activity.
Stop Smoking: Please consult with you practitioner about
how acupuncture and Chinese herbs, can help with a smoking cessation program.
Posture: When sleeping, elevate your upper body by 5 - 6
inches or try sleeping on your left side. Avoid bending from the waist or
stooping just after meals.
Clothing: Avoid tight belts, clothing and bras that
increase pressure on your stomach and chest.
A natural Chinese herbal antacid,
Sai Mei An, can help
soothe the uncomfortable symptoms of GERD.