WHSIC Consumer Health - Gastroesophageal Reflux

	Wegner Health Science Information Center Consumer Health Digital Library

Description - from the National Digestive Diseases Information Clearinghouse

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.

The main symptoms of GERD 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.

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

alcohol use
overweight
pregnancy
smoking

Also, certain foods can be associated with reflux events, including

citrus fruits

chocolate

drinks with caffeine

fatty and fried foods

garlic and onions

mint flavorings

spicy foods

tomato-based foods, like spaghetti sauce, chili, and pizza

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 surgery.

Lifestyle Changes

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.

Medications

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.

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.

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

Wegner Center Resources

Heartburn: Extinguishing the Fire Inside - Book
Wegner Books WI 145 W855h 1997

Waking Up America to a Serious Burning Issue - Video
Wegner Electronic WI 145 W149 2003

Homespun Medical Tips - Requires RealAudio

GERD - Gastro-Esophageal Reflux Disease (Heartburn)
with Dr. Michael Bess, General Surgeon from Sioux Falls, SD (December 2001)

Web Resources

About GERD - the International Foundation for Functional Gastrointestinal Disorders (IFFGD)
http://www.aboutgerd.org
The IFFGD works to increase awareness, fight for more research, and publish state-of-the-art information about gastrointestinal disoders.

American College of Gastroenterology (ACG) - Patient Information
http://www.acg.gi.org/patientinfo/index.htm
The ACG provides a variety of information for patients. They also provide information on locating a GI Physician.

National Digestive Diseases Information Clearinghouse (NDDIC)
http://digestive.niddk.nih.gov/index.htm
The goal of NDDIC is to increase knowledge and understanding about digestive diseases among people with these conditions and their families, health care professionals, and the general public. Information provided includes information on digestive diseases, resources, and clinical trials. Information is available in English and Spanish.

Current Literature

Gastroesophageal Reflux from MEDLINEplus
http://www.nlm.nih.gov/medlineplus/gastroesophagealrefluxhiatalhernia.html
MEDLINEplus provides extensive information from the a variety of trusted sources, in English and in Spanish.

Medem Medical Library - Digestive Health/Abdominal Conditions
http://www.medem.com/medlb/medlib_entry.cfm
Medem's award-winning Medical Library represents the full rant of patient education information from medical societies and other trusted sources, and is unsurpassed in quality, breadth and depth of health care information.

Wegner Health Science Information Center

Consumer Health Digital Library

Lifestyle Changes

Points to Remember