Gastroesophageal reflux disease (GERD) is when food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). This partially digested material is usually acidic and can irritate the esophagus, often causing heartburn and other symptoms.
Alternative Names
Peptic esophagitis; Reflux esophagitis; GERD; heartburn - chronic
Causes, incidence, and risk factors
Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms. Some conditions are associated with incompetent esophageal sphincters, including pregnancy , hiatal hernia , obesity , recurrent or persistent vomiting and nasogastric tubes. Risk factors for reflux include previous esophageal surgery or esophageal stricture .
Signs and tests
A positive stool guaiac
Continuous esophageal pH monitoring showing reflux
Endoscopy showing ulceration or inflammation of the esophagus
Esophageal manometry showing abnormal sphincter pressure A barium swallow showing reflux
A positive Bernstein test for gastric acid reflux
Treatment
General measures include:
Weight reduction Avoiding lying down after meals Sleeping with the head of the bed elevated Taking medication with plenty of water Avoiding dietary fat , chocolate, caffeine , peppermint (they may cause lower esophageal pressure)
Avoiding alcohol and tobacco
Medications that alleviate symptoms include:
Antacids after meals and at bedtime Histamine H2 receptor blockers Promotility agents Proton pump inhibitors
Anti-reflux operations ( Nissen fundoplication ) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.
Expectations (prognosis)
The majority of people respond to nonsurgical measures with behavioral modification and medications.
Calling your health care provider
Call your health care provider if symptoms worsen or do not improve with lifestyle changes and/or medication.
Prevention
Avoid foods and activities that worsen symptoms. Maintain a healthy weight.