Health Encyclopedia

Gastroesophageal reflux disease

Definition

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, 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.

The risk factors for reflux include hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities), pregnancy, and scleroderma.

A number of studies suggest that obesity contributes to gastroesophageal reflux. For instance, the Nurses Health Study found that being overweight or obese significantly increased reflux symptoms in women. (Women who lost weight in the study, meanwhile, had fewer symptoms.)

Heartburn and gastroesophageal reflux can be brought on or worsened by pregnancy and by many different medications. Such drugs include:

Anticholinergics (e.g. for seasickness)
Beta blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants

If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop medication you take regularly without talking to your doctor.

Symptoms

Belching
Cough or wheezing
Difficulty swallowing
Heartburn
- Involves a burning pain in the chest (under the breastbone)
- Increased by bending, stooping, lying down, or eating
- More frequent or worse at night
- Relieved by antacids
Hoarseness or change in voice
Nausea and vomiting
Regurgitation of food
Sore throat
Vomiting blood

Signs and tests

A number of tests may help diagnose reflux or identify complications:

A barium swallow showing reflux
A positive Bernstein test for gastric acid reflux
Continuous esophageal pH monitoring showing reflux
Endoscopy showing ulceration or inflammation of the esophagus, or Barrett's esophagus
Esophageal manometry showing abnormal sphincter pressure
A positive stool guaiac, which may diagnose bleeding from the irritation in the esophagus

Treatment

General measures include:

Avoiding alcohol and tobacco
Avoiding dietary fat, chocolate, caffeine, peppermint, onions, garlic, citrus juices, and tomato products (which may cause lower esophageal pressure)
Avoiding lying down after meals
Sleeping with the head of the bed elevated
Taking medication with plenty of water
Weight reduction

Medications that alleviate symptoms include:

Over-the-counter antacids after meals and at bedtime, although they do not last very long
Histamine H2 receptor blockers, mostly for milder symptoms
Promotility agents
Proton pump inhibitors, which may take up to four days to relieve symptoms

Anti-reflux operations (Nissen fundoplication and others) may help a small number of patients whose symptoms do not go away with lifestyle changes and drugs, Even after surgery, many patients still need to take drugs to relieve their symptoms. 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 lifestyle changes and medications. However, many patients need to continue to take drugs to control their symptoms.

Complications

Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and resulting spasm of airways due to acid)
Chronic pulmonary disease
Esophageal ulcer
Hoarseness
Inflammation of the esophagus
Stricture (a narrowing of the esophagus due to scarring from the inflammation)

Calling your health care provider

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Also call for any of the following symptoms:

Bleeding
Choking (coughing, shortness of breath)
Early satiety (feeling filled up quickly when eating)
Frequent vomiting
Hoarseness
Loss of appetite
Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
Weight loss

Prevention

Heartburn prevention techniques
Looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination esophagoscopy with biopsy) may be recommended to diagnose Barrett's esophagus.
Follow-up endoscopy to look for dysplasia or cancer is often advised.

References

Wang, KK, Sampliner, R E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Khan, M, Santana, J, Donnellan, C, Preston, C, Moayyedi, P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev(2). 2007;CD003244.

Wilson, J F. In the clinic. Gastroesophageal reflux disease. Ann Intern Med. 2008;149(3): ITC2-1-15; quiz ITC2-16

Review Date:9/7/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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