About Gastroesophageal Reflux Disease
Please consult with your medical professional about the applicability of this information to your own situation. The content below includes links to external sites which will open in a new browser window.
What is GERD?
Gastroesophageal reflux disease results when highly acidic gastric juices chemically “burn” and irritate the lower esophagus. GERD occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GERD is sometimes called acid reflux or acid regurgitation, because acidic digestive juices rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.
When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional heartburn is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.
What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.
What causes GERD?
The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.
Other factors that may contribute to GERD include obesity, pregnancy, or smoking. Common foods that can worsen reflux symptoms include citrus fruits, chocolate drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavorings, spicy foods, or tomato-based foods, such as spaghetti sauce, salsa, chili, and pizza.
How is GERD treated?
See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.
Lifestyle Changes:
• If you smoke, stop.
• Avoid foods and beverages that worsen symptoms.
• Lose weight if needed.
• Eat small, frequent 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 securing wood blocks under the bedposts. Just using extra pillows will not help.
Medications:
Your health care provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication. Some common medications for GERD:
• Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. 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.
• H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.
• Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.
• Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
• Fundoplication is the standard surgical treatment for GERD. Usually a specific type of this procedure, called Nissen fundoplication, is performed. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.
• Endoscopic techniques used to treat chronic heartburn include the Bard EndoCinch system, NDO Plicator, and the Stretta system. These techniques require the use of an endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems involve putting stitches in the LES to create pleats that help strengthen the muscle.
• The Stretta system uses electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps toughen the muscle.
The long-term effects of these three procedures are unknown.
What are the long-term complications of GERD?
Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its complications should be monitored closely by a physician.
Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.
What new therapies are being tested?
Newer medications that are extended-release inhibitors of stomach acid production are being developed. If you have GERD and would like to participate in a study please contact Rochester Clinical Research, either through this website, or by calling, (585) 288-0890.
For more information on GERD:
American College of Gastroenterology
American Gastroenterological Association
International Foundation for Functional Gastrointestinal Disorders
Contact Rochester Clinical Research today
to learn more about becoming a clinical research study volunteer!
Sign up for one of our active clinical studies.
[ Back to Top ]to learn more about becoming a clinical research study volunteer!
Sign up for one of our active clinical studies.
Rochester Clinical Research performs clinical research trials and studies for pharmaceutical and biotechnology companies. We rapidly recruit and screen quality volunteers to participate in clinical studies, and we maintain a large database of volunteers. Study volunteers receive free study-related medical care, investigational medicines, and a monetary stipend to compensate for their time and travel. RCR studies include therapeutic areas and drug categories such as weight loss, diabetes, hypertension, high cholesterol, flu vaccines, and smoking cessation. Our state-of-the-art medical office facility is staffed by highly qualified, caring physicians, investigators, and nurses. RCR is located in Rochester NY and serves the Finger Lakes region of New York. RCR is a WBENC-Certified Women's Business Enterprise.
