Up to 30 percent of Americans live with gastroesophageal reflux disease (GERD), a disorder that allows stomach contents (acid and non-acid) to reflux back into the esophagus. Often there is a problem with the valve between the esophagus and stomach called the lower esophageal sphincter (LES).
Normally, the LES opens to let food into the stomach and closes to prevent food and stomach acids from coming back into the esophagus. GERD occurs when the LES doesn’t function properly and the stomach's contents flow up into the esophagus. This can cause symptoms ranging from mild to severe.
“One of the most common symptoms of GERD is heartburn, which feels like burning that begins in the chest and spreads to the neck and throat,” says Walter Coyle, MD, a gastroenterologist and head of the Scripps Clinic Gastroenterology Division. “Another is acid regurgitation, which happens when acids from the stomach back up and cause a very sour taste in the mouth.”
Though GERD most often affects adults, recent studies suggest that it may be more common among children and infants than previously thought. Children with GERD may have recurrent vomiting, coughing and breathing problems.
Several factors may contribute to GERD, including:
- Diet: Some foods and drinks are thought to play a part in GERD, including peppermint, chocolate, coffee, alcoholic beverages and fried or high-fat foods.
- Smoking: Smoking relaxes the LES, which may affect its ability to prevent reflux.
- Pregnancy: Pregnant women are more likely to experience GERD symptoms.
- Obesity: People who are overweight may have a higher likelihood of GERD.
- Hiatal hernia: A hiatal hernia develops when the opening in the diaphragm muscle that separates the abdomen from the chest expands and allows the upper stomach to move into the chest. In some people, this is thought to weaken the LES and allow reflux.
Most cases of GERD can be successfully treated with lifestyle changes and/or medication to decrease the amount of reflux and protect the lining of the esophagus. In some cases, untreated GERD can lead to serious complications, such as ulceration of the esophagus, scarring and strictures of the esophagus and a precancerous change called Barrett’s esophagus.
Dr. Coyle recommends that people with GERD try the following:
- Avoid foods and beverages that can contribute to GERD (see above). In addition, avoid foods that may further irritate the lining of the esophagus, including citrus fruits and juices, tomato and pepper.
- Avoid eating at least two hours before bedtime to decrease the amount of acid in your stomach. When you lie down, it is easier for acid to move back into the esophagus.
- If you are overweight, losing excess weight may provide relief.
- If you smoke, quit.
Your doctor may also recommend medication to help relieve symptoms and protect your esophagus. Over-the-counter antacids can reduce the effects of acid. However, do not use them regularly for more than two weeks without talking to your doctor.
Prescription medications, such as H2 blockers and proton pump inhibitors, can reduce stomach acid production. You may need an exam of your esophagus, called an endoscopy, to evaluate the lining of the esophagus.
Some people with severe GERD may need surgery if nothing else proves successful. A procedure called Nissen fundoplication reinforces the LES muscle to reduce acid backup. Scripps physicians can perform this procedure through minimally invasive surgery using robot-assisted techniques, which use smaller incisions than open surgery and can also reduce the amount of time it takes to heal.
You don’t have to live with GERD. If you are experiencing symptoms, make an appointment with your physician to find out what is causing your discomfort and how best to treat it.