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Gastroesophageal Reflux Disease—Overview

(Chronic Heartburn; Gastro-oesophageal Reflux Disease [GORD]; GERD; Reflux)

See also:

Definition

Heartburn is a burning sensation behind the breastbone. It is caused by many different conditions. However, periodic heartburn does not mean there is a problem. Chronic heartburn, with or without other digestive symptoms more than 2 times per week for several weeks, may indicate gastroesophageal reflux disease (GERD). Acid reflux irritates the esophagus, which can cause permanent damage over the course of time.
Gastroesophageal Reflux Disease
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Causes

The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. Certain conditions can keep this muscle from closing completely, which allows acid to flow upward, causing heartburn.
These conditions may include:
Heartburn
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Risk Factors

Factors that may increase your chance of chronic heartburn or GERD include:
Foods and drinks that may cause symptoms include:
Medications and supplements that cause symptoms may include:

Symptoms

Heartburn and other digestive symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.
Common symptoms may include:
The regular reflux of stomach acid can cause irritation of the tissue and other structures of the throat. This irritation can lead to other symptoms, such as:
Long-term complications of GERD may include:

When Should I Call My Doctor?

It is common to experience heartburn occasionally. If you have heartburn at least 2 times per week, make an appointment to see your doctor. Call your doctor if you have any complications from chronic heartburn.

When Should I Call for Emergency Medical Services?

The muscles of the esophagus can tighten or spasm. This can cause pain that radiates through the chest and back, similar to how a heart attack may feel. Do not assume that chest pain is an esophageal spasm.
If you have chest pains or other symptoms of a possible heart attack, call for emergency medical services right away:
  • Squeezing or chest pressure
  • Pain in the left shoulder, left arm, or jaw
  • Trouble breathing
  • Sweating, clammy skin
  • Nausea
  • Weakness
  • Lightheadedness
  • Pain that starts during activity or stress
  • Feeling of impending doom

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take x-rays (using contrast material) of your esophagus or stomach with an upper GI series. A biopsy of your esophagus may be taken. A biopsy is a tissue sample that is examined under a microscope. This is often done during an endoscopy.
Other tests may include:

Treatment

Talk to your doctor about the best treatment plan for you. Treatment will depend the cause of the heartburn. Treatment focuses on preventing symptoms from occurring and healing any damage to the esophagus.

Lifestyle Changes

To help decrease chronic heartburn symptoms:
  • Keep a food diary of what you eat and what the reaction is. Make gradual changes to your diet and record the results.
  • Avoid foods and drinks that trigger digestive symptoms.
  • Eat smaller portions.
  • Allow at least 2-3 hours between meals and lying down, and exercise.
  • If you are overweight, your doctor will advise you how to safely lose weight.
  • If you smoke, your doctor will tell you how to successfully quit.
  • Avoid alcohol or drink in moderation. Moderation is 1-2 drinks per day for men and one drink per day for women.
  • Avoid belts and clothing that are too tight. This increases pressure on the abdomen.
  • Elevate head of your bed 6-8 inches.

Medication

Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend.
  • Proton-pump inhibitors
  • H-2 blockers
  • Antacids

Surgery

Surgery may be an option if symptoms are severe, other treatment methods fail, or medication cannot be tolerated. Surgical treatments include:
Fundoplication
The most common surgery for GERD is fundoplication. The doctor wraps the stomach around the esophagus. This creates pressure on the muscle at the opening to the stomach. This can be done as an open or laparoscopic procedure.
Endoscopic Antireflux Procedures
A lighted device called an endoscope is inserted through the mouth and down the esophagus. Many procedures can be done using endoscopy to decrease the backward flow of stomach acid into the esophagus. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach, tightening the LES muscle.
LINX Reflux Management System
LINX is a small band with magnetic beads made from titanium. Laparoscopic surgery is used to place the band around the end of the esophagus where it meets the stomach. This band helps support LES function. When the LES should be closed, the magnetic beads are attracted together. Pressure from swallowed food or drink pushes the beads apart, allowing entry into the stomach.
Some people will be able to stop taking medications after surgery. Others may need less medication, or may experience significant relief from other symptoms of GERD.
Some people will be able to stop taking medications after surgery. Others may need less medication, or may experience significant relief from other symptoms of GERD.

Prevention

There are no current guidelines to prevent GERD/heartburn.

RESOURCES

American Gastroenterological Association http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Institute for Health Information http://www.cihi.ca

Health Canada http://www.hc-sc.gc.ca

References

Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-adults/Pages/overview.aspx. Accessed July 9, 2015.

Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 26, 2015. Accessed July 9, 2015.

Heartburn. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/heartburn.html. Updated March 2014. Accessed July 9, 2015.

Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack%5FUCM%5F002039%5FArticle.jsp#.VumYEU2FPmI. Updated June 19, 2015. Accessed July 9, 2015.

9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168(16):1798-1804.

4/25/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.

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