TREATMENT S FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter
(LES) does not close properly and stomach contents leak back, or reflux, into the
esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a
valve between the esophagus and stomach. The esophagus carries food from the mouth
to the stomach.
When refluxed stomach acid touches the lining of the esophagus, it causes a burning
sensation in the chest or throat called heartburn. The fluid may even be tasted in the back
of the mouth, and this is called acid indigestion. Occasional heartburn is common but
does not necessarily mean one has gastroesophageal reflux disease. Heartburn that
occurs more than twice a week may be considered gastroesophageal reflux disease
The main symptoms are persistent heartburn and acid regurgitation. Some people have
gastroesophageal reflux disease (GERD) without heartburn. Instead, they experience
pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you
have food stuck in your throat or like you are choking or your throat is tight.
Gastroesophageal reflux disease (GERD) can also cause a dry cough and bad breath.
Gastroesophageal reflux disease (GERD) in Children Studies* show that
gastroesophageal reflux disease is common and may be overlooked in infants and
children. It can cause repeated vomiting, coughing, and other respiratory problems.
Children's immature digestive systems are usually to blame, and most infants grow out of
gastroesophageal reflux disease (GERD) by the time they are 1 year old. Still, you should
talk to your child's doctor if the problem occurs regularly and causes discomfort. Your
doctor may recommend simple strategies for avoiding reflux, like burping the infant
several times during feeding or keeping the infant in an upright position for 30 minutes
after feeding. If your child is older, the doctor may recommend avoiding sodas that
contain caffeine, chocolate and peppermint, spicy foods like pizza, acidic foods like
oranges and tomatoes and fried and fatty foods. [Jung AD. Gastroesophageal reflux in
infants and children. American Family Physician. 2001;64(11):1853Â¡V1860.]
Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that
the child sleep with head raised. If these changes do not work, the doctor may prescribe
medicine for your child. In rare cases, a child may need surgery. What causes
gastroesophageal reflux disease? No one knows why people get gastroesophageal
reflux disease. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part
of the stomach is above the diaphragm, the muscle wall that separates the stomach from
the chest. The diaphragm helps the LES keep acid from coming up into the esophagus.
When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal
hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise
healthy people over 50 have a small one.
Other factors that may contribute to gastroesophageal reflux disease include alcohol use,
overweight, pregnancy and smoking
Also, certain foods can be associated with reflux events, including citrus fruits, chocolate,
drinks with caffeine, fatty and fried foods, garlic and onions, mint flavorings, spicy foods,
tomato-based foods, like spaghetti sauce, chili, and pizza
How is gastroesophageal reflux disease treated? If you have had heartburn or any of
the other symptoms for a while, you should see your doctor. You may want to visit an
internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor
who treats diseases of the stomach and intestines. Depending on how severe your
gastroesophageal reflux disease is, treatment may involve one or more of the following
lifestyle changes and medications or surgery. Your doctor may also advise you to change
your lifestyle, such as stop smoking, stop drinking alcohol, control weight (if needed),
eating small meals, wearing loose-fitting clothes, avoiding lying down for 3 hours after a
meal and raising the head of your bed 6-8 inches higher.
Medications include (1) Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol,
Rolaids, and Riopan, (2) Foaming agents, such as Gaviscon, work by covering your
stomach contents with foam to prevent reflux. (3) H2 blockers, such as cimetidine
(Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75),
impede acid production. (4) Proton pump inhibitors - omeprazole (Prilosec),
lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and
esomeprazole (Nexium), (5) Prokinetics, helps strengthen the sphincter and makes the
stomach empty faster-bethanechol (Urecholine) and metoclopramide (Reglan).
Because drugs work in different ways, combinations of drugs may help control
symptoms. People who get heartburn after eating may take both antacids and H2
blockers. The antacids work first to neutralize the acid in the stomach, while the H2
blockers act on acid production.
What if symptoms persist?
If your heartburn does not improve with lifestyle changes or drugs, you may need
A barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal
hernia and severe inflammation of the esophagus. With this test, you drink a solution and
then x rays are taken. Mild irritation will not appear on this test, although narrowing of the
esophagusÂ¡Xcalled strictureÂ¡Xulcers, hiatal hernia, and other problems will.
Upper endoscopy is more accurate than a barium swallow radiograph and may be
performed in a hospital or a doctor's office. The doctor will spray your throat to numb it
and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the
endoscope allows the doctor to see the surface of the esophagus and to search for
abnormalities. If you have had moderate to severe symptoms and this procedure reveals
injury to the esophagus, usually no other tests are needed to confirm gastroesophageal
reflux disease (GERD).
The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of
tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by
acid reflux and rule out other problems if no infecting organisms or abnormal growths are
In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the
esophagus that will stay there for 24 hours. While you go about your normal activities, it
measures when and how much acid comes up into your esophagus. This test is useful in
people with gastroesophageal reflux disease (GERD) symptoms but no esophageal
damage. The procedure is also helpful in detecting whether respiratory symptoms,
including wheezing and coughing, are triggered by reflux. Surgery Surgery is an option
when medicine and lifestyle changes do not work. Surgery may also be a reasonable
alternative to a lifetime of drugs and discomfort.
Fundoplication, usually a specific variation called Nissen fundoplication, is the standard
surgical treatment for gastroesophageal reflux disease (GERD). The upper part of the
stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux
and to repair a hiatal hernia.
This fundoplication procedure may be done using a laparoscope and requires only tiny
incisions in the abdomen. To perform the fundoplication, surgeons use small instruments
that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively
in people of all ages, even babies. When performed by experienced surgeons, the
procedure is reported to be as good as standard fundoplication. Furthermore, people
can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic
devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES
to create little pleats that help strengthen the muscle. The Stretta system uses electrodes
to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the
muscle. The long-term effects of these two procedures are unknown. Implant Recently the
FDA approved an implant that may help people with gastroesophageal reflux disease D
who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the
LES to keep stomach acid from flowing into the esophagus. It is injected during
endoscopy. The implant is approved for people who have gastroesophageal reflux
disease and who require and respond to proton pump inhibitors. The long-term effects of
the implant are unknown.
What are the long-term complications of gastroesophageal reflux disease
(GERD)? Sometimes gastroesophageal reflux disease (GERD) can cause serious
complications. Inflammation of the esophagus from stomach acid causes bleeding or
ulcers. In addition, scars from tissue damage can narrow the esophagus and make
swallowing difficult. Some people develop Barrett's esophagus, where cells in the
esophageal lining take on an abnormal shape and color, which over time can lead to
Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be
aggravated or even caused by gastroesophageal reflux disease (GERD).
Points to Remember Heartburn, also called acid indigestion, is the most common
symptom of gastroesophageal reflux disease (GERD). Anyone experiencing heartburn
twice a week or more may have gastroesophageal reflux disease (GERD).
You can have gastroesophageal reflux disease (GERD) without having heartburn. Your
symptoms could be excessive clearing of the throat, problems swallowing, the feeling that
food is stuck in your throat, burning in the mouth, or pain in the chest.
In infants and children, gastroesophageal reflux disease may cause repeated vomiting,
coughing, and other respiratory problems. Most babies grow out of gastroesophageal
reflux disease by their first birthday.
If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most
doctors can treat gastroesophageal reflux disease. Or you may want to visit an
internistÂ¡Xa doctor who specializes in internal medicineÂ¡Xor a gastroenterologistÂ¡Xa
doctor who treats diseases of the stomach and intestines.
Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many
people with gastroesophageal reflux disease (GERD) also need medication. Surgery
may be an option.
CAUSES OF GERD
No one knows why some people who have heartburn develop gastroesophageal reflux
disease. Several factors may be involved, and research is under way on many levels.
Risk factorsÂ¡Xwhat makes some people get gastroesophageal reflux disease but not
othersÂ¡Xare being explored, as is gastroesophageal reflux disease 's role in other
conditions such as asthma and bronchitis.
The role of hiatal hernia in gastroesophageal reflux disease (GERD) continues to be
debated and explored. It is a complex topic because some people have a hiatal hernia
without having reflux, while others have reflux without having a hernia.
Much research is needed into the role of the bacterium Helicobacter pylori. Our ability to
eliminate H. pylori has been responsible for reduced rates of peptic ulcer disease and
some gastric cancers. At the same time, gastroesophageal reflux disease (GERD),
Barrett's esophagus, and cancers of the esophagus have increased. Researchers
wonder whether having H. pylori helps prevent gastroesophageal reflux disease (GERD)
and other diseases. Future treatment will be greatly affected by the results of this
Resource for this article: The National Digestive Diseases Information Clearinghouse
(NDDIC) 2 Information Way Bethesda, MD 20892Â¡V3570, Email:
email@example.comAugust 2, 2005.
Discuss with your doctor before taking any alternative medicine. This article is for
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