GERD (Chronic Acid Reflux)
What is GERD (chronic acid reflux)?
GERD (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-containing contents in your stomach persistently leak back up into your esophagus, the tube from your throat to your stomach.
Acid reflux happens because a valve at the end of your esophagus, the lower esophageal sphincter, doesn’t close properly when food arrives at your stomach. Acid backwash then flows back up through your esophagus into your throat and mouth, giving you a sour taste.
Acid reflux happens to nearly everyone at some point in life. Having acid reflux and heartburn now and then is totally normal. But, if you have acid reflux/heartburn more than twice a week over a period of several weeks, constantly take heartburn medications and antacids yet your symptoms keep returning, you may have developed GERD. Your GERD should be treated by your healthcare provider. Not just to relieve your symptoms, but because GERD can lead to more serious problems.
What are the main symptoms of GERD (chronic acid reflux)?
The main symptoms are persistent heartburn and acid regurgitation. Some people have 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. GERD can also cause a dry cough and bad breath.
What is heartburn?
Heartburn is a symptom of acid reflux. It’s a painful burning sensation in the middle of your chest caused by irritation to the lining of the esophagus caused by stomach acid.
This burning can come on anytime but is often worse after eating. For many people heartburn worsens when they recline or lie in bed, which makes it hard to get a good night’s sleep.
Fortunately, heartburn can usually be managed with over-the-counter (OTC) heartburn/acid indigestion drugs. Your healthcare provider can also prescribe stronger medicines to help tame your heartburn.
What do I do if I think I have GERD (chronic acid reflux)?
With GERD -- when reflux and heartburn happen more than once in a while -- the tissue lining your esophagus is getting battered regularly with stomach acid. Eventually the tissue becomes damaged. If you have this chronic acid reflux and heartburn you can see it’s affecting your daily eating and sleeping habits.
When GERD makes your daily life uncomfortable in this way, call your healthcare provider. Although GERD isn’t life-threatening in itself, its chronic inflammation of the esophagus can lead to something more serious. You may need stronger prescription medications or even surgery to ease your symptoms.
How common is GERD (chronic acid reflux)?
GERD is very common. The condition and its symptoms touch a huge number of people: 20% of the U.S. population.
Anyone of any age can develop GERD, but some may be more at risk for it. For example, the chances you’ll have some form of GERD (mild or severe) increase after age 40.
You’re also more likely to have it if you’re:
- Overweight or obese.
- Smoking or are regularly exposed to second-hand smoke.
- Taking certain medications that may cause acid reflux.
Symptoms and Causes
What causes acid reflux?
Acid reflux is caused by weakness or relaxation of the lower esophageal sphincter (valve). Normally this valve closes tightly after food enters your stomach. If it relaxes when it shouldn’t, your stomach contents rise back up into the esophagus.
Stomach acids flow back up into the esophagus, causing reflux.
Factors that can lead to this include:
- Too much pressure on the abdomen. Some pregnant women experience heartburn almost daily because of this increased pressure.
- Particular types of food (for example, dairy, spicy or fried foods) and eating habits.
- Medications that include medicines for asthma, high blood pressure and allergies; as well as painkillers, sedatives and anti-depressants.
- A hiatal hernia. The upper part of the stomach bulges into the diaphragm, getting in the way of normal intake of food.
What are the symptoms of GERD (chronic acid reflux)?
Different people are affected in different ways by GERD. The most common symptoms are:
- Regurgitation (food comes back into your mouth from the esophagus).
- The feeling of food caught in your throat.
- Chest pain.
- Problem swallowing.
- Sore throat and hoarseness.
Infants and children can experience similar symptoms of GERD, as well as:
- Frequent small vomiting episodes.
- Excessive crying, not wanting to eat (in babies and infants).
- Other respiratory (breathing) difficulties.
- Frequent sour taste of acid, especially when lying down.
- Hoarse throat.
- Feeling of choking that may wake the child up.
- Bad breath.
- Difficulty sleeping after eating, especially in infants.
How do I know I’m having heartburn and not a heart attack?
Chest pain caused by heartburn may make you afraid you’re having a heart attack. Heartburn has nothing to do with your heart, but since the discomfort is in your chest it may be hard to know the difference while it’s going on. But symptoms of a heart attack are different than heartburn.
Heartburn is that uncomfortable burning feeling or pain in your chest that can move up to your neck and throat. A heart attack can cause pain in the arms, neck and jaw, shortness of breath, sweating, nausea, dizziness, extreme fatigue and anxiety, among other symptoms.
If your heartburn medication doesn’t help and your chest pain is accompanied by these symptoms, call for medical attention right away.
Can GERD (chronic acid reflux) cause asthma?
We don’t know the exact relationship between GERD and asthma. More than 75% of people with asthma have GERD. They are twice as likely to have GERD as people without asthma. GERD may make asthma symptoms worse, and asthma drugs may make GERD worse. But treating GERD often helps to relieve asthma symptoms.
The symptoms of GERD can injure the lining of the throat, airways and lungs, making breathing difficult and causing a persistent cough, which may suggest a link. Doctors mostly look at GERD as a cause of asthma if:
- Asthma begins in adulthood.
- Asthma symptoms get worse after a meal, exercise, at night and after lying down.
- Asthma doesn’t get better with standard asthma treatments.
If you have asthma and GERD, your healthcare provider can help you find the best ways to handles both conditions -- the right medications and treatments that won’t aggravate symptoms of either disease.
Is GERD (chronic acid reflux) dangerous or life-threatening?
GERD isn’t life-threatening or dangerous in itself. But long-term GERD can lead to more serious health problems:
- Esophagitis: Esophagitis is the irritation and inflammation the stomach acid causes in the lining of the esophagus. Esophagitis can cause ulcers in your esophagus, heartburn, chest pain, bleeding and trouble swallowing.
- Barrett's esophagus: Barrett's esophagus is a condition that develops in some people (about 10%) who have long-term GERD. The damage acid reflux can cause over years can change the cells in the lining of the esophagus. Barrett’s esophagus is a risk factor for cancer of the esophagus.
- Esophageal cancer: Cancer that begins in the esophagus is divided into two major types. Adenocarcinoma usually develops in the lower part of the esophagus. This type can develop from Barrett’s esophagus. Squamous cell carcinoma begins in the cells that line the esophagus. This cancer usually affects the upper and middle part of the esophagus.
- Strictures: Sometimes the damaged lining of the esophagus becomes scarred, causing narrowing of the esophagus. These strictures can interfere with eating and drinking by preventing food and liquid from reaching the stomach.
Diagnosis and Tests
How is GERD (chronic acid reflux) diagnosed?
Usually your provider can tell if you have simple acid reflux (not chronic) by talking with you about your symptoms and medical history. You and your provider can talk about controlling your symptoms through diet and medications.
If these strategies don’t help, your provider may ask you to get tested for GERD. Tests for GERD include:
- Upper gastrointestinal GI endoscopy and biopsy: Your provider feeds an endoscope (a long tube with a light attached) through your mouth and throat to look at the lining of your upper GI tract (esophagus and stomach and duodenum). The provider also cuts out a small bit of tissue (biopsy) to examine for GERD or other problems.
- Upper GI series: X-rays of your upper GI tract show any problems related to GERD. You drink barium, a liquid that moves through your tract as the X-ray tech takes pictures.
- Esophageal pH and impedance monitoring and Bravo wireless esophageal pH monitoring: These tests both measure the pH levels in your esophagus. Your provider inserts a thin tube through your nose or mouth into your stomach. Then you are sent home with a monitor that measures and records your pH as you go about your normal eating and sleeping. You’ll wear the esophageal pH and impedance monitor for 24 hours while the Bravo system is worn for 48 hours.
- Esophageal manometry: A manometry tests the functionality of lower esophageal sphincter and esophageal muscles to move food normally from the esophagus to the stomach. Your provider inserts a small flexible tube with sensors into your nose. These sensors measure the strength of your sphincter, muscles and spasms as you swallow.
When does a child/infant need to be hospitalized for GERD?
GERD is usually treated on an outpatient basis. However your child will need to be hospitalized if he or she:
- Has poor weight gain or experiences a failure to thrive.
- Has cyanosis (a bluish or purplish discoloration of the skin due to deficient oxygenation of the blood) or choking spells.
- Experiences excessive irritability.
- Experiences excessive vomiting/dehydration.
Management and Treatment
What medications do I take to manage the symptoms of GERD (chronic acid reflux)?
Many over-the-counter (OTC) and prescription medications relieve GERD. Most of OTC drugs come in prescription strength too. Your provider will give you a prescription for these stronger drugs if you’re not getting relief from the OTC formulas.
The most common GERD medications:
Antacids (provide quick relief by neutralizing stomach acids) include Tums®, Rolaids®, Mylanta®, Riopan® and Maalox®.
H-2 receptor blockers (which decrease acid production) include Tagamet®, Pepcid AC®, Axid AR® and Zantac®.
Proton pump inhibitors (stronger acid blockers that also help heal damaged esophagus tissue) include Prevacid®, Prilosec®, Zegerid®, Nexium®, Protonix®, AcipHex® and Dexilant®.
Baclofen is a prescription drug used to reduce the relaxation of the lower esophageal sphincter which allows acid backwash.
Is there surgery to treat GERD (chronic acid reflux)?
GERD is usually controlled with medications and lifestyle changes (like eating habits). If these don’t work, or if you can’t take medications for an extended period, surgery may be a solution.
- Laparoscopic antireflux surgery (or Nissen fundoplication) is the standard surgical treatment. It’s a minimally invasive procedure that fixes your acid reflux by creating a new valve mechanism at the bottom of your esophagus. The surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so food won’t reflux back into the esophagus.
- LINX device implantation is another minimally invasive surgery. A LINX device is a ring of tiny magnets that are strong enough to keep the junction between the stomach and esophagus closed to refluxing acid but weak enough to allow food to pass through.
What treatments approaches will be considered if my child has GERD?
Approaches may include one or more of the following:
- Advice on avoiding triggers (certain types of food, changing formulas in infants) that may be causing GERD symptoms or making them worse.
- Over-the-counter medications.
- Prescription medications.
- Information on proper body positioning, e.g., maintaining an upright position after eating meals/feedings.
- Surgery (reserved as a last resort, or for when certain surgical correctable causes are identified).
How do I prevent symptoms of GERD (chronic acid reflux)?
Here are 10 tips to help prevent GERD symptoms:
- Achieve and maintain a healthy weight.
- Eat small, frequent meals rather than huge amounts a few times a day.
- Reduce fat by decreasing the amount of butter, oils, salad dressings, gravy, fatty meats and full-fat dairy products such as sour cream, cheese and whole milk.
- Sit upright while eating and stay upright (sitting or standing) for 45 to 60 minutes afterward.
- Avoid eating before bedtime. Wait at least three hours after eating to go to bed.
- Try not to wear clothes that are tight in the belly area. They can squeeze your stomach and push acid up into the esophagus.
- When sleeping, raise the head of the bed 6 to 8 inches, using wooden blocks under the bedposts. Extra pillows don’t work.
- Stop smoking.
- Your healthcare provider may prescribe acid-reducing medications. Be sure to take them as directed.
- Cut out possible trigger foods.
What foods should I avoid if I have GERD (chronic acid reflux)?
Adjusting your diet and eating habits play a key role in controlling the symptoms of GERD. Try to avoid the trigger foods that keep giving you heartburn.
For example, many people get heartburn from:
- Spicy foods.
- Fried foods.
- Fatty (including dairy) foods.
- Tomato sauces.
- Garlic and onions.
- Alcohol, coffee and carbonated drinks.
- Citrus fruits.
Keep a record of the trigger foods that give you trouble. Talk with your provider to get help with this. They’ll have suggestions about how to log foods and times of day you should eat.
Outlook / Prognosis
What is the outlook for GERD (chronic acid reflux)?
You can control the symptoms of GERD. If you adjust your eating and sleeping habits and take medications when needed, you should be able to get your GERD symptoms to a manageable level.
When should I call my healthcare provider?
If you experience acid reflux/heartburn more than twice a week over a period of several weeks, constantly take heartburn and antacids and your symptoms keep returning, call your healthcare provider.