GERD - Diagnosis and Treatment
Gastroesophageal Reflux Disease (GERD)
How is GERD diagnosed?
GERD is diagnosed after your doctor performs a physical exam and reviews your medical history. Tests that may be ordered to confirm the diagnosis of GERD include:
- Barium swallow test
- 24-hour pH monitoring
- Esophageal manometry
- Gastric emptying studies
How GERD is treated?
Many people will get relief from heartburn and the pressure accompanying esophageal reflux by following these recommendations:
- Raise the head of your bed by six inches to allow gravity to help keep the stomach's contents in the stomach. You can put blocks under the posts of your bed, or use one or two pillows to elevate your head when lying down. Do not use piles of pillows because this puts your body into a bent position that can actually aggravate the condition by increasing pressure on the abdomen.
- Eat meals at least three to four hours before lying down, and avoid bedtime snacks.
- Eat moderate portions of food and smaller meals.
- Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra pounds.
- Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, colas, and alcohol — all of which relax the lower esophageal sphincter or delay stomach emptying. Also, avoid tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus.
- Give up smoking, which relaxes the lower esophageal sphincter.
- Wear loose belts and clothing.
- Take over-the-counter antacid medicines — such as Tums, Rolaids, Maalox, Zantac, Tagamet, Pepcid, and Axid — to relieve esophageal reflux symptoms.
If it persists:
Patients with more severe symptoms or those who have been using antacids for more than two weeks should contact their doctors, who can prescribe medications including:
Medications that help strengthen the LES and make the stomach empty faster. Prokinetics include bethanechol (Urecholine) and metoclopramide (Reglan).
Proton pump inhibitors:
Medications that control or eliminate acid. Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium).
Medications that control or eliminate acid, but may not be as effective as proton pump inhibitors. H2-receptor antagonists include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). Some of these medications are available over-the-counter, but should not be used for more than a few weeks at a time.
Because these medications work differently, a combination of drugs may be prescribed to help control your symptoms.
If an esophagoscopy reveals that the lining of the esophagus is severely inflamed and irritated by stomach acid (reflux esophagitis), medications may be necessary to block acid production in the stomach or to increase the strength of the LES. This condition, known as esophagitis, might lead to bleeding, ulcers or difficulty in swallowing, if left untreated.
If medications do not successfully treat symptoms, a small number of patients may need surgery to correct the disorder.