What is acid reflux disease or GERD?

Gastroesophageal reflux disease (GERD), commonly referred to as acid reflux disease, is a chronic condition in which the acid of the stomach backs up into the esophagus (food tube) causing persistent heartburn symptoms and/or potentially serious damage to the lining of the esophagus.

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What causes acid reflux disease?

Acid reflux disease is caused by the abnormal function of the lower esophageal sphincter (LES).  The LES is a type of valve located between the esophagus and the stomach that contracts and closes off the passage of acid and stomach contents back into the esophagus (see picture).

This abnormality can happen when the LES has a weak contraction or when it has prolonged relaxations, which allow the stomach acid to back up into the esophagus.

What are the symptoms of acid reflux disease?

The most common symptoms of acid reflux disease include:

• Chronic, frequent, and persistent heartburn
• Persistent cough
• Sour or bitter taste in the mouth
• Hoarseness
• Regurgitation (food or fluid in the stomach coming up into the mouth)
• Central upper abdominal pain
• Chest pain
• Difficulty swallowing

Important note: Report chest pain to your health care provider immediately so he or she can determine whether your symptoms are associated with a stomach or a heart problem.

When do the symptoms get worse?

The symptoms usually get worse:

• After eating
• When bending over
• When lying down or during physical activity

How are acid reflux disease and heartburn different?

Acid reflux disease is often mistaken for occasional heartburn because of its frequent and persistent heartburn symptoms.  Unlike occasional heartburn, persistent heartburn symptoms that characterize the acid reflux disease occur on 2 or more days a week despite change of diet and treating the symptoms.

Who is at higher risk of developing acid reflux disease?

Anyone can develop acid reflux disease.  Obese people and pregnant women may also be at higher risk of developing the symptoms of acid reflux due to the increase pressure in the abdomen.  The risk for developing acid reflux disease increases with age.

Who can diagnose acid reflux disease?

A health care provider that specializes in internal medicine, also known as internist, can diagnose and treat this disease.  However, if the symptoms persist even when receiving treatment and changing the diet, you can visit a specialist that treats diseases of the digestive system.  This type of specialist is called a gastroenterologist.

How is acid reflux disease diagnosed?

Acid reflux disease is usually diagnosed based on the patient's medical history and symptoms.  To confirm the diagnosis, physicians often treat patients with medications to decrease the production of acid by the stomach (also known as empiric therapy).  If the heartburn improves or goes away, the diagnosis of acid reflux disease is usually confirmed.  Another way to confirm the diagnosis of acid reflux disease is through laboratory tests and other exams such as:

• Upper Endoscopy
• pH Monitoring Examination
• Barium Swallow Radiography

Talk to your health care provider to find out if you need any exams and to determine which test is the most appropriate for you. 

Is there a cure for acid reflux disease?

No, there is no cure for acid reflux disease yet.  However, there are various types of over-the-counter and prescribed medications, as well as dietary and lifestyle changes that can help you manage your symptoms.

What dietary and life style changes can I do to manage my symptoms?

The following list includes recommended lifestyle and dietary changes that can help you feel better:

• Eat small meals. Try to eat 4 to 5 small meals throughout the day to avoid filling your stomach.
• Avoid spicy and acidic foods and drinks. The following foods and beverages can worsen your symptoms:
  • Coffee and tea
  • Alcoholic beverages
  • Carbonated drinks
  • Condiments (pepper and garlic)
  • Tomatoes, tomato juice or salsa
  • Citrus fruits and juices (oranges)
  • Fried or fatty foods
  • Onions
  • Chocolate
  • Peppermint
• If you smoke, stop smoking.  Cigarette smoke relaxes the lower esophageal sphincter (LES) and allows the gastric acid to back up into the esophagus. 
• Lose weight if you are overweight or obese.  Being overweight puts additional pressure in the stomach, which can worsen the symptoms.
• Wear loose clothing around the abdominal area.  Try to use clothes that are not too tight around the waist because they can put extra pressure on the stomach. 
• Do not lie down after eating.  Wait 3 hours after eating before ling down or bending over to help keep the stomach acid from backing up into the esophagus.
• Raise the head of your bed.  This position helps keep the acid in the stomach and could lead to a better night's rest. 
• Keep a record of your symptoms. Write down what causes your symptoms and what medicines you take to control them.  This record will show you what foods and drinks to avoid and what makes you feel better.

What medicines are available to treat the symptoms of acid reflux?

There are various types of over-the-counter and prescribed medications that your health care provider can recommend to manage your symptoms.  Some of these medications are:

• Antacids
• Proton pump inhibitors (PPIs)
• Histamine receptor antagonists (H2RAs)
• Promotility drugs

What happens if I do not seek treatment?

If acid reflux disease is left untreated, the acid escaping back up from your stomach can over time wear away or erode the inner lining of the esophagus causing erosive esophagitis.  Erosive esophagitis happens because the esophagus lacks the same protection the stomach has against gastric acids.  Only your health care provider can determine if you have erosive esophagitis. 

Other complications of acid reflux disease include ulcers and strictures of the esophagus, cough and asthma, throat and laryngeal inflammation, inflammation and infection of the lungs, and collection of fluids in the sinuses and middle ear. 

What happens if the treatment and changes in diet and life style do not reduce my symptoms?

Most patients with acid reflux disease effectively manage their condition with medication and changes in their diet and life style.  However, if none of this works, a gastroenterologist may recommend a surgery to prevent the acid reflux from backing up into the esophagus.  This surgery is known as a Nissen Fundoplication.

Resources

National Alliance for Hispanic Health
Su Familia: The National Hispanic Family Health Helpline
1-866-SU-FAMILIA (1-866-783-2645)
SuFamilia@hispanichealth.org
http://www.hispanichealth.org

The American College of Gastroenterology
http://www.acg.gi.org

National Digestive Diseases Information Clearinghouse (NDDIC)
http://digestive.niddk.nih.gov/index.htm

Pediatric/Adolescent Gastroesophageal Reflux Association Inc. (PAGER)
http://www.reflux.org

The North American Society for Pediatric Gastroenterology, Hematology and Nutrition
http://www.naspghan.org