Gastroesophageal Reflux / Heartburn

Gastroesophageal Reflux Disease—Overview

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

Definition

Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. Heartburn happen often or every once in a while.
Heartburn that occurs more than 2 times a week for several weeks may be gastroesophageal reflux disease (GERD). It can cause permanent damage over the course of time.
Gastroesophageal Reflux Disease
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Causes

A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:
  • Problems with the nerves that control the muscles of the ring
  • Problems with muscle tone of the ring
  • Muscles that move food down into the stomach are weak
  • Abnormal pressure on the area
  • Increased relaxation of the muscles
  • Increased pressure within the abdomen—pushes up against the stomach
Heartburn
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Risk Factors

Factors that may increase your chance of heartburn or GERD include:
  • Obesity
  • Smoking
  • Alcohol use
  • Exercising or strenuous activity immediately after eating
  • Lying down, bending over, or straining after eating
  • Pregnancy
  • Prior surgery for heartburn
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube
Foods and drinks that are more likely to cause symptoms include:
  • Caffeinated products
  • Carbonated drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
Medications and supplements that cause symptoms may include:
  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates

Symptoms

Heartburn often occurs 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:
  • Burning feeling that starts in the lower chest and moves up the throat—most common symptom
  • Regurgitation—a feeling that food is coming back up
  • Sour or bitter taste in the throat
  • Burping
  • Bloating
The repeated, regular episodes can lead to other symptoms such as:
  • Sore throat
  • Hoarseness
  • Chronic laryngitis
  • Chronic cough
  • Feeling of a lump in the throat
  • Waking up with a sensation of choking
  • Difficulty swallowing
Long-term complications of GERD may include:
  • Inflammation and scarring of the esophagus—esophagitis
  • Bleeding and ulcers in the esophagus
  • Narrowing of the esophagus—esophageal stricture
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel
  • Asthma attacks
  • Vomiting blood
  • Black or tarry stools
  • Precancerous condition that can lead to esophageal cancer—Barrett esophagus
  • Esophageal cancer

When Should I Call My Doctor?

Make an appointment to see your doctor if you have heartburn 2 or more times a week, every week.

Diagnosis

The doctor will ask about your symptoms and medical history. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.
Further testing is not always needed. Your doctor may order the following to look for complications:
  • Upper GI series
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
  • Manometry to test muscle strength in the lower esophagus

Treatment

Treatment will depend the cause of the heartburn. The goal is to prevent further symptoms and heal any damage.

Lifestyle Changes

To help decrease chronic heartburn symptoms:
  • Keep a food diary. Note what you eat and how you feel after.
  • Make gradual changes to your diet. Record the results.
    • Avoid foods and drinks that trigger heartburn.
    • Eat smaller portions.
    • Allow at least 2-3 hours after a meal before lying down or exercise.
    • Avoid alcohol or drink in moderation. Moderation is 1-2 drinks per day for men and one drink per day for women.
  • If you are overweight, talk to your doctor about a plan to lose weight.
  • If you smoke, look for ways to help you quit.
  • Avoid belts and clothing that are too tight. They can increases pressure on the abdomen.
  • Elevate head of your bed 6-8 inches. It may relieve heartburn at night.

Medication

Medicine may help relieve symptoms. Some can also help to repair damage. Many heartburn medicines are available over-the-counter. Options include:
  • Proton-pump inhibitors
  • H2 blockers
  • Antacids
Talk to your doctor about which ones may be best for you.

Surgery

Surgery may be an option if:
  • Symptoms are severe
  • Other treatment methods fail
  • Medicine 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 extra pressure on the opening to the stomach and helps keep it closed.
Endoscopic Antireflux Procedures
There are a number of procedures that can be done with an endoscope. These procedures use a long thin tube called a scope. It is passed through the mouth and down the throat and has a camera that will help the doctor see inside. Small tools can also be passed through the scope to do a number of procedures. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach. It will help tighten the ring muscles.
LINX Reflux Management System
LINX is a small band with magnetic beads. A surgeon places the band around the end of the esophagus where it meets the stomach. The magnets pull together to help close the opening. Swallowed food or drink push apart the beads so that it can move into the stomach.
Some people will be able to stop or reduce medicine after surgery.
Some people will be able to stop or reduce medicine after surgery.

Prevention

There are no current guidelines to prevent GERD.

RESOURCES

American Gastroenterological Association
http://www.gastro.org
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Association of Gastroenterology
https://www.cag-acg.org
Canadian Digestive Health Foundation
http://www.cdhf.ca

References

Acid reflux (GER & GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults. Accessed April 4, 2018.
Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated September 14, 2017. Accessed April 4, 2018.
Heartburn. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/heartburn/. Updated November 8, 2017. Accessed April 4, 2018.
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#.WsUYIy7wZQJ. Updated January 11, 2018. Accessed April 4, 2018.
9/30/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: 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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: 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.

Revision Information

  • Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
  • Review Date: 04/2018
  • Update Date: 07/09/2015
Article written by Wood D