Topic Overview
Is this topic for you?
This topic is about
gastroesophageal reflux disease (GERD) in adults. For
information on reflux in babies and children, see
Gastroesophageal Reflux in Babies and Children.
What is gastroesophageal reflux disease (GERD)?
Reflux
means that
stomach acid and juices flow from the stomach back up
into the tube that leads from the throat to the stomach (esophagus). This causes
heartburn. When you have heartburn that bothers you often, it is called gastroesophageal reflux disease, or GERD.
Eating too much or bending forward after eating sometimes causes
heartburn and a sour taste in the mouth. But having heartburn from time to time
doesn't mean you have GERD. With GERD, the reflux and heartburn last longer and
come more often. If this happens to you, be sure to get it treated, because
GERD can cause
ulcers and damage to your esophagus.
See a
picture of the
esophagus.
What causes GERD?
Normally when you swallow your
food, it travels down the food pipe (esophagus) to a valve that opens to let
the food pass into the stomach and then closes. With GERD, the valve doesn't
close tightly enough. Stomach acid and juices flow from the stomach and back up
(reflux) into the esophagus.
What are the symptoms?
The main symptom of GERD is
heartburn. It may feel like a burning, warmth, or pain just behind the
breastbone. It is common to have symptoms at night when you are trying to
sleep.
If you have pain behind your breastbone, it is important to
make sure it is not caused by a problem with your heart. The burning sensation
caused by GERD usually occurs after you eat. Pain from the heart usually feels
like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull
ache. It occurs most often after you are active.
How is GERD diagnosed?
First, your doctor will do
a physical exam and ask you questions about your health. You may or may not
need further tests. Your doctor may just treat your symptoms by prescribing
medicines that reduce or block stomach acid. These include H2 blockers (for
example, Pepcid) or proton pump inhibitors (for example, Prilosec). If your
heartburn goes away after you take the medicine, your doctor will likely
diagnose GERD.
How is it treated?
For mild symptoms of GERD, you
can try over-the-counter medicines. These include antacids (for example, Tums),
H2 blockers (for example, Pepcid), or proton pump inhibitors (for example,
Prilosec). Changing your diet, losing weight if needed, and making other
lifestyle changes can also help. If you still have symptoms after trying
lifestyle changes and over-the-counter medicines, talk to your doctor.
Your doctor may recommend surgery if medicine doesn't work or if you
can't take medicine because of the side effects. For example, fundoplication
surgery strengthens the valve between the esophagus and stomach. But many
people continue to need some medicine even after surgery.
GERD is
common in pregnant women. Lifestyle changes and antacids are usually tried
first to treat pregnant women who have GERD. Antacids are safe to use for
heartburn symptoms during pregnancy. If lifestyle changes and antacids don't
help control your symptoms, talk to your doctor about using other medicines.
Most of the time, symptoms get better after the baby is born.
How can you manage GERD?
Many people with GERD
have it for the rest of their lives. You may need to take medicine for many
years to help control the symptoms. But you can make changes to your lifestyle
to help relieve your symptoms of GERD, too. Here are some things to try:
- Change your eating habits.
- It’s best to eat several small meals
instead of two or three large meals.
- After you eat, wait 2 to 3
hours before you lie down. Late-night snacks aren't a good
idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax
the valve between the esophagus and the stomach.
- Spicy foods, foods
that have a lot of acid (like tomatoes and oranges), and coffee can make GERD
symptoms worse in some people. If your symptoms are worse after you eat a
certain food, you may want to stop eating that food to see if your symptoms get
better.
- Do not smoke or chew tobacco.
- If
you get heartburn at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows does not work.)
- Do not wear tight clothing
around your middle.
- Lose weight if you need to. Losing just 5 to 10 pounds can
help.
Frequently Asked Questions
|
Learning about gastroesophageal reflux disease (GERD):
|
|
|
Being diagnosed:
|
|
|
Getting treatment:
|
|
|
Ongoing concerns:
|
|
|
Living with GERD:
|
|
Cause
Gastroesophageal reflux disease (GERD)
develops when
stomach acid and juices back up, or reflux, into the
esophagus, the muscular tube that connects the throat
to the stomach. This happens when the valve between the lower end of the
esophagus and the stomach (the
lower esophageal sphincter) does not close tightly
enough.
See a picture of
how reflux happens.
GERD most commonly occurs when the lower
esophageal sphincter relaxes at the wrong time (that is, when you are not
swallowing) and remains open too long. Normally, the valve opens for only a few
seconds when you swallow. But certain foods may relax the valve so that it does
not close as tightly, making reflux more likely. These foods include chocolate and peppermint.
Alcohol, tobacco (nicotine), and some medicines can also relax the lower
esophageal sphincter.
Certain foods can be associated with reflux. Though they will not cause GERD, eating these foods can make the symptoms worse. Avoiding these foods can help reduce heartburn. These include citrus fruits, fatty and fried foods, garlic and onions, spicy foods, and tomato-based foods like spaghetti sauce and pizza. Some people notice that their symptoms get worse after drinking coffee or soda. If you notice that your symptoms are worse after eating a specific food, you may want to stop eating it to see if your symptoms get better.
Other factors can allow stomach juices to back up into the esophagus,
such as:
-
Hormonal changes during pregnancy. The valve may
not close as tightly during pregnancy because of hormonal changes and increased
abdominal pressure. Heartburn is common during pregnancy, because hormones cause
the digestive system to slow down.
-
A weak lower esophageal sphincter. If this valve is
weak, it will not close properly, and reflux will occur frequently. This is a
rare cause of mild GERD, but among people who have severe GERD, about 25% have
this problem.1
-
Hiatal hernia. GERD is common among people with a
hiatal hernia. GERD symptoms in these people can vary
from mild to severe.
-
Slow digestion. If food stays in your stomach too
long before it goes to the small intestine (called delayed gastric emptying),
the stomach contents are more likely to get pushed up into the esophagus and
cause heartburn.
-
Overfull stomach. Having a very full stomach—such
as from eating a very large meal—increases the likelihood that the lower
esophageal sphincter will relax and allow stomach juices to back up (reflux)
into your esophagus.
If the stomach juice that backs up into the esophagus
is not removed quickly, it can irritate the esophagus and cause the burning,
warmth, heat, or pain just behind the breastbone. This feeling is commonly
referred to as heartburn. Normally the acid is quickly pushed back into the
stomach by squeezing movements that move down the esophagus (peristalsis).
Swallowing saliva, which has a natural antacid (bicarbonate) that helps protect
the lining of the esophagus, helps neutralize the acid.
Symptoms
The main symptoms of
gastroesophageal reflux disease (GERD) include:
-
Persistent heartburn. Heartburn is an
uncomfortable feeling or burning pain behind the breastbone. It may occur after
eating, soon after lying down, or when bending forward. Nonprescription
medicines that reduce or block acid may relieve the pain. Heartburn caused by GERD is
usually felt within 2 hours after eating. If your heartburn lasts for several
hours—for example, all night—you may have severe GERD.
-
A sour or bitter taste in the mouth. The backflow
of
stomach acid and juices into the esophagus may be
severe enough to cause a sour or bitter taste in your mouth. This often occurs
along with heartburn, but in some cases it may be your only symptom.
If these symptoms bother you often, you
may have GERD. Many people have occasional heartburn or a sour taste in the
mouth. These instances are not considered to be GERD.
Some people
have GERD without heartburn. Other symptoms of GERD can include:
- Chest pain. This may be a dull, heavy
discomfort that spreads across the chest. This chest pain may occur with
heartburn and may be confused with the pain of a heart attack. For more
information on chest pain and heart attack, see the topic
Chest Problems.
- Hoarseness.
- Trouble swallowing. This is
more common with advanced GERD.
- A feeling that you have something
stuck in your throat.
- A cough.
- Having extra saliva
(this is called water brash).
- Nausea.
There are many
other conditions with symptoms similar to GERD, such
as
peptic ulcer disease or an infection of the
esophagus.
What Happens
Gastroesophageal reflux disease (GERD)
may cause
irritation or
inflammation in the esophagus. This condition is
called esophagitis. GERD without esophagitis is sometimes called nonerosive
reflux disease.
If you have mild GERD symptoms—an uncomfortable
feeling of burning, warmth, heat, or pain just behind the breastbone, commonly
referred to as
heartburn—you may be able to successfully treat
yourself with nonprescription medicines that reduce or block acid. These
include antacids (such as Tums), H2 blockers (such as Pepcid), or proton pump
inhibitors (such as Prilosec). Changing your diet, losing weight, and
making other lifestyle changes can also help reduce heartburn.
Up
to 80% of pregnant women have
symptoms of GERD during pregnancy.1 Heartburn is common during pregnancy, because hormones cause
the digestive system to slow down. The muscles that push food down the
esophagus also move more slowly during pregnancy. Also, as the uterus
grows, it pushes on the stomach and sometimes forces stomach acid up into the
esophagus.
Advanced GERD can cause complications such as:
- Severe inflammation of the lining of the
esophagus (esophagitis), esophageal erosion, and ulcers.
- Narrowing of the esophagus (esophageal
stricture).
-
Barrett's esophagus
, in which the cells that line the
inside of the esophagus are replaced by cells similar to those that line the
inside of the stomach and intestine. Barrett's esophagus is not common, but it can
lead to cancer of the esophagus.
- Respiratory problems, such as a
persistent cough,
asthma, pneumonia, or laryngitis.
- The
speeding up of
tooth decay, because stomach acid gets into the mouth
and wears away tooth enamel.
Some people who have GERD may be at increased risk for
cancer of the esophagus.
What Increases Your Risk
Things that increase your
risk of developing symptoms of
gastroesophageal reflux disease (GERD) include:
- Being overweight.
- Being
pregnant.
- Smoking.
- Drinking alcohol.
- Eating
certain foods, such as chocolate or peppermint, that may relax the valve
between the stomach and esophagus.
- Taking certain medicines. If you
think a medicine you take may be causing your GERD symptoms, talk to your
doctor.
- Having a
hiatal hernia.
- Having a condition called
scleroderma, a rare disease in which a person's immune
system begins to destroy normal, healthy tissues (autoimmune disease).
If you have too little saliva, heartburn is more likely.
Cigarette smoking, certain diseases, or medicines can reduce the amount of
saliva your body produces. If you have a problem with the lining of your
esophagus that makes the lining more sensitive to stomach acid, your heartburn
may be more severe.
When To Call a Doctor
The main symptom of
gastroesophageal reflux disease (GERD) is an
uncomfortable feeling of burning, warmth, heat, or pain just behind the
breastbone, a feeling commonly referred to as heartburn. Sometimes heartburn
can feel like the chest pain of a heart attack. Call 911 or other emergency services immediately if you have:
- Chest pain that is crushing or squeezing, feels
like a heavy weight on the chest, or is occurring with any of the following
symptoms:
- Sweating
- Shortness of
breath
- Nausea or vomiting
- Pain that spreads from the
chest to the neck or jaw or one or both shoulders or arms
- Dizziness
or lightheadedness
- Fast or irregular pulse
- Signs of shock,
such as lightheadedness or rapid, shallow breathing
- Chest pain
(that has been previously diagnosed as a heart problem by a doctor) that
has not gone away after using your home treatment plan
to treat it
Call your doctor immediately if
you:
- Vomit blood.
- Have bloody, black, or
maroon-colored stools.
Call your doctor if you have GERD symptoms:
- That are not improving after 2 weeks of home
treatment, are different or getting worse, or are interfering with normal
activities.
- With choking or difficulty
swallowing.
- Along with any significant weight loss.
-
That have occurred frequently over several years and are only partially
relieved with lifestyle changes and nonprescription medicines that reduce or
block acid.
Watchful Waiting
Occasional mild heartburn can often be relieved
by making lifestyle changes and taking nonprescription medicines that reduce or
block acid. These include antacids (such as Tums), H2 blockers (such as
Pepcid), or proton pump inhibitors (such as Prilosec OTC). Contact a doctor if
any of the above symptoms develop.
If you have not been diagnosed
with GERD but you have symptoms such as heartburn or a sour taste in your
mouth, see the topic
Heartburn.
Who To See
The following health professionals can evaluate
symptoms of gastroesophageal reflux disease (GERD):
You may be referred to a doctor who specializes in
diseases of the digestive tract (gastroenterologist) to check severe
GERD symptoms or to get an opinion on whether surgery is needed. If you are
thinking about having surgery, you may also be referred to a general surgeon
who has experience treating stomach and esophagus problems.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Extensive testing is not usually needed in people who have symptoms of
gastroesophageal reflux disease (GERD). A doctor may
first ask you questions about your symptoms, such as whether you have a
frequent uncomfortable feeling of burning, warmth, heat, or pain just behind
the breastbone, a feeling commonly referred to as heartburn. If you have
frequent, severe episodes of heartburn, your doctor may prescribe medicines
normally used to treat symptoms of GERD without performing any other tests. If
your symptoms get better with these medicines, your doctor will usually
diagnose you as having GERD.
Depending on your symptoms, your
doctor may refer you to a specialist (such as a
gastroenterologist) for a test called an
upper gastrointestinal endoscopy. This allows your
doctor to look at the inner lining of your
esophagus, stomach, and the first part of your small
intestine (duodenum) through a thin, flexible viewing instrument
called an endoscope.
Endoscopy is
used to:
- Look for problems in people who have symptoms of GERD and also
trouble swallowing (dysphagia).
- Look for other causes of your
symptoms if medicines have not helped.
Other tests
Sometimes endoscopy is normal but you
still have symptoms that don't get better with medicine. If so,
esophageal tests may be done. This testing includes:
- Manometry testing, which determines how well
muscles in the esophagus move food into the stomach and how tightly the valve
between the esophagus and stomach (the lower esophageal sphincter) closes.
Manometry testing is also often required before doing surgery to treat
GERD.
- pH monitoring, which tests how often acid from the stomach
gets into the esophagus and how long it stays there.
X-ray pictures of the esophagus and stomach are not used
to diagnose GERD. But they may be useful for finding other problems that may
be causing GERD symptoms, such as a
hiatal hernia or a narrowing in the esophagus
(stricture). These X-rays may be done as part of a series of tests called an
upper gastrointestinal series.
The tests your doctor may recommend are based on your
specific GERD symptoms. Before you have more GERD testing, you may want to talk
to your doctor. He or she will be able to tell you what information the test is
expected to provide and how the results will change your treatment.
Treatment Overview
Treatment for
gastroesophageal reflux disease (GERD) is aimed at
reducing the abnormal backflow, or reflux, of
stomach acid and juices into the
esophagus. It is also aimed at preventing injury to the lining of the
esophagus or to help it to heal if injury has already occurred. Treatment is also aimed at preventing GERD
from recurring and preventing other conditions that might arise as
complications of GERD.
Initial treatment
Treatment for people who have
symptoms of
gastroesophageal reflux disease (GERD) begins with
making lifestyle changes and taking nonprescription medicines that reduce or
block acid. If you have been
using nonprescription medicines to treat your symptoms for longer than 2 weeks,
talk to your doctor. If you have GERD, the stomach acid could be causing damage
to your esophagus. Your doctor can help you find the right treatment. If you
have frequent or severe GERD symptoms, your doctor may recommend that you use
prescription medicines along with lifestyle changes. When prescription
medicines are used to treat GERD symptoms:
- You may need to try different medicines or
combinations of medicines before finding the one that best relieves your
symptoms.
- The dose or frequency may need to be gradually increased
until the most effective dose for you is found.
- Long-term—perhaps
for the rest of your life—medicine therapy is usually needed to treat
severe, persistent symptoms or complications of GERD.
Medicines for GERD include
proton pump inhibitors (such as lansoprazole and omeprazole)
and H2 blockers (such as cimetidine and famotidine). Many of
these medicines are available in both prescription and nonprescription
forms.
An important part of treating GERD is avoiding the things
that trigger your symptoms. These may include foods such as spicy or fatty
foods, chocolate, drinks that contain caffeine or alcohol, behaviors such as
smoking, and taking certain medicines. If you think that your symptoms are
worse after eating a certain food, you can stop eating that food to see if it
helps your symptoms. If you think a medicine you are taking is making your
symptoms worse, talk to your doctor.
Ongoing treatment
If medicines and lifestyle
changes control symptoms of
gastroesophageal reflux disease (GERD), you will
likely continue the same treatment. Be sure to continue to take
medicines as instructed by your doctor, because stopping therapy will often
bring symptoms back.
Medicine may not prevent all of your GERD symptoms all the time. Even if you are taking an acid reducer every day, you may still have heartburn from time to time. It's okay to take antacids when you have heartburn like this. But if you feel like your daily medicine is not working to control your GERD symptoms, talk with your doctor. You may need to try a different medicine.
Treatment if the condition gets worse
If your
symptoms of
gastroesophageal reflux disease (GERD) do not improve
with treatment, or if complications develop, your doctor may suggest that you
take your medicine more often. Or you may be switched to a higher dose or a
stronger medicine. Your doctor may reevaluate your diet and lifestyle
also.
Depending on your symptoms, your doctor may refer you to a
specialist for an
upper gastrointestinal endoscopy
(esophagogastroduodenoscopy, or EGD).
If your
biopsy during upper gastrointestinal endoscopy (EGD)
leads to a diagnosis of Barrett's esophagus, this condition will need to be
watched. Your doctor may advise you to keep taking medicine and have
regular EGDs to watch the problem. Talk to your doctor about how often you
should have follow-up EGDs to watch your condition.
Your doctor may conduct other
esophageal tests, such as esophageal manometry. This
test can detect spasms of the esophagus and problems with the ability of the
esophagus to move food down to the stomach (motility problems). Manometry is
the most useful test for these purposes.
Surgery may
be an option when:
- Treatment with medicines does not completely
relieve your symptoms, and the remaining symptoms are proved to be caused by
reflux of stomach juices.
- You do not want or, because of side
effects, you are unable to take medicines over an extended period of time to
control GERD symptoms.
- Along with reflux you have complications such as asthma,
hoarseness, or cough that do not improve when treated with medicines.
The benefits of surgery need to be compared with the possible complications and new symptoms you may have after surgery. Surgery for GERD can cause problems with swallowing and burping. It can also cause extra gas in the digestive tract, which leads to bloating and flatulence. After surgery, you may need to have other procedures to fix these problems. Some people still have to take medicine to control their symptoms, even after surgery. And some people have to have surgery again.
For more information, see:
-
GERD: Which Treatment Should I Use?
What To Think About
Up to 80% of pregnant women
have
symptoms of GERD during pregnancy.1 Heartburn is common during pregnancy, because hormones cause
the digestive system to slow down. The muscles that push food down the
esophagus also move more slowly during pregnancy. Also, as the uterus
grows, it pushes on the stomach and sometimes forces stomach acid up into the
esophagus. Lifestyle changes and antacids are usually tried first to treat
pregnant women who have GERD. Antacids are safe to use for heartburn symptoms
during pregnancy. If lifestyle changes and antacids don't help control your
symptoms, talk to your doctor about using other medicines. Most of the time,
symptoms get better after the baby is born.
Many people who
develop GERD have the condition for the rest of their lives. Depending on how
bad your symptoms are, you may need to take medicines on a daily basis or only
now and then when GERD symptoms occur. Long-term—often lifelong—medicine
treatment is usually required for GERD symptoms that are more severe, because
symptoms tend to return (recur) when the medicine is stopped. Even when
symptoms can be controlled with lifestyle changes or nonprescription medicines,
these treatments need to be maintained over the long term to prevent GERD
symptoms from recurring.
Prevention
Symptoms of
gastroesophageal reflux disease (GERD), such as
heartburn, can be uncomfortable or even painful.
You can make changes to your lifestyle to help relieve
your symptoms of GERD. Here are some things to try:
- Change your
eating habits.
- It’s best to eat several small meals
instead of two or three large meals.
- After you eat, wait 2 to 3
hours before you lie down. Late-night snacks aren't a good
idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax
the valve between the esophagus and the stomach.
- Spicy foods, foods
that have a lot of acid (like tomatoes and oranges), and coffee can make GERD
symptoms worse in some people. If your symptoms are worse after you eat a
certain food, you may want to stop eating that food to see if your symptoms get
better.
- Do not smoke or chew tobacco.
- If you
have GERD symptoms at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows does not work.)
- Avoid or
reduce pressure on your stomach. Do not wear tight
clothing around your middle.
- Lose weight if you need to. Losing just 5 to 10
pounds can help.
Some medicines
may cause reflux and heartburn as a side effect. If medicines you are taking
seem to be the cause of your heartburn, talk with your doctor. Do not stop
taking a prescription medicine until you talk with your doctor.
Home Treatment
Home treatment measures may help you
control the symptoms of mild
gastroesophageal reflux disease (GERD).
You can make changes to your lifestyle to help relieve
your symptoms of GERD. Here are some things to try:
- Change your
eating habits.
- It’s best to eat several small meals
instead of two or three large meals.
- After you eat, wait 2 to 3
hours before you lie down. Late-night snacks aren't a good
idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax
the valve between the esophagus and the stomach.
- Spicy foods, foods
that have a lot of acid (like tomatoes and oranges), and coffee can make GERD
symptoms worse in some people. If your symptoms are worse after you eat a
certain food, you may want to stop eating that food to see if your symptoms get
better.
- Do not smoke or chew tobacco.
- If you
have GERD symptoms at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows does not work.)
- Avoid or
reduce pressure on your stomach. Do not wear tight
clothing around your middle.
- Lose weight if you need to. Losing just 5 to 10
pounds can help.
For more information, see:
-
GERD: Controlling Heartburn by Changing Your Habits
Along with lifestyle changes, nonprescription
medicines may be needed to control occasional heartburn. Medicines used for
home treatment of GERD include antacids (for example, Tums), H2 blockers (for
example, Pepcid), and proton pump inhibitors (for example, Prilosec OTC). If
you have been using nonprescription medicines to treat your symptoms for longer
than 2 weeks, talk to your doctor. If you have GERD, the stomach acid could be
causing damage to your esophagus. Your doctor can help you find the right
treatment. For more information about prescription forms of these drugs, see
the Medications section of this topic.
Medications
Lifestyle changes along with antacids, H2
blockers, and proton pump inhibitors—either prescription or nonprescription—are usually tried first to
treat symptoms that are likely caused by
gastroesophageal reflux disease (GERD). Medicines are
used in the treatment of GERD to:
- Relieve symptoms (heartburn, sour taste, or pain).
- Allow the
esophagus to heal.
- Prevent complications of GERD.
Depending on how
bad your symptoms are, you may need to take medicines daily or only
now and then when GERD symptoms occur. Long-term—often lifelong—medicine
treatment is usually needed for GERD symptoms that are more severe, because
symptoms tend to return when the medicine is stopped.
Medication Choices
The following nonprescription and prescription medicines
may be used to treat GERD.
-
Antacids, such as Mylanta or Tums. Antacids
neutralize stomach acid and relieve heartburn. If you want to take medicine
only when your symptoms bother you, antacids are a good choice. They relieve
symptoms quickly. Making lifestyle changes and taking antacids are usually
tried first when you have infrequent and mild symptoms.
-
H2 blockers, such as cimetidine (Tagamet) or famotidine (Pepcid). H2 blockers reduce the amount of
acid in the stomach. Most are available in both nonprescription and
prescription strength. If nonprescription-strength H2 blockers don't relieve
your symptoms, talk to your doctor about trying prescription-strength medicine.
Taking H2 blockers and making lifestyle changes often help if you have more
frequent GERD symptoms. These medicines will also help heal damage in the esophagus (esophagitis).
-
Proton pump inhibitors, such as lansoprazole (Prevacid) or omeprazole (Prilosec). Proton pump inhibitors (PPIs) reduce the amount of
acid in the stomach. Some are available without a prescription. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis).
If you have been using nonprescription medicines to treat your symptoms for
longer than 2 weeks, talk to your doctor. If you have GERD, the stomach acid
could be causing damage to your esophagus. Your doctor can help you find the
right treatment. Making lifestyle changes is still an important part of the
treatment of GERD when you are using medicine.
For more information, see:
-
GERD: Which Treatment Should I Use?
What To Think About
Doctors usually try to choose a
treatment that uses enough medicine to control your symptoms but not so much
that side effects become a serious problem.
Depending on how bad
your symptoms are, you may need to take medicines every day or only
now and then when GERD symptoms occur. Long-term—often lifelong—medicine
treatment is usually needed for GERD symptoms that are more severe, because
symptoms tend to return when the medicine is stopped. Surgery is the
only other effective option to prevent GERD symptoms from recurring.
Up to 80% of pregnant women have
symptoms of gastroesophageal reflux disease (GERD) during pregnancy.1Heartburn is common during pregnancy, because hormones
cause the digestive system to slow down. The muscles that push food down the
esophagus also move more slowly during pregnancy. Also, as the uterus
grows, it pushes on the stomach and sometimes forces stomach acid up into the
esophagus. Lifestyle changes and antacids are usually tried first to treat
pregnant women who have GERD. Antacids are safe to use for heartburn symptoms
during pregnancy. If lifestyle changes and antacids don't help control your
symptoms, talk to your doctor about using other medicines.
Surgery
Fundoplication surgery may be used to treat
gastroesophageal reflux disease (GERD) symptoms that
have not been well controlled by medicines. In fundoplication surgery, the
upper curve of the
stomach (the fundus) is wrapped around the esophagus
and sewn into place to strengthen the valve between the esophagus and stomach
(lower esophageal sphincter).
Surgery may
be an option when:
- Treatment with medicines does not completely
relieve a person's symptoms, and the remaining symptoms are proved to be caused
by reflux of stomach juices.
- A person does not want or, because of
side effects, a person is not able to take medicines over an extended period of
time to control his or her GERD symptoms.
- Along with reflux a person has symptoms such as asthma,
hoarseness, or cough that do not adequately improve when treated with
medicines.
The benefits of surgery need to be compared to the possible complications and new symptoms you may have after surgery. Surgery for GERD can cause problems with swallowing and burping. It can also cause extra gas in the digestive tract, which leads to bloating and flatulence. After surgery, you may need to have other procedures to fix these problems. Some people still have to take medicine to control their symptoms, even after surgery. And some people have to have surgery again.
Surgery Choices
Fundoplication surgery is the most
common surgery used to treat GERD. This surgery strengthens the valve between
the esophagus and stomach (lower esophageal sphincter) to keep acid from
backing up into the esophagus as easily.
Other types of surgery
for gastroesophageal reflux disease may include:
-
Partial fundoplication. Partial fundoplication
involves wrapping the stomach only partway around the
esophagus. Full fundoplication involves wrapping the stomach around the
esophagus so that it completely encircles it. Most fundoplication surgery uses
the full fundoplication method.
-
Gastropexy. A gastropexy attaches the stomach to
the diaphragm so that the stomach cannot move through the opening in the
diaphragm into the chest. Gastropexy is done less often than
fundoplication.
What To Think About
Fundoplication surgery relieves GERD symptoms and inflammation of the esophagus (esophagitis).2 But fundoplication surgery is not always stable and effective
over the long term. And people may have to continue to take some medicines
after surgery.
Even though some studies show that surgery works a little bit better than medicine for GERD, that benefit needs to be compared to the side effects and complications of surgery. Surgery can cause new and troublesome symptoms. For example, in the longest study done so far, 7 years after surgery:3
- More than 1 out of 10 people had trouble swallowing.
- More than 6 out of 10 people had increased flatulence.
- More than 2 out of 10 people were unable to belch.
For more information, see:
-
GERD: Which Treatment Should I Use?
Before surgery, additional tests will usually be done to be
certain surgery is likely to help relieve the person's GERD symptoms and to
diagnose problems that surgery could make worse. For more information on this
testing, see esophageal testing in the Exams and Tests section of this
topic.
Other Treatment
Some nonsurgical procedures are being tested that
may be an alternative to surgery for GERD. These procedures are still
undergoing trials to find out their long-term safety and effectiveness. These
are nonsurgical treatments, so no cuts are made. Instead, these treatments are
done through the mouth into the esophagus. An
endoscope is placed in your mouth and down your throat
into your esophagus. The endoscope is a long, thin, flexible tube. The doctor
can see into your esophagus using this tube. The different kinds of nonsurgical
treatments use endoscopes that can do different things. But all the procedures
developed so far try to block stomach acid from backing up (or refluxing) into
the esophagus.
Other Places To Get Help
Organizations
|
American College of
Gastroenterology
|
| P.O. Box 342260 |
| Bethesda, MD 20827-2260 |
| Phone: |
(301) 263-9000 |
| Web Address: |
www.acg.gi.org |
| |
|
The American College of Gastroenterology is an organization of
digestive disease specialists. The Web site contains information about common
gastrointestinal problems.
|
|
|
American Gastroenterological
Association
|
| 4930 Del Ray Avenue |
| Bethesda, MD 20814 |
| Phone: |
(301) 654-2055 |
| Fax: |
(301) 654-5920 |
| Web Address: |
www.gastro.org |
| |
|
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
and disorders.
|
|
|
National Digestive Diseases Information Clearinghouse
(NDDIC)
|
| 2 Information Way |
| Bethesda, MD 20892-3570 |
| Phone: |
1-800-891-5389 |
| Fax: |
(703) 738-4929 |
| Email: |
nddic@info.niddk.nih.gov |
| Web Address: |
www.digestive.niddk.nih.gov |
| |
|
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
|
|
References
Citations
-
Richter JE (2006). Gastroesophageal reflux disease and
its complications. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp.
905–936. Philadelphia: Saunders Elsevier.
-
American Gastroenterological Association (2008). American Gastroenterological Association technical review on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1392–1413.
-
Lundell L, et al. (2007). Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. British Journal of Surgery, 94(2): 198–203.
Other Works Consulted
- American Gastroenterological Association (2008).
American Gastroenterological Association medical position statement on the
management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1383–1391.
- Saltzman JR, Poneros JM (2009). Gastroesophageal reflux disease. In NJ Greenberger et al., eds., Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy, pp. 139–147. New
York: McGraw-Hill.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Kathleen Romito, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Peter J. Kahrilas, MD - Gastroenterology |
|
Last Revised
|
March 16, 2010 |