Gastroesophageal Reflux Disease (GERD)

Topic Overview

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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 at least 2 times a week, 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, it is important to treat it, because GERD can cause ulcers and damage to the 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 OTC). 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

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	GERD: Controlling heartburn by changing your habits

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, onions, peppermint, coffee, high-sugar foods, and possibly high-fat foods. Alcohol, tobacco (nicotine), and some medicines can also relax the lower esophageal sphincter.

Other foods, though they do not relax the valve, may cause heartburn if the esophagus is already irritated. These foods include spicy foods, citrus products, and tomato products.

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. These include antacids (for example, Tums), H2 blockers (for example, Pepcid), and proton pump inhibitors (for example, Prilosec OTC). 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.²
• 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 occur more than twice a week, 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

Mild gastroesophageal reflux disease (GERD) may cause irritation or inflammation in the esophagus. This condition is called esophagitis. But some studies indicate that less than half of the people with GERD show signs of esophagitis.^{3, 4} 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 OTC). 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. In addition, 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).
• Wearing away (erosion) the lining of the esophagus that may lead to crater-shaped sores (ulcers) in the lining of the esophagus (esophageal erosion and ulcers).
• Narrowing of the esophagus (esophageal stricture).
• Bleeding from the esophagus.
• 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 can lead to cancer of the esophagus.
• Respiratory problems, such as a persistent cough, asthma, or pneumonia.
• Structural changes of the lungs or voice box (larynx). This may be noticeable as increased hoarseness or frequent laryngitis.
• Irritation of the passage that connects the nasal airways to the upper portion of the throat (pharynx), causing pharyngitis.
• 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 developing cancer of the esophagus.

What Increases Your Risk

Factors 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.
• Have chest pain and have not been diagnosed with gastroesophageal reflux disease (GERD).

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. These include antacids (such as Tums), H2 blockers (such as Pepcid), or proton pump inhibitors (such as Prilosec OTC).

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):

• Family medicine doctor
• General practice doctor
• Internist
• Physician assistant (PA)
• Nurse practitioner (NP)
• Pediatrician, if you think your child has GERD symptoms
• Obstetrician or gynecologist, if you are pregnant

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 necessary. 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 may not be needed in all 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 detecting 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, to prevent injury to the lining of the esophagus or to help it to heal if injury has already occurred, to prevent GERD from recurring, and to prevent 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. These include antacids (such as Tums), H2 blockers (such as Pepcid), or proton pump inhibitors (such as 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. 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—medication therapy is usually necessary to treat severe, persistent symptoms or complications of GERD.

Medicines for GERD include proton pump inhibitors (such as Nexium and Prilosec) and H2 blockers (such as Pepcid and Tagamet). 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.

Fundoplication surgery, which strengthens the valve between the stomach and the esophagus, may be used to treat GERD if lifestyle changes don't help or if treatment with medicines does not relieve your symptoms.

Ongoing treatment

If medicines and lifestyle changes control symptoms of gastroesophageal reflux disease (GERD), you will likely continue the same treatment. It is important that you continue to take medicines as instructed by your doctor, because stopping therapy will often bring symptoms back.

You can try basic treatments like lifestyle changes and nonprescription medicines that reduce or block acid before you try prescription medicines. The nonprescription medicines include antacids (such as Tums), H2 blockers (such as Pepcid), and proton pump inhibitors (such as 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. The approach your doctor chooses will depend the symptoms you are having, how severe they are, and how much damage (if any) has been done. You and your doctor will also need to balance the effectiveness and safety of various treatments against the costs.

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 recommend that you 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 monitor your condition.

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, and you are willing to accept the risks of surgery.
• Along with reflux you have complications such as asthma, hoarseness, or cough that do not improve when treated with medicines.

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.

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. In addition, 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 occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually required for GERD symptoms that are more severe because symptoms tend to return (recur) when medication treatment 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.

Surgery may be effective in controlling GERD symptoms, but the risks of failure, complications, and side effects associated with surgery need to be considered carefully.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

Prevention

Symptoms of gastroesophageal reflux disease (GERD), such as heartburn, can be uncomfortable or even painful. You may be able to prevent these symptoms by making lifestyle changes such as losing weight if needed, not smoking, not using alcohol, and avoiding certain foods that cause GERD symptoms, such as chocolate.

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). These include making lifestyle changes and taking nonprescription medicines that reduce or block acid. These 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.

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.

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 (for example, Pepcid), and proton pump inhibitors (for example, Prilosec)—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.

Nonprescription medicines can be tried when symptoms are mild and infrequent. Prescription medicines will probably be required if symptoms are more severe or if you are using nonprescription medicines to control your symptoms for longer than 2 weeks.

Depending on how bad your symptoms are, you may need to take medicines daily or only occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when medication treatment is stopped.

Medication Choices

The following nonprescription and prescription medicines may be used to treat GERD.

• Antacids (such as Gaviscon, Mylanta, Rolaids, or Tums) 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 (acid reducers), such as nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac), 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.
• Proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex), are prescription medicines that reduce the amount of acid in the stomach. These medicines often help when H2 blockers have failed to control symptoms of GERD. They are also used to treat severe GERD symptoms or inflammation of the esophagus (esophagitis). There is a nonprescription version of omeprazole (Prilosec OTC) available for the treatment of frequent heartburn. But 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 proton pump inhibitors.

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 occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when medication treatment is stopped. Surgery is the only other effective option to prevent GERD symptoms from recurring.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

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. In addition, 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 unable to take medicines over an extended period of time to control his or her GERD symptoms and is willing to accept the risks of surgery.
• Along with reflux a person has symptoms such as asthma, hoarseness, or cough that do not adequately improve when treated with medicines.

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 (Toupet procedure) 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.

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.

Nonsurgical treatments being studied for GERD include:

• Sewing "pleats" (plication) in the area where the esophagus and stomach meet (the lower esophageal sphincter, or LES). These pleats strengthen the LES and help keep stomach acid out of the esophagus.
• Radiofrequency thermal treatments. These treatments use radiofrequency waves to heat the tissues of the LES. The heat damages the tissue and may affect the nerves that relax the LES. The scar tissue that forms may help strengthen the LES. It is also thought that if the nerves are damaged, the amount of acid backing up into the stomach is less.
• Injectable or implantable treatments. These involve injecting or implanting something (usually plastic) into the muscle in the esophagus. The injected substance acts as a bulking agent, making the LES smaller and making is less likely that stomach acid can back up into the esophagus.

What To Think About

Fundoplication surgery is successful in about 6 to 9 out of 10 cases.⁵ Successful surgery relieves GERD symptoms and inflammation of the esophagus (esophagitis). 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.

Fundoplication surgery using a laparoscopic technique is done most often. In this method, a thin, lighted tube (laparoscope) is inserted into the abdominal cavity through a very small incision in the wall of the abdomen. The laparoscope allows the surgeon to see inside the abdomen without making a large incision. Surgical instruments can also be inserted through additional small incisions. Recovery time and hospital stays are both shorter with laparoscopic surgery than with open surgery, which requires a larger incision. When you are choosing a surgeon, the most important thing to consider is experience. Find out the number of these procedures the surgeon has performed and his or her success rate.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

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

At this time, no other treatment for gastroesophageal reflux disease (GERD) has been shown to be effective. A number of experimental treatments are being investigated.

Related Information

• Chest Problems
• Esophagitis
• Gastroesophageal Reflux in Babies and Children
• Heartburn
• Hiatal Hernia

References

Citations

1. 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.
2. Katzka DA, Rustgi AK (2000). Gastroesophageal reflux disease and Barrett's esophagus. Medical Clinics of North America, 84(5): 1137–1161.
3. Arora AS, Castell DO (2001). Medical therapy for gastroesophageal reflux disease. Mayo Clinic Proceedings, 76(1): 102–106.
4. Fass R, et al. (2001). Nonerosive reflux disease: Current concepts and dilemmas. American Journal of Gastroenterology, 96(2): 303–314.
5. Kahrilas PJ (2001). Management of GERD: Medical versus surgical. Seminars in Gastrointestinal Disease, 12(1): 3–15.

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.
• Dent J, et al. (2001). Management of gastro-oesophageal reflux disease in general practice. BMJ, 322(7282): 344–347.
• Hogan WJ, Shaker R (2000). Life after reflux surgery. American Journal of Medicine, 108(Suppl 4A): 181S–191S.
• Kahrilas PJ (2001). Surgical therapy for reflux disease. JAMA, 285(18): 2376–2378.
• McGuigan JE (2001). Treatment of gastroesophageal reflux disease: To step or not to step. American Journal of Gastroenterology, 96(6): 1679–1681.

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