Gastroesophageal reflux (GER) happens when acid from the stomach flows up into the tube that connects the mouth and the stomach (esophagus). Normally, food travels down the esophagus and stays in the stomach to be digested. However, when a person has GER, food and stomach acid sometimes move back up into the esophagus.
If this becomes a more serious problem, the person may be diagnosed with a disease called gastroesophageal reflux disease (GERD). GERD occurs when the reflux:
- Happens often.
- Causes frequent or severe symptoms.
- Causes problems such as damage to the esophagus.
When stomach acid comes in contact with the esophagus, the acid may cause soreness (inflammation) in the esophagus. Over time, GERD may create small holes (ulcers) in the lining of the esophagus.
What are the causes?
This condition is caused by a problem with the muscle between the esophagus and the stomach (lower esophageal sphincter, or LES). Normally, the LES muscle closes after food passes through the esophagus to the stomach. When the LES is weakened or abnormal, it does not close properly, and that allows food and stomach acid to go back up into the esophagus.
The LES can be weakened by certain dietary substances, medicines, and medical conditions, including:
- Tobacco use.
- Pregnancy.
- Having a hiatal hernia.
- Alcohol use.
- Certain foods and beverages, such as coffee, chocolate, onions, and peppermint.
What increases the risk?
You are more likely to develop this condition if you:
- Have an increased body weight.
- Have a connective tissue disorder.
- Use NSAID medicines.
What are the signs or symptoms?
Symptoms of this condition include:
- Heartburn.
- Difficult or painful swallowing.
- The feeling of having a lump in the throat.
- A bitter taste in the mouth.
- Bad breath.
- Having a large amount of saliva.
- Having an upset or bloated stomach.
- Belching.
- Chest pain. Different conditions can cause chest pain. Make sure you see your healthcare provider if you experience chest pain.
- Shortness of breath or wheezing.
- Ongoing (chronic) cough or a night-time cough.
- Wearing away of tooth enamel.
- Weight loss.
How is this diagnosed?
Your healthcare provider will take a medical history and perform a physical exam. To determine if you have mild or severe GERD, your healthcare provider may also monitor how you respond to treatment. You may also have tests, including:
- A test to examine your stomach and esophagus with a small camera (endoscopy).
- A test that measures the acidity level in your esophagus.
- A test that measures how much pressure is on your esophagus.
- A barium swallow or modified barium swallow test to show the shape, size, and functioning of your esophagus.
How is this treated?
The goal of treatment is to help relieve your symptoms and to prevent complications. Treatment for this condition may vary depending on how severe your symptoms are. Your health care provider may recommend:
- Changes to your diet.
- Medicine.
- Surgery.
Follow these instructions at home:
Eating and drinking
- Follow a diet as recommended by your healthcare provider. This may involve avoiding foods and drinks such as:
- Coffee and tea (with or without caffeine).
- Drinks that contain alcohol.
- Energy drinks and sports drinks.
- Carbonated drinks or sodas.
- Chocolate and cocoa.
- Peppermint and mint flavourings.
- Garlic and onions.
- Spicy and acidic foods, including peppers, chili powder, curry powder, vinegar, hot sauces, and barbecue sauce.
- Citrus fruit juices and citrus fruits, such as oranges, lemons, and limes.
- Tomato-based foods, such as red sauce, chili, salsa, and pizza with red sauce.
- Fried and fatty foods, such as donuts, french fries, potato chips, and high-fat dressings.
- High-fat meats, such as hot dogs and fatty cuts of red and white meats, such as rib eye steak, sausage, ham, and bacon.
- High-fat dairy items, such as whole milk, butter, and cream cheese.
- Eat small, frequent meals instead of large meals.
- Avoid drinking large amounts of liquid with your meals.
- Avoid eating meals during the two to three hours before bedtime.
- Avoid lying down right after you eat.
- Do not exercise right after you eat.
Lifestyle
- Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your healthcare provider.
- Try to reduce your stress by using methods such as yoga or meditation.
- If you are overweight, reduce your weight to an amount that is healthy for you.
General instructions
- Pay attention to any changes in your symptoms.
- Take over-the-counter and prescription medicines only as told by your healthcare provider. Do not take aspirin, ibuprofen, or other NSAIDs unless your healthcare provider told you to do so.
- Wear loose-fitting clothing. Do not wear anything tight around your waist that causes pressure on your abdomen.
- Raise (elevate) the head of your bed about 6 inches (15 cm).
- Avoid bending over if this makes your symptoms worse.
- Keep all follow-up visits as told by your healthcare provider. This is important.
Contact a healthcare provider if:
- You have:
- New symptoms.
- Unexplained weight loss.
- Difficulty swallowing or it hurts to swallow.
- Wheezing or a persistent cough.
- A hoarse voice.
- Your symptoms do not improve with treatment.
Get help right away if you:
- Have pain in your arms, neck, jaw, teeth, or back.
- Feel sweaty, dizzy, or light-headed.
- Have chest pain or shortness of breath.
- Vomit and your vomit looks like blood or coffee grounds.
- Faint.
- Have stool that is bloody or black.
- Cannot swallow, drink, or eat.
Summary
- Gastroesophageal reflux happens when acid from the stomach flows up into the esophagus. GERD is a disease in which the reflux happens often, causes frequent or severe symptoms, or causes problems such as damage to the esophagus.
- Treatment for this condition may vary depending on how severe your symptoms are. Your healthcare provider may recommend diet and lifestyle changes, medicine, or surgery.
- Contact a healthcare provider if you have new or worsening symptoms.
- Take over-the-counter and prescription medicines only as told by your healthcare provider. Do not take aspirin, ibuprofen, or other NSAIDs unless your healthcare provider told you to do so.
- Keep all follow-up visits as advised by your healthcare provider. This is important.
This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.
References:
Freedberg DE et al: The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology 2017. 152(4):706-15.
Iwakiri K et al: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 51(8):751-67.
Katz PO et al: Guidelines for the diagnosis and management of gastroesophageal reflux disease 2013. Am J Gastroenterol. 108(3):308-28.
Kellerman R et al: Gastroesophageal reflux disease. Prim Care 2017. 44(4):561-73.
Sandhu DS et al: Current trends in the management of gastroesophageal reflux disease. Gut Liver 2018. 12(1):7-16.
For more information on GERD, visit:
Health Hub - Gastroesophageal Reflux Disease
Updated on 3 May 2021 by CaregiverAsia.
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