What are some of the typical symptoms of GERD

The major symptoms of GERD include heartburn, chest pain, sour taste in your mouth, and painful or difficult swallowing. The major or typical symptom of GERD is heartburn, but this can vary among individuals. GERD symptoms fall on a spectrum for some they are mild or silent, and for others they can be severe. Heartburn is the feeling described as stomach contents and acid travel up into the chest area. The mildest symptoms may be just a slight sense of uneasiness and burning in the chest that...

What are the major side effects associated with H2 blockers and PPIs

All medications have benefits and risks. Unfortunately, the side effects of a prescription or OTC drug cannot always be predicted or prevented. In certain people, however rare, these medications can cause side effects. The side effects are very similar between the two classes of medications discussed here, and the effects seem to be dose dependent with higher doses comes an increased risk of potential side effects. H2 blockers and proton pump inhibitors (PPIs) act primarily on the digestive...

Is an endoscopy painful and does it carry risks

Endoscopy is a safe and routine procedure. The major risks involve the anesthesia. On rare occasions, patients can have allergic reactions to the medications. The anesthetic risks are generally cardiac and pulmonary, or heart- and lung-related. Examples are irregular heart rates or, very rarely, heart attacks. These complications may occur in patients with a history of heart disease or lung disease. The major risk for the actual endoscopy is bleeding or perforation. A perforation is a tear in...

What causes newonset GERD

GERD is a disease that is caused by stomach acid abnormally moving up into the esophagus and possibly higher into the mouth or airway structures. Many different factors can contribute to the development and presence of acid reflux. Normally, your body's natural protective factors limit reflux. We produce 1 pint to 1 quart of saliva per day that is swallowed. Saliva has many jobs. Saliva neutralizes acid, which means it buffers any acid that refluxes into the esophagus. It also helps to digest...

Is there a link between obesity and GERD in the United States

The average body weight of Americans is slowly going up. Obesity is becoming a major issue in our society, starting in young children and continuing through adulthood (See Figure 4.). Two-thirds of Americans are overweight, and 1 in 3 are obese or about 30 pounds overweight and at increased risk of obesity-related disease. The number of obese and morbid obese (100 pounds over your normal weight) people is increasing annually and is considered an epidemic. Changes in the American diet are...

How else can I change my eating habits to prevent GERD

Changing your lifestyle and eating habits is easier said than done. However, by making some simple modifications you can improve GERD symptoms and decrease some of the dangers associated with GERD. As mentioned previously, eating late at night and eating large meals can increase your heartburn symptoms. If you lie down to sleep with a stomach full of food and acid, chances are you will experience heartburn symptoms. Avoiding late-night meals and avoiding eating for at least 2 hours prior to...

What is gastroesophageal reflux disease or GERD

GERD is an abbreviation for gastroesophageal reflux disease. GERD has several manifestations. Classically, it can be a sensation of warmth or burning in the chest, which can be a mild discomfort to frank pain. You might regurgitate bitter material or burp it up into your mouth. These symptoms are caused by acidic stomach material refluxing from the stomach into the esophagus, which is the food pipe (Figure 1). Reflux can occur during the day or at night while you're asleep. Several factors...

Can I have GERD without any

Yes, GERD can occur with silent symptoms. Each individual's body reacts differently to different situa- tions, so not everyone will have heartburn and be diagnosed with GERD. Silent GERD is one of the most difficult conditions to diagnose. Instead of complaining of heartburn, often some people report sleep disruption, which is caused by acid refluxed into the esophagus as they lie down to sleep. As the acid travels up into the esophagus, people occasionally become aroused from their sleep....

Can GERD cause changes in my voice

Yes, GERD can cause changes in your voice. High reflux can irritate your voice box, or larynx. Chronic acid damage of the larynx can cause voice changes. Repeated acid damage of the voice box can cause growths (polyps) to develop and can increase your risk of cancer. Cancer of the larynx is the most common cancer of the head and neck and is usually related to smoking. However, laryngeal cancer has been reported in people who have never smoked and who do not live with a smoker. These people...

How can I avoid GERD problems if I have to take my pills

Any medication has side effects, and sometimes you might resort to alternative medications to alleviate particular side effects, but in some cases you may not have a choice but to take a drug that will exacerbate your GERD. Many of the medications mentioned earlier are necessary to treat medical conditions, and the side effects that come along with them may be unavoidable. However, even if the side effects are present, you may be able to take precautions to decrease their severity. It is...

What kind of foods can make GERD worse

Different types of food can increase reflux or can increase the amount of acid the stomach produces. These include high-fat foods, spicy foods, carbonated beverages, chocolate, mint, and alcohol. High-fat foods are more difficult to digest. The digestion of fatty food can cause increased stomach acid production and delays stomach emptying. Both of these effects cause higher amounts of acid to be present, and the longer time the food dwells in your stomach, the chances of reflux disease...

Will eating fast food make my GERD worse

Fast food is exactly what it sounds like food that is available quickly with very little effort. Fast-food restaurants prepare foods that come ready made, have a long shelf life, are filling, are easy to make in vast quantities, and are cheap. They attract customers to return by making food very tasty, high in flavor, filling and a good value for your dollar. Unfortunately, this is a very bad combination. Fast foods are very high in fat and are highly salted, and sodas are liquid candy....

Can my weight affect my GERD

Weight plays a major role in many aspects of your health and well-being. Being overweight can increase your chance of heart disease, diabetes, high blood pressure, strokes, certain cancers, and acid reflux. GERD has a higher association with those who are overweight as defined by an elevated body mass index. Body mass index (BMI) is a standardized measure of weight for height. The BMI is calculated by taking your weight in kilograms and dividing it by your height in meters squared. For example,...

When should I consider medications for GERD

Initial management of GERD takes the form of lifestyle modification. Often, making small changes in diet or time of eating can improve symptoms. On the other hand, when you suffer from GERD and have tried the recommendations outlined in this book to no avail, medications may be in order. Different types of medications and different tiers, or strengths, of medications are available for the treatment of GERD. The mildest GERD medications are antacids these are generally the safest, cheapest, and...

What are the complications of GERD and are they serious

Complications of GERD include those that occur in the esophagus and outside the esophagus (extra-esophageal complications) (see Figure 7). Esophageal complications include esophagitis (inflammation of the lining of the esophagus), Barrett's esophagus, narrowing or strictures, and, rarely, cancers. Extraesophageal complications can include sinus problems or infections, ringing in the ears, voice changes, dental problems, worsening of asthma, and recurrent pneumonia. Some of these complications...

Is there a relationship between GERD and asthma or chronic lung disease

Fifteen million Americans have asthma, and it is estimated that about 30-90 of asthmatics have reflux. Asthma is a lung disease characterized by muscle spasms in the airways of the lungs. When these muscles go into spasm and contract, it limits the ability of air to move in or out of the lungs and causes wheezing, shortness of breath, or coughing. This is treated usually with inhaled medications that relax the airways. Many factors can start an asthma attack, such as pollen and other allergens...

Is there a relationship between GERD and a chronic cough

Chronic coughing is defined as the presence of a cough for more than 3 weeks and is one of the most common reasons for which people seek medical attention. A cough is a vigorous contraction or shortening of the muscles for breathing that results in a high-pressure movement of air out of the lungs. The purpose of a cough is to clear mucus, particles, or irritants from the lungs or airways. Nerves in the throat and airways can sense mucus and irritants such as noxious fumes, allergens such as...

Does GERD play a role in chronic chest pain

There are many causes of chest pain because many structures live in the chest. The chest wall, the muscles, ribs, and cartilage can cause pain. Chest pain may be related to the heart or lungs or the esophagus. The types and character of the discomfort related to these organs are generally different but can be quite similar in some individuals. Sometimes it can be very difficult to tell whether the chest pain a patient is experiencing is a heart attack or just heartburn. Because of this have a...

Should I just have a trial of medication for GERD

If you experience GERD symptoms or heartburn rarely or infrequently, over-the-counter medication is a good place to start. Antacids may be helpful for more rarely experienced symptoms. For more frequent or severe symptoms, drugs called H2 blockers such as ranitidine, cimetidine (Tagamet), and famotidine (Pepcid) can be used. For more severe GERD, omeprazole (Prilosec-OTC) can be used. However, omeprazole is approved for use only for 14 days. All of these medications are over the counter (OTC)...

Does gastroesophageal reflux disease cause ulcers

As mentioned earlier, when people talk about ulcers, they usually are speaking of ulcers in the stomach or part of the small intestine, the duodenum. GERD does not cause this type of ulcer. Ulcers can occur in the esophagus, but through a different mechanism. Esophageal ulcers are generally caused by GERD when acid damages the lining of the esophagus. Esophageal ulcers can cause symptoms or can be silent and have no symptoms. The symptoms associated with an esophageal ulcer can be heartburn,...

Does H pylori cause GERD

H. pylori does not really cause GERD. But some recent medical studies suggest that H. pylori infection can play a small role in heartburn. Because H. pylori damages the lining of the stomach, the stomach produces less acid. If acid production is decreased, in some people H. pylori infection may actually protect against GERD or at least decrease the amount of acid in the material that is refluxed from the stomach into the esophagus. So, if you have GERD and find out that you also have an H....

Should I have surgery for my GERD

This is a difficult question to answer, and the decision really is yours. The real issue is how bad your GERD and or regurgitation is. Does medication control your symptoms adequately How difficult or costly is it to take a medication once or twice a day Is your GERD making your life difficult or miserable If the answer to these questions is yes, then surgery may be an option. The goal of anti-reflux surgery is to strengthen the lower esophageal sphincter, which is the barrier to reflux of...

Will I be able to stay off GERD medications ifI have surgery

Few studies have addressed this question. Short-term studies (2 years after surgery) show that surgery decreases the risk of esophagitis on endoscopy and improves GERD symptoms when compared to those patients who only take medications. However, medications are effective for alleviating both symptoms and esophagitis. A long-term study by Spechler and associates that was published in 1992 in the New England Journal of Medicine looked at patients 9 to 10 years after anti-reflux surgery and...

Bonus Question What would I do if I had chronic GERD

DLB answers This is a good question because I have had GERD almost daily for the last 20 years. I take my medication every day, and it controls my symptoms. And if I miss a dose, I know it. Lifestyle modification truly helps, and the greatest benefit is avoiding food for 2 hours prior to bed. Given the lack of long-term documented benefit of endoscopic anti-reflux procedures, I would not have one and do not recommend these procedures to my patients. As for anti-reflux surgery, well, surgery has...

What is heartburn

Heartburn is discomfort or pain in the chest that is caused by acid in the esophagus. It is a manifestation of how pain is felt in the esophagus. Heartburn feels like burning, warmth, or pain in the midchest area. Although heartburn, a symptom of reflux, often feels like burning and can be very similar to the pain or discomfort caused by heart problems or heart attacks, heartburn does not affect the heart, as its name suggests. The reason is that the esophagus passes through the chest almost...

What is acid reflux

Acid for digestion of food is normally produced in the stomach in response to eating. Normally, acid can reflux, or move up, into the esophagus, but protective mechanisms are in place to remove or neutralize refluxed acid. These include saliva, which neutralizes acid, and esophageal pumping, which moves refluxed acid back down to the stomach. Acid reflux disease occurs when increased or prolonged episodes of reflux overwhelm the protective factors, resulting in symptoms. Excessive acid sitting...

Do children get GERD

Yes, children can also get GERD it can affect anyone. Infants may exhibit symptoms different from adults. They may become irritable after eating, repeatedly belch or vomit, or suffer from persistent coughing. These symptoms may manifest as poor feeding and impaired weight gain or colic. GERD is often overlooked in young children because their symptoms are very subtle and infants often outgrow the condition. Parents can take precautions to prevent GERD symptoms in infants, such as keeping...

Is GERD serious

GERD is a serious disease when it goes untreated or is ignored. It can cause occasional or daily problems that are noticeable as a result of pain or discomfort. Reflux disease can be silent or can manifest with atypical symptoms. Frequent episodes often cause pain or suffering in a patient's everyday life. Untreated chronic GERD can lead to damage of the esophagus. Typical esophageal complications may be inflammation of the esophageal lining, narrowing of the esophagus that leads to difficulty...

What is a hiatal hernia and why does it cause reflux

Normally, a muscle called the diaphragm separates the abdomen and chest. The diaphragm is the main muscle that controls breathing. The esophagus passes from the back of the throat into the chest, behind the heart, down through a hole in the diaphragm called a hiatus to join with the stomach in the abdomen. The position of the stomach and the esophagus as it passes through the diaphragm are important and are maintained by ligaments that hold the structures in proper position. As you age, the...

Does my bed make a difference in nighttime symptoms

Your bed, its position, and type of mattress can make a difference in nighttime symptoms. As discussed previously, nighttime GERD can cause symptoms that you may not even be aware of. These symptoms can affect your sleep and make you wake up without feeling refreshed. Night symptoms include heartburn, regurgitation with coughing, choking, gasping for air, and a bitter taste in your mouth or excessive drooling. On rare occasions nocturnal regurgitation can lead to aspiration and pneumonia....

What is Barretts esophagus

Acid damage to the esophagus causes inflammation of the esophageal mucosa. This chronic inflammation can lead to a change in the mucosa to a different type that is more acid resistant. Barrett's, which can lead to cancer, is diagnosed during an endoscopy. This change can be diagnosed when an esophageal biopsy is examined under the microscope. (A barium study cannot make the diagnosis because a biopsy is required.) This abnormal acid-resistant lining is called Barrett's esophagus (see color...

Will I get cancer from having Barretts esophagus

As mentioned, Barrett's is an abnormal lining of the esophagus made of cells that are usually found elsewhere in the gut and it can predispose you to esophageal cancer. In the medical literature, many studies examine the association between cancer risk and Barrett's esophagus. Studies demonstrate an annual risk of getting cancer at 0.2-2 or on average about 0.5 per year. Another way to look at this is if 200 people have Barrett's esophagus, one person will get cancer each year. It is felt that...

What can be done to make Barretts esophagus better or make it go away

There is some debate in the literature whether Barrett's will regress, shrink, or go away with aggressive antacid treatment or with surgery for GERD. But the information is mixed some doctors feel that regular use of antacid drugs such as proton pump inhibitors (for example, omeprazole) may decrease the amount of Barrett's lining the esophagus. It has been clearly demonstrated that the more of the esophagus lined by Barrett's, the greater the cancer risk. My...

What are the alarm or concerning symptoms that might suggest esophageal cancer

Unfortunately, when esophageal cancer causes symptoms, the cancer is usually too advanced for treatment or cure and options may be limited (see Table 3). This is demonstrated by the fact that more than 90 of Table 3 GERD Alarm Signs Suggesting Workup cancer causes symptoms, the cancer is usually too advanced for treatment or cure and options may be limited. those diagnosed with esophageal cancer die of their disease. Hopefully, by doing endoscopy on people with chronic heartburn and diagnosing...

How can I decrease my risk of getting cancer of the esophagus

Overall, you can do some easy things to decrease cancer risk, esophageal or otherwise. Avoid smoking or chewing tobacco and limit your alcohol use. Two-thirds of all Americans are overweight, which is associated with an increased risk of certain cancers. Thus, trying to maintain an ideal weight may reduce cancer risk and will certainly decrease your risk of high blood pressure, heart disease, stroke, abnormal cholesterol, and diabetes. Eat fresh fruits and vegetables and avoid foods that...

What symptoms should prompt a doctors evaluation

Frequent GERD, occurring three or more times a week or longstanding symptoms of more than 6 months may be a sign of damage to the esophagus. Acid damage of the esophagus called esophagitis is present in about half of patients who have an endoscopy test. About 5-10 may have Barrett's esophagus (see color plate 3). Barrett's esophagus is an inflammatory change in the lining of the esophagus that can predispose you to the development of esophageal cancer. If you have difficulty swallowing and...

What is a barium study or upper GI series

If you see a doctor, he or she may recommend evaluation of GERD symptoms or difficulty swallowing. A barium study is one of these tests. It goes by multiple names such as upper GI series, barium swallow, or barium esophagram. This is a simple and easy test that is usually done at a hospital in the X-ray or radiology department. It involves drinking a liquid material that may be chalky tasting that is closely followed by an X-ray examination. The entire exam usually takes less than 30 minutes....

Should I be checked for H pylori at the endoscopy

As discussed earlier, an endoscopic biopsy is a benign and painless procedure. Helicobacter pylori (H. pylori) is the bacterium that causes ulcers and predisposes you to the development of stomach cancer. Thus, finding and treating H. pylori is desirable. Generally, biopsies are done for H. pylori in patients who have ulcers or a history of prior ulcers because they may have a chronic H. pylori infection. Those with stomach irritation on endoscopy, a family history of stomach cancer, or...

Who should have an endoscopy and why

As mentioned, nearly 60 of people with chronic or frequent GERD have positive findings on endoscopy. Endoscopy is recommend for all patients with GERD symptoms longer than 6 months in duration and or symptoms that occur 2 or more times per week. Endoscopy serves as a baseline exam and enables your physician to determine whether there is active inflammation or damage and chronic changes that require treatment and further follow-up. Or you may be reassured that everything looks normal. Barrett's...

What is a manometry or motility study and why is it done

Several different tests are available for evaluation of GERD and heartburn symptoms. Barium studies and endoscopy give your physician information about the structure of both a normal and abnormal esophagus and upper gastroesophageal tract. Sometimes if patients have atypical symptoms, do not respond appropriately to medications, or are under consideration for surgery, other tests may be in order. During a normal swallow of food or liquid, muscles contract and relax in a very closely coordinated...

How should I take the medications and when will they work

As discussed earlier, different medications have different mechanisms of action to treat reflux. Antacids are most effective during a bout of reflux because they directly neutralize the acid. But they do not prevent reflux and only last for brief periods of time. Proton pump inhibitors work by a different mechanism and are very ineffective for treating GERD that is already occurring. These medications take 24 to 48 hours to start working. PPIs need to be taken at the appropriate time for...

What should I do if the medication is not working

You may not find over-the-counter H2 blockers effective for moderate to severe heartburn. If the reflux disease is severe enough, it may require increased medication dosing or a prescription-strength H2 blocker. If H2 blockers are not effective enough in controlling symptoms, then movement to the next tier of GERD therapy is warranted. PPIs are the most potent of the Ifthe reflux disease is severe enough, it may require increased medication dosing or a prescription-strength H2 blocker....

Will surgery decrease my risk of getting Barrettsassociated esophageal cancer

There really is no data in the medical literature to answer this question. Of all patients with chronic GERD, 10 have Barrett's esophagus, and the risk of getting esophageal cancer with Barrett's is 0.5 per year (in other words, if 2000 people have GERD, 1 person per year will get esophageal cancer). Really, the risk of getting cancer with chronic GERD is low but is increased compared to those without GERD. For example, of those 2000 people previously mentioned, 80 will get colorectal cancer...

What is aspiration

Reflux is the movement of fluid and or food from the stomach up into the esophagus. In the back of throat are the openings to the esophagus and the airway to the lungs called the trachea. When you breathe, this valve opens, allowing air into the trachea and lungs (see Figure 12). When you eat, the epiglottis in the back of the throat closes so that food material does not pass into the trachea (see Figure 13). Sometimes when you eat, liquids particularly might go down the wrong pipe, and you...

What is an endoscopy

When patients have had frequent or long-standing GERD symptoms, they can develop inflammatory changes to the esophagus called Barrett's esophagus that can predispose them to esophageal cancer. The only way to make the diagnosis of Barrett's is to do an endoscopy test. Difficulty swallowing can be evaluated and treated at the time of endoscopy. An endoscopy test is usually done at a hospital or an ambulatory endoscopy center, which is a freestanding facility not associated with a hospital. An...

What is H pylori

There really is no strong association between H. pylori infection and GERD. However, we discuss it here because invariably patients have questions about H. pylori infection and its association to disease, particularly to stomach problems. H. pylori is a bacterium or germ and is one of the most common infections in humans. It is present in about half of the world population. H. pylori is uncommon in children living in the developed world and is usually acquired as people age. In the United...

Risks of surgery

Ability to stop taking or to reduce GERD medications possibly for life. Finally, surgery can lead to improvement in asthma or extraesophageal GERD symptoms. Any operation and anesthesia is risky. A specific risk associated with anti-reflux surgery is resulting difficulty swallowing with food getting stuck. This can require endoscopy and dilation for treatment. Normally, you can belch and relieve excess gas but patients who have had anti-reflux surgery can have abdominal bloating because they...

How do I know whether my heart is causing the chest pain

Heartburn is a pain in the chest, but is a type of misnomer. True heartburn is related to refluxing acidic materials back into the esophagus where is passes through the chest, which causes a burning sensation. Even though the name is heartburn, the condition actually has nothing to do with your heart's health. The name of this condition likely was developed when people mistakenly confused reflux pain with a heart attack. A heart attack is a condition in which the heart receives a decreased...

Glossary

Adenocarcinoma Two types of cancer occur in the esophagus. Adeno-carcinoma is a certain type of cancer characterized by the presence of glands when examined under the microscope. This is the kind of cancer associated with Barrett's esophagus. Alka Seltzer A brand of antacid medication that effervesces. An antacid that contains aspirin. Anemia A low blood count from either blood loss or inadequate blood production. Antacid A medication available over the counter, effective for active symptoms of...

Can stress increase GERD

Stress affects all people differently. Each individual's body reacts differently to stress, whether it comes in the form of a new assignment at work or a stressful conversation at home. Stress incorporates itself into your life and must be dealt with daily. If stress always led to GERD, most people would experience heartburn and reflux almost every day But this is not the case. In stressful situations, your body responds by producing hormones that regulate organ function. During times of...

What are the symptoms of a hiatal hernia

Symptoms you might experience are heartburn and regurgitation. A hiatal hernia causes the LES to be less effective, resulting in GERD, but the hiatal hernia itself really has no symptoms. Many patients report dyspepsia, which is the feeling of a sour stomach, and they think that means they have a hiatal hernia. But dyspepsia is a nonspecific stomach disorder treated with a proton pump inhibitor (PPI). The chance of developing a hiatal hernia increases with

What kind of foods should I eat ifI have GERD

Question 32 discusses the foods you should avoid. Eating smaller meals should be your goal because they are emptied from the stomach faster and do not increase pressures within the stomach like a large meal does. Smaller and lighter meals can also help with weight control. Most fruits and vegetables are preferred because they are healthy, low in fat, empty from the stomach relatively quickly, and are lower in acid. Some may actually settle your stomach. On the other hand, juices such as orange,...

How many people are affected by GERD

GERD is not a new disease it is a common disease that affects many people. In 1994, the U.S. Department of Health and Human Services reported that about 7 million people in the United States at that time suffered from chronic GERD. That number has grown since, likely because of the increasing incidence of obesity and people being overweight, which are contributing factors to reflux problems. These days, Americans work longer hours, buy more fast food, and eat on the run. Poor dietary habits and...

What factors cause GERD

GERD is affected by many different factors. It can be caused by factors out of your control as well as other factors that you can change or eliminate. A major cause of GERD and regurgitation is an incompetent valve, or barrier, between the esophagus and stomach. The circular muscle at the bottom of the esophagus is called the lower esophageal sphincter (LES). The LES contributes to the high-pressure zone at the junction of the esophagus and stomach that keeps ingested material out of the...

Can smoking cause GERD

Smoking is a dangerous habit that can result in many health risks. Smoking is associated with many cancers, heart disease, vascular disease, stomach ulcers, and lung disease, to name a few. Some studies have shown a link between smoking and GERD. Even though smoking does not directly cause GERD, it can exacerbate GERD symptoms. The nicotine in cigarette smoke can reduce the ability of the lower esophageal sphincter to contract or close, allowing acid to reflux. The LES is a muscle that keeps...

Does GERD get worse with age

Aging is inevitable and unavoidable the body becomes less efficient at functioning and does not seem to work like it used to. As you age, the tendency is that you will slowly gain weight, which contributes to GERD symptoms. Acid in the esophagus is neutralized by saliva, and saliva production decreases with age. Further, many medications used by the elderly cause dry mouth and decrease saliva production, compounding the problem. With increasing age, stomach emptying is slowed and further...

What are alarm signs of GERD

When symptoms start affecting your overall health, you should seek medical attention. Look for the following key signs to distinguish the severity of your GERD Do you experience GERD or heartburn 3 or more times per week Is the pain in your chest from heartburn or reflux debilitating Does the pain radiate to your arm or cause you to become short of breath Does the pain wake you from sleep or prevent you from getting a full night's rest High reflux can irritate your...

Can medicines exacerbate GERD

Most medications are taken by mouth they are absorbed through the gut and then enter the bloodstream. From the bloodstream, medications can act on various organs. All medications have desired actions and possible side effects. Sometimes when a medicine is prescribed for one problem, it can end up leading to another problem. Every individual's body can react differently to various medications, and it is not always possible to predict drug effects and side effects. Some medications can exacerbate...

When should I see my doctor about my GERD symptoms

You should see your doctor about GERD or heartburn before waiting too long. A burning chest discomfort may be GERD or it could be something else such as a heart problem. Angina or heart pain can be difficult to differentiate from GERD. If you are not sure or have any questions, this should prompt a visit to your doctor, especially if the discomfort is associated with shortness of breath, dizziness, sweating, and or arm or jaw pain or if the chest discomfort is associated with exercise. People...

What are the longterm risksbenefits of endoscopic antireflux procedures

The short answer is we really do not know the long-term risks of endoscopic anti-reflux procedures because they have only been on the market for a few years. Likewise, we do not know their long-term durability to control GERD symptoms and provide heartburn relief without medications. These are promising technologies that make sense from a medical standpoint, but they have not yet stood the test of time. Because these technologies are still fairly new, think carefully before you have your...

What is an esophageal dilation

Esophageal dilation is the technique of stretching the esophagus and is used to treat difficulty swallowing caused by strictures or rings. Most patients with GERD do not need dilation. It is done at the time of endoscopy while patients are sedated. Several different kinds of dilators and different tools are used for different jobs. Your doctor will choose the appropriate dilator based on the location of the narrowing, its length, how tight it is, and experience. We discuss only two kinds of...

If my GERD is chronic and possibly lifelong do I need to take medications for life or are there any other options

If you have long-standing frequent GERD and lifestyle modifications such as weight loss do not improve your symptoms, then you may need to take medications for life. The good news is that H2 blockers are safe for long-term use and have been on the market for more than 25 years demonstrating their safety. Proton pump inhibitors are felt to be safe for long-term use as well, and these have been on the market for more than 15 years. There were early concerns with long-term PPI use because initial...

What kind of doctor treats GERD

Your primary care doctor should do the initial evaluation of GERD. This kind of doctor is usually an internist or doctor who does general internal medicine and only treats adults. Other primary care doctors might be family practitioners who treat both adults and children. Your doctor may treat you with medication for GERD and or order tests. If you are on medication that is not working or have any of the symptoms from the preceding question, your doctor may refer you to a gastroenterologist....

Can I have chest pain caused by conditions other than GERD

GERD is only one of the many conditions that can cause chest pain. Other causes of chest pain range from life-threatening to minor inconveniences. Of course, a severe and life-threatening cause of chest pain is a heart attack as discussed earlier (see Question 13). For instance, a pulmonary embolism is a life-threatening condition that can cause severe chest pain. A pulmonary embolism is a blood clot that travels to the lungs and decreases blood flow to the lungs. It can lead to difficulty...

Do I need a biopsy of the esophagus and does it hurt

It is fairly common to do biopsies during an endoscopy. A small biopsy forceps is passed down the endoscope and a tiny pinch of tissue is removed. This is sent to a pathologist, who examines the tissue under a microscope. This can be extremely helpful for the evaluation of patients with GERD. A normal-appearing esophagus on endoscopy can have microscopic clues to the presence of reflux disease. Abnormal areas can be biopsied to check for cancer. As previously mentioned, chronic reflux can put...

Can exercise affect my reflux

Exercise is generally good and beneficial, but not always. Exercise is good for improving strength, heart conditioning, weight control, and overall health. On the other hand, it can affect reflux and make it worse. Exercise can cause problems with reflux because of its effects on the digestive system and the physical positioning and pressures it places on the stomach and the esophagus. However, acid reflux should not be a reason to avoid exercising because exercise has so many positive and...

Which medications can affect both esophagus and stomach

The esophagus and stomach are exposed to a wide variety of consumed substances that are potentially irritating or damaging. For this reason, a protective layer of cells called the mucosa lines the stomach and esophagus. The mucosa is a microscopic layer of cells, like skin that it is constantly changing and renewing itself. In the esophagus, the mucosa is a smooth surface that is slippery and allows substances swallowed to pass easily through to the stomach. Stomach mucosa is different it has...

Can GERD manifest as mouth symptoms in the absence oftypical chest discomfort

Yes, mouth symptoms can occur in the absence of chest discomfort. The acid can travel up from the stomach through the esophagus and into your mouth this is called regurgitation. Most individuals experience symptoms with acid reflux however, this is not always the case. Occasionally, people may not feel any pain because their esophagus has a decreased sensation to pain, or over the years they have become accustomed to the feeling and might not even notice it. This is called silent reflux....

What is apHstudy and why is it done

The stomach makes acid that aids in digestion of food. GERD, or heartburn, is movement of the acid into the esophagus. Sometimes patients have vague, odd, or atypical symptoms instead of classic burning chest discomfort. A trial of antacid medication can help sort this out if your symptoms go away with treatment. But other things can cause chest pain like heart or lung problems and can be very difficult to differentiate from GERD. Additionally, patients with GERD symptoms may be on a maximum...

What is an Endo Cinch or endoscopic plication

A Nissen fundoplication is, as mentioned earlier, surgical reinforcement of the lower esophageal sphincter accomplished by wrapping the top of the stomach around the bottom of the esophagus and stitching it into place. Several companies have manufactured endoscopic devices that can sew or staple and effectively provide a similar effect as a Nissen procedure. Currently, three endoscopic stitching or sewing devices are approved by the FDA and are on the market. Each device is different and...

What does an endoscopy show when patients have GERD

Patients with chronic GERD symptoms undergoing endoscopy have been studied by Winters and colleagues. In a report published in Gastroenterology in 1987, the authors found that of approximately 100 patients with longstanding or chronic GERD who had an upper endoscopy, 42 were normal, 45 demonstrated erosive esophagitis, and 12 had Barrett's esophagus. So, it is reassuring that more than 40 of patients were found to be normal however, it is the other nearly 60 of patients who have a positive exam...

Which specific medications can exacerbate GERD or damage the esophagus

As mentioned, medications can act in different ways to affect GERD and reflux symptoms (see Table 1). Medications can either affect the nerves that control the LES or the muscles that control the tightness of the LES. All muscles, including the LES, are controlled by nerves. Muscles of the gut are called smooth muscle and you cannot consciously control them by thinking about it. The nerves transmit signals from the brain to the rest of the body. Nerves that make up what is called the autonomic...

Do I need to be checked for H pyloric

If you have a history of stomach or duodenal ulcers even in the remote past, then yes, you should be checked. If you have a primary relative like a parent or brother or sister who has stomach cancer, then it is probably a good idea to be checked for H. pylori infection. Treating an H. pylori infection can decrease your chances of getting future ulcers and your risk for getting stomach cancer. In an endoscopy, if your physician finds any irritation of the...

If antacids do not work or are not appropriate for my GERD what is the next step or tier ofmedications to try

Antacids are first-line therapy for mild or infrequent heartburn however, sometimes these medications will not work or are simply not appropriate. To properly understand the other options available for anti-reflux therapy, it is important to know the biology of the stomach and how it produces acid for digestion. The stomach has multiple actions that aid in digestion of food. The stomach stores food and, with strong muscles, grinds food material into pieces less than a half inch in size....

What are the different proton pump inhibitors How should they be taken

Proton pump inhibitors completely shut down stomach cells that produce acid because they work directly on the site of acid production. Because they are the strongest acid-blocking medication, they are considered third-tier treatment for GERD. The tiers represent the step-wise management of GERD symptoms, starting with the cheapest and safest medication as first tier and ending with PPIs as third tier. PPIs are the most expensive medications for GERD and have, generally speaking, more side...

What are antacids and how and when should they be used

Antacids are compounds that can be used to neutralize acid on the spot, thus providing immediate relief of heartburn symptoms. Antacids are available at any drugstore, convenience store, and supermarket. All antacid products are over the counter and do not require a prescription. They are available for the general consumer to use at his or her own discretion. As mentioned, more than 7 million people suffer from regular GERD, and even more people suffer from occasional or infrequent heartburn...

What is a Stretta procedure

Stretta Procedure

Generally, a weak or lax lower esophageal sphincter causes reflux, although some reflux is related to inappropriate relaxation of the LES. Historically, antireflux surgical procedures wrap part of the stomach around the LES to tighten or reinforce this region. As mentioned earlier, several techniques have been developed to accomplish this nonoperatively with an endoscope to avoid the risks and discomfort of surgery. When tissue is damaged, it scars and shortens or contracts and becomes stiffer....

If my symptoms get better can I stop taking medication

It is reassuring to know that symptoms can respond to medication therapy. However, if your symptoms get dramatically better on prescription medication, it is important you continue this medication for a course of time, or at least until your doctor evaluates you again. As previously discussed, medications work in two ways they heal acid damage and they maintain healing. Generally speaking, it takes about 8 weeks to heal esophagitis, and the maintenance phase can last from months to years. Once...

What is esophagitis

Esophagitis is inflammation of the lining of the esophagus that is diagnosed by a barium X-ray or endoscopy. Generally, it is not a diagnosis that can be made by a doctor in the office through a history or physical examination. The inflammation is usually caused by reflux of acid that burns, damaging the esophagus. However, medications can sometimes cause esophagitis, for example, aspirin or over-the-counter pain relievers, iron pills, potassium pills, some antibiotics, and certain drugs used...

What is an esophageal stricture or ring

Patients with and without chronic problems with GERD may be at risk of having a stricture or an esophageal ring. These are two different types of constrictions or narrowing of the esophagus. An esophageal ring manifests as rare episodic difficulty swallowing with solid food getting stuck (see color plate 1). The sensation of food getting stuck can occur a couple times a year or may happen only once every few years. It is nonprogressive, meaning that over time swallowing generally does not get...

What is the relationship between ulcers and GERD

An ulcer is a break in the lining of the gut generally defined as greater than 5 millimeters, which is about a quarter of an inch. Ulcers can occur anywhere in the gut from the mouth to the anus. The causes of ulcers vary depending on their location. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen (Naprosyn) can cause ulcers anywhere in the gut. Classically, ulcers are located in the stomach and first part of the small intestine (called the duodenum)....

What is Enteryx

Enteryx is a material that could be injected into the area of the LES at the time of endoscopy. It is a liquid polymer that stays in place where it is injected and solidifies into a spongy material. This material can bulk up the LES and become a barrier to reflux. Small studies suggested that Enteryx was effective for GERD. Side effects included chest pain, difficulty swallowing, bloating, nausea, garlic odor, and fever. Enteryx was previously FDA approved, but because of complications (11...

What about other chest symptoms with GERD

GERD can affect other systems in your chest besides your mouth and stomach. To understand how it can affect other systems in your chest, it is important for you to visualize the anatomy of the human body. affect other systems in your chest besides your mouth and stomach. Visualize the path food takes as it moves through your body (see Figure 6). You can see that it moves to the back of the mouth and then makes a sharp turn down into the esophagus. Similarly, when you breathe through your nose,...

Does GERD affect one gender more than the other

Females are slightly more affected by GERD than males are. The reason women are more prone to develop GERD may be related to female hormones. The female body produces the hormones estrogen and progesterone. One of the many functions of these hormones is to relax muscles in the body. For example, during pregnancy, women produce larger amounts of these hormones to relax the muscles in the uterus to allow it to grow along with the baby. Just as hormone levels change during pregnancy, women...

Antacids seem benign Do they have side effects

Antacids are medications, and even though they are available without a prescription, you should be advised that they too can cause side effects and have adverse effects. Antacids are drugs that contain multiple ingredients in addition to the active agent that neutralizes acid. There are dyes for coloring, flavors, fillers to form the actual tablet or pill, and other additives. Any one of these can cause problems in certain people. Some antacids are mixed with aspirin to act as a pain reliever,...

Neeral L Shah MD

Department of Gastroenterology Lahey Clinic Burlington, MA Sudbury, Massachusetts BOSTON TORONTO LONDON SINGAPORE Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario London W6 7PA Jones and Bartlett's books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax...

Is there a difference between daytime and nighttime GERD

GERD can occur at any time because the stomach is constantly producing acid, but acid production varies at different times. Food enters the mouth and moves down to the stomach, stimulating production of stomach enzymes and acid for digestion. The first major step in food processing is in the stomach, which slowly moves material into the small intestines where nutrients are absorbed. Certain fried and high-fat foods can stimulate the stomach to produce more acid and digestive juices than normal....