Gastroesophageal Reflux Disease

Gastroesophageal reflux is a backward flow or reflux of stomach contents into the esophagus. Everybody has some reflux. Abnormal amounts of gastroesophageal reflux can cause gastroesophageal reflux disease (GERD). This occurs when the valve of smooth muscle between the esophagus and the stomach does not function properly. This muscle band is called the lower esophageal sphincter.

What causes gastroesphageal reflux disease?
What are signs and symptoms of GERD?
How is gastroesphageal reflux disease diagnosed?
What is the treatment for GERD?

What causes gastroesphageal reflux disease?

Each time you eat, stomach acids are released. Normally the lower esophageal sphincter acts as a guard to prevent stomach acids from backing up into the esophagus. An increase of the pressure in the stomach and/or relaxation of the muscle tone of the valve may cause reflux to occur.

Factors that cause an increase in pressure are:

• Full stomach
• Obesity
• Lying down
• Bending forward
• Lifting heavy objects
• Pregnancy
• Uncontrolled obstructive lung disease

Factors that loosen the muscle tone of the valve can be caused by:

• Pregnancy
• Medications that are smooth muscle relaxants, such as theophylline, other oral bronchodilators, calcium channel blockers and diazepam.
• Nicotine
• Alcohol, Coffee
• Chocolate
• Mint
• Fatty foods

What are signs and symptoms of GERD?

Signs and symptoms of gastroesphageal reflux disease include:

• Heartburn or a sour taste in the mouth.
• Pain occurring in the middle of the chest.
• Coughing and/or choking while lying down.
• Increased trouble breathing while asleep.

How is gastroesphageal reflux disease diagnosed?

A physician diagnoses GERD from a history of signs and symptoms. He or she may order tests such as a barium swallow or an esophageal pH probe to help diagnose this condition.

What is the treatment for GERD?

The following treatments may be recommended:

Lifestyle changes:

• If you are overweight, talk with your healthcare provider about losing weight.
• If you smoke, quitting smoking is important. Your healthcare provider may have ideas to help you quit.

Dietary measures:

• Limit citrus and tomato products, strong spices, caffeinated drinks, carbonated drinks, fatty foods, chocolate, mint, alcohol or nicotine.
• Eat smaller, more frequent meals rather than three large ones.
• Avoid food or liquids for 2-3 hours before bedtime.

Physical measures:

• Elevate the head of the bed 6-8 inches, by placing blocks under the legs of the head of the bed.
• Avoid lifting heavy objects.
• Avoid bending forward at the waist.
• Avoid wearing tight fitting clothing.

Medications that may be prescribed to help this condition:

• Antacids after meals and at bedtime.
• Tagamet® (cimetadine), Zantac® (ranitidine), Pepcid® (famotidine), Axid® (nizatidine)
• Prilosec® (omeprazole), Prevacid® (lansoprazole)
• Reglan® (metoclopramide)

Occasionally surgery may be recommended to help eliminate gastroesophageal disease.

This information has been approved by Gary Larsen, MD (February 2006).