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Gastroesophageal reflux disease

Definition

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Alternative Names

Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic

Causes

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

A number of studies suggest that obesity contributes to gastroesophageal reflux. For instance, the Nurses Health Study found that being overweight or obese significantly increased reflux symptoms in women. (Women who lost weight in the study, meanwhile, had fewer symptoms.)

Symptoms

Exams and Tests

Treatment

General measures include:

  • Weight reduction
  • Avoiding lying down after meals
  • Sleeping with the head of the bed elevated
  • Taking medication with plenty of water
  • Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
  • Avoiding alcohol and tobacco
Medications that alleviate symptoms include:
  • Antacids after meals and at bedtime
  • Histamine H2 receptor blockers
  • Promotility agents
  • Proton pump inhibitors
Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.

Outlook (Prognosis)

The majority of people respond to nonsurgical measures with behavioral modification and medications.

Possible Complications

  • Inflammation of the esophagus
  • Stricture
  • Esophageal ulcer
  • Hoarseness, bronchospasm
  • Chronic pulmonary disease
  • Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)

When to Contact a Medical Professional

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Prevention

Avoid foods and activities that worsen symptoms. Maintain a healthy weight.


Review Date: 12/19/2007
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz, Kelli A. Stacy, ELS. Previously reviewed by Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-TorresdaleHospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network (7/28/2006).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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