Heartburn, Gastroesophageal Reflux
(GER), and Gastroesophageal Reflux
National Digestive Diseases Information Clearinghouse
What is GERD? What are the symptoms of
Gastroesophageal reflux disease (GERD) GERD?
is a more serious form of gastroesophageal
reflux (GER), which is common. GER The main symptom of GERD in adults
occurs when the lower esophageal sphinc- is frequent heartburn, also called acid
of Health and
Human Services ter (LES) opens spontaneously, for varying indigestion—burning-type pain in the
periods of time, or does not close prop- lower part of the mid-chest, behind the
NATIONAL erly and stomach contents rise up into the breast bone, and in the mid-abdomen.
esophagus. GER is also called acid reflux Most children under 12 years with GERD,
or acid regurgitation, because digestive and some adults, have GERD without
juices—called acids—rise up with the food. heartburn. Instead, they may experience
The esophagus is the tube that carries food a dry cough, asthma symptoms, or trouble
from the mouth to the stomach. The LES swallowing.
is a ring of muscle at the bottom of the
esophagus that acts like a valve between What causes GERD?
the esophagus and stomach.
The reason some people develop GERD
When acid reflux occurs, food or fluid can is still unclear. However, research shows
be tasted in the back of the mouth. When that in people with GERD, the LES relaxes
refluxed stomach acid touches the lining of while the rest of the esophagus is working.
the esophagus it may cause a burning sensa- Anatomical abnormalities such as a hiatal
tion in the chest or throat called heartburn hernia may also contribute to GERD. A
or acid indigestion. Occasional GER is hiatal hernia occurs when the upper part of
common and does not necessarily mean one the stomach and the LES move above the
has GERD. Persistent reflux that occurs diaphragm, the muscle wall that separates
more than twice a week is considered the stomach from the chest. Normally, the
GERD, and it can eventually lead to more diaphragm helps the LES keep acid from
serious health problems. People of all ages rising up into the esophagus. When a hia-
can have GERD. tal hernia is present, acid reflux can occur
more easily. A hiatal hernia can occur in
people of any age and is most often a nor-
mal finding in otherwise healthy people
over age 50. Most of the time, a hiatal
hernia produces no symptoms.
Other factors that may contribute to GERD • drinks with caffeine or alcohol
include • fatty and fried foods
• obesity • garlic and onions
• pregnancy • mint flavorings
• smoking • spicy foods
Common foods that can worsen reflux • tomato-based foods, like spaghetti
symptoms include sauce, salsa, chili, and pizza
• citrus fruits
What is GERD in children? feeding. If your child is older, your health
care provider may recommend that your
Distinguishing between normal, physio child eat small, frequent meals and avoid
logic reflux and GERD in children is the following foods:
important. Most infants with GER are
happy and healthy even if they frequently • sodas that contain caffeine
spit up or vomit, and babies usually out • chocolate
grow GER by their first birthday. Reflux • peppermint
that continues past 1 year of age may be
GERD. Studies show GERD is common • spicy foods
and may be overlooked in infants and • acidic foods like oranges, tomatoes,
children. For example, GERD can pres and pizza
ent as repeated regurgitation, nausea, • fried and fatty foods
heartburn, coughing, laryngitis, or
respiratory problems like wheezing, Avoiding food 2 to 3 hours before bed
asthma, or pneumonia. Infants and may also help. Your health care provider
young children may demonstrate irritabil may recommend raising the head of your
ity or arching of the back, often during or child’s bed with wood blocks secured
immediately after feedings. Infants with under the bedposts. Just using extra
GERD may refuse to feed and experience pillows will not help. If these changes
poor growth. do not work, your health care provider
may prescribe medicine for your child.
Talk with your child’s health care provider In rare cases, a child may need surgery.
if reflux-related symptoms occur regularly For information about GER in infants,
and cause your child discomfort. Your children, and adolescents, see the
health care provider may recommend Gastroesophageal Reflux in Infants and
simple strategies for avoiding reflux, Gastroesophageal Reflux in Children and
such as burping the infant several times Adolescents fact sheets from the National
during feeding or keeping the infant in Institute of Diabetes and Digestive and
an upright position for 30 minutes after Kidney Diseases (NIDDK).
2 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
How is GERD treated? magnesium, calcium, and aluminum—with
hydroxide or bicarbonate ions to neutralize
See your health care provider if you have the acid in your stomach. Antacids, how
had symptoms of GERD and have been ever, can have side effects. Magnesium salt
using antacids or other over-the-counter can lead to diarrhea, and aluminum salt
reflux medications for more than 2 weeks. may cause constipation. Aluminum and
Your health care provider may refer you to magnesium salts are often combined in a
a gastroenterologist, a doctor who treats single product to balance these effects.
diseases of the stomach and intestines.
Depending on the severity of your GERD, Calcium carbonate antacids, such as Tums,
treatment may involve one or more of the Titralac, and Alka-2, can also be a supple
following lifestyle changes, medications, mental source of calcium. They can cause
or surgery. constipation as well.
Lifestyle Changes Foaming agents, such as Gaviscon, work by
• If you smoke, stop. covering your stomach contents with foam
to prevent reflux.
• Avoid foods and beverages that
H2 blockers, such as cimetidine (Tagamet
• Lose weight if needed. HB), famotidine (Pepcid AC), nizatidine
(Axid AR), and ranitidine (Zantac 75),
• Eat small, frequent meals. decrease acid production. They are avail
• Wear loose-fitting clothes. able in prescription strength and over-the
• Avoid lying down for 3 hours after
counter strength. These drugs provide
short-term relief and are effective for about
half of those who have GERD symptoms.
• Raise the head of your bed 6 to
8 inches by securing wood blocks
Proton pump inhibitors include omepra
under the bedposts. Just using
zole (Prilosec, Zegerid), lansoprazole
extra pillows will not help.
(Prevacid), pantoprazole (Protonix),
rabeprazole (Aciphex), and esomeprazole
Medications (Nexium), which are available by prescrip
Your health care provider may recommend tion. Prilosec is also available in over-the
over-the-counter antacids or medications counter strength. Proton pump inhibitors
that stop acid production or help the are more effective than H2 blockers and can
muscles that empty your stomach. You can relieve symptoms and heal the esophageal
buy many of these medications without a lining in almost everyone who has GERD.
prescription. However, see your health
Prokinetics help strengthen the LES and
care provider before starting or adding
make the stomach empty faster. This group
includes bethanechol (Urecholine) and
Antacids, such as Alka-Seltzer, Maalox, metoclopramide (Reglan). Metoclo
Mylanta, Rolaids, and Riopan, are usually pramide also improves muscle action in the
the first drugs recommended to relieve digestive tract. Prokinetics have frequent
heartburn and other mild GERD symp side effects that limit their usefulness—
toms. Many brands on the market use fatigue, sleepiness, depression, anxiety,
different combinations of three basic salts— and problems with physical movement.
3 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
Because drugs work in different ways, com The doctor also may perform a biopsy.
binations of medications may help control Tiny tweezers, called forceps, are
symptoms. People who get heartburn after passed through the endoscope and
eating may take both antacids and H2 allow the doctor to remove small
blockers. The antacids work first to neu pieces of tissue from your esophagus.
tralize the acid in the stomach, and then The tissue is then viewed with a micro
the H2 blockers act on acid production. scope to look for damage caused by
By the time the antacid stops working, the acid reflux and to rule out other prob
H2 blocker will have stopped acid produc lems if infection or abnormal growths
tion. Your health care provider is the best are not found.
source of information about how to use
medications for GERD. • pH monitoring examination involves
the doctor either inserting a small tube
into the esophagus or clipping a tiny
What if GERD symptoms device to the esophagus that will stay
persist? there for 24 to 48 hours. While you
go about your normal activities, the
If your symptoms do not improve with
device measures when and how much
lifestyle changes or medications, you may
acid comes up into your esophagus.
need additional tests.
This test can be useful if combined
• Barium swallow radiograph uses with a carefully completed diary—
x rays to help spot abnormalities such recording when, what, and amounts
as a hiatal hernia and other structural the person eats—which allows the
or anatomical problems of the esopha doctor to see correlations between
gus. With this test, you drink a solu symptoms and reflux episodes. The
tion and then x rays are taken. The procedure is sometimes helpful in
test will not detect mild irritation, detecting whether respiratory symp
although strictures—narrowing of toms, including wheezing and cough
the esophagus—and ulcers can be ing, are triggered by reflux.
A completely accurate diagnostic test for
• Upper endoscopy is more accurate GERD does not exist, and tests have not
than a barium swallow radiograph and consistently shown that acid exposure to
may be performed in a hospital or a the lower esophagus directly correlates
doctor’s office. The doctor may spray with damage to the lining.
your throat to numb it and then, after
lightly sedating you, will slide a thin, Surgery
flexible plastic tube with a light and Surgery is an option when medicine and
lens on the end called an endoscope lifestyle changes do not help to manage
down your throat. Acting as a tiny GERD symptoms. Surgery may also be
camera, the endoscope allows the doc a reasonable alternative to a lifetime of
tor to see the surface of the esophagus drugs and discomfort.
and search for abnormalities. If you
have had moderate to severe symp
toms and this procedure reveals injury
to the esophagus, usually no other
tests are needed to confirm GERD.
4 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
Fundoplication is the standard surgical What are the long-term
treatment for GERD. Usually a specific
type of this procedure, called Nissen fundo complications of GERD?
plication, is performed. During the Nissen Chronic GERD that is untreated can cause
fundoplication, the upper part of the serious complications. Inflammation of the
stomach is wrapped around the LES to esophagus from refluxed stomach acid can
strengthen the sphincter, prevent acid damage the lining and cause bleeding or
reflux, and repair a hiatal hernia. ulcers—also called esophagitis. Scars
from tissue damage can lead to strictures—
The Nissen fundoplication may be per narrowing of the esophagus—that make
formed using a laparoscope, an instrument swallowing difficult. Some people develop
that is inserted through tiny incisions in Barrett’s esophagus, in which cells in the
the abdomen. The doctor then uses small esophageal lining take on an abnormal
instruments that hold a camera to look at shape and color. Over time, the cells can
the abdomen and pelvis. When performed lead to esophageal cancer, which is often
by experienced surgeons, laparoscopic fun fatal. Persons with GERD and its compli
doplication is safe and effective in people cations should be monitored closely by a
of all ages, including infants. The proce physician.
dure is reported to have the same results
as the standard fundoplication, and people Studies have shown that GERD may
can leave the hospital in 1 to 3 days and worsen or contribute to asthma, chronic
return to work in 2 to 3 weeks. cough, and pulmonary fibrosis.
Endoscopic techniques used to treat For information about Barrett’s esophagus,
chronic heartburn include the Bard see the Barrett’s Esophagus fact sheet from
EndoCinch system, NDO Plicator, and the the NIDDK.
Stretta system. These techniques require
the use of an endoscope to perform the
anti-reflux operation. The EndoCinch
and NDO Plicator systems involve putting
stitches in the LES to create pleats that
help strengthen the muscle. The Stretta
system uses electrodes to create tiny burns
on the LES. When the burns heal, the scar
tissue helps toughen the muscle. The long-
term effects of these three procedures are
5 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
Points to Remember • The persistence of GER along with
other symptoms—arching and irritabil-
• Frequent heartburn, also called acid
ity in infants, or abdominal and chest
indigestion, is the most common
pain in older children—is GERD.
symptom of GERD in adults. Anyone
GERD is the outcome of frequent and
experiencing heartburn twice a week or
persistent GER in infants and children
more may have GERD.
and may cause repeated vomiting,
• You can have GERD without hav- coughing, and respiratory problems.
ing heartburn. Your symptoms could
include a dry cough, asthma symptoms, Hope through Research
or trouble swallowing.
The reasons certain people develop GERD
• If you have been using antacids for and others do not remain unknown.
more than 2 weeks, it is time to see Several factors may be involved, and
your health care provider. Most doc- research is under way to explore risk factors
tors can treat GERD. Your health for developing GERD and the role of
care provider may refer you to a gas- GERD in other conditions such as asthma
troenterologist, a doctor who treats and laryngitis.
diseases of the stomach and intestines.
Participants in clinical trials can play a more
• Health care providers usually recom- active role in their own health care, gain
mend lifestyle and dietary changes to access to new research treatments before
relieve symptoms of GERD. Many they are widely available, and help others
people with GERD also need medica- by contributing to medical research. For
tion. Surgery may be considered as a information about current studies, visit
treatment option. www.ClinicalTrials.gov.
• Most infants with GER are healthy
even though they may frequently spit
up or vomit. Most infants outgrow
GER by their first birthday. Reflux
that continues past 1 year of age may
6 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
For More Information Acknowledgments
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Internet: www.acg.gi.org Fennerty, M.D., Oregon Health and Science
University, and Benjamin D. Gold, M.D.,
American Gastroenterological Association Emory University School of Medicine.
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7 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
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