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Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 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 U.S. Department 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. INSTITUTES esophagus. GER is also called acid reflux Most children under 12 years with GERD, OF HEALTH 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 • chocolate 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 worsen symptoms. 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 a meal. 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 a medication. 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. observed. 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 unknown. 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 be GERD. 6 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) For More Information Acknowledgments American College of Gastroenterology Publications produced by the Clearinghouse P.O. Box 342260 are carefully reviewed by both NIDDK Bethesda, MD 20827–2260 scientists and outside experts. This Phone: 301–263–9000 publication was reviewed by M. Brian 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. 4930 Del Ray Avenue Bethesda, MD 20814 Phone: 301–654–2055 You may also find additional information about this Fax: 301–654–5920 topic by visiting MedlinePlus at www.medlineplus.gov. Email: email@example.com This publication may contain information about Internet: www.gastro.org medications. When prepared, this publication included the most current information available. International Foundation for Functional For updates or for questions about any medications, contact the U.S. Food and Drug Administration Gastrointestinal Disorders toll-free at 1–888–INFO–FDA (1–888–463–6332) P.O. Box 170864 or visit www.fda.gov. Consult your health care provider for more information. Milwaukee, WI 53217–8076 Phone: 1–888–964–2001 or 414–964–1799 Fax: 414–964–7176 Email: firstname.lastname@example.org The U.S. Government does not endorse or favor any Internet: www.iffgd.org specific commercial product or company. Trade, proprietary, or company names appearing in this North American Society for Pediatric Gas- document are used only because they are considered necessary in the context of the information provided. troenterology, Hepatology and Nutrition If a product is not mentioned, the omission does not P.O. Box 6 mean or imply that the product is unsatisfactory. Flourtown, PA 19031 Phone: 215–233–0808 Fax: 215–233–3918 Email: email@example.com Internet: www.naspghan.org Pediatric/Adolescent Gastroesophageal Reflux Association P.O. Box 7728 Silver Spring, MD 20907 Phone: 301–601–9541 Email: firstname.lastname@example.org Internet: www.reflux.org 7 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892–3570 Phone: 1–800–891–5389 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: email@example.com Internet: www.digestive.niddk.nih.gov The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.digestive.niddk.nih.gov. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 07–0882 May 2007 The NIDDK prints on recycled paper with bio-based ink.
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