Gastroesophageal Reflux (GERD) and Heartburn
Heartburn, also called acid indigestion, is a burning sensation in the esophagus just behind the breastbone. You get heartburn when food and digestive juices from the stomach flow backward up into the esophagus. It’s normal to get occasional heartburn, but you should see a doctor if you have heartburn more than two or three times a week. It could be a symptom of gastroesophageal reflux disease (GERD).
GERD is a chronic condition that occurs when frequent acid reflux irritates the lining of the esophagus. Common symptoms include heartburn, acid reflux, difficulty swallowing, dry cough, a hoarse or sore throat and chest pain.
You may be more likely than others to have GERD if:
- You are older
- You smoke
- You eat high-fat or fried foods
- You are overweight or obese
- You are pregnant
- You drink alcohol
Common Triggers for Heartburn and GERD
Certain medicines and foods can bring on or worsen GERD and heartburn. Medicines that may trigger symptoms include:
- Sedatives for anxiety or sleeplessness
- Tricyclic antidepressants
- Beta blockers for heart disease or high blood pressure
- Anticholinergics (for example, for seasickness)
- Dopamine-active drugs for Parkinson’s disease
- Calcium channel blockers
If you think a medicine you are taking is causing heartburn, see your doctor before making any changes in the medications you regularly take.
Foods that can make heartburn or GERD worse include:
- Spicy foods
- Drinks with caffeine
- Tomato-based foods, such as spaghetti sauce, salsa, chili, and pizza
- Mint flavoring
- Citrus fruits
- Fried and fatty foods
- Garlic and onion
Diagnosis of Heartburn or GERD
To diagnose heartburn your doctor will examine you and take your medical history. If your symptoms are severe or return after treatment, your doctor may recommend tests to determine if you have GERD. These tests may include:
- Upper GI endoscopy, or esophagogastroduodenoscopy (EGD): Using a long, thin, flexible tube with a light and camera at the end, doctors can look inside the upper part of the GI tract, the esophagus, stomach and duodenum. This procedure can help doctors diagnose and evaluate stomach pain, nausea, vomiting, difficulty swallowing and heartburn.
- Esophageal manometry: This procedure helps doctors evaluate GERD symptoms and difficulty swallowing. A thin tube is inserted through the patient’s mouth or nose into the stomach, and then the tube is pulled back into the esophagus. After the tube is in place, the patient swallows, and the esophagus muscles’ function is measured.
- Barium swallow: This is a set of x-rays of the patient’s esophagus, stomach and small intestine. It’s also called an upper GI series. The patient swallows a barium mixture, which can be seen on a fluoroscope as it goes from the esophagus into the stomach. X-rays record images of what happens at the appropriate times.
- Esophageal pH (acid) monitoring: This test helps doctors find out how often stomach acid enters the esophagus, and how long it stays there. A small tube is inserted through the patient’s nose and passed into the esophagus. A monitor attached to the tube tracks the amount of acidity in the esophagus. The patient keeps a diary of daily activities and symptoms while the tube is in place for 24 hours. Another way to do this test is to place a wireless transducer in the lower esophagus at the time of an upper endoscopy. While the patient goes through normal activities (24 to 48 hours), the transducer records data and sends it to a receiver on the patient’s belt. Data on the receiver is analyzed for abnormal acid reflux activity. The transducer passes through the GI tract and does not need to be retrieved.
There are three ways to treat heartburn and GERD: Lifestyle changes medications and surgery. They can be used in combination or individually.Helpful lifestyle changes include:
- Don’t smoke
- Avoid foods, beverages and medicines that worsen GERD and heartburn. Examples include:
- Fried foods or foods high in fat content
- Tomato- and citrus-containing foods
- Vinegar, mustard, and ketchup
- Alcoholic drinks
- Carbonated drinks
- Decaffeinated and caffeinated coffee
- Lose weight, if appropriate.
- Wear loose clothes that do not put a lot of pressure on the stomach.
- Eat slowly, and eat small, frequent meals.
- Use over-the-counter antacids after meals and at bedtime.
- Do not lie down for 2 to 3 hours following eating.
- Do not eat for 2 to 3 hours before you sleep.
- Raise the head end of your bed about four to six inches by putting blocks under the head side of your frame. Or use a wedge foam support that raises the upper half of your body when you lie in bed.
Helpful medicines may include:
- Antacids: Examples are Mylanta®, Maalox®, Alka-Seltzer®, and Rolaids®. These are often recommended first to relieve mild heartburn or GERD symptoms. Constipation and diarrhea are side effects of antacids.
- H2 blockers (or H2-receptor antagonists): H2 blockers lower production of stomach acid. You can get them as over-the-counter medications or by prescription. Examples include ranitidine (Zantac 75®), famotidine (Pepcid® or Pepcid AC®), cimetidine (Tagamet® or Tagamet HB®), and nizatidine (Axid® and Axid AR®). Generally these medicines are only effective for short periods.
- Proton pump inhibitors: Proton pump inhibitors are more effective than H2 blockers. Two of these drugs, Prevacid and Prilosec, are available in two strengths, with or without a prescription. They help relieve symptoms and can promote healing of the esophagus lining in nearly all patients with GERD. Other proton pump inhibitors that require a prescription include omeprazole (Zegerid®); esomeprazole (Nexium®); pantoprazole (Protonix®); rabeprazole (Aciphex) and dexlansoprazole (Dexilant®). Patients should be aware of a study that showed a higher risk of heart disease if Plavix (Clopidogrel®) was taken in combination with proton pump inhibitors. Taking these drugs together can also lead to other drug interactions. Patients should consult with their doctors if they are talking both medications.
- Prokinetics: These drugs help the stomach empty more rapidly. Metoclopramide (Reglan®) is an example of this type of drug. Prokinetics often have side effects, including depression, movement problems, tiredness, anxiety and sleepiness.
These medications can be used occasionally to relieve the symptoms of heartburn. If you use them more often than twice weekly, see a doctor to get an accurate diagnosis and treatment plan. Sometimes combinations of these medications work better than just one drug. Talk to your doctor if you think you need to take a combination of medicines.
Also, be sure to consult with a doctor if you have these symptoms:
- Appetite loss
- Loss of weight (unexplained)
- Difficulty or pain on swallowing
- Eating and feeling full too soon
Those symptoms could be signs of other GI problems besides heartburn or GERD.
Surgery for GERD
Nissen fundoplication is the standard surgical treatment for GERD. In this procedure, the upper stomach is completely or sometimes partially wrapped around the lower end of the esophagus. This reinforces the closing function of the lower esophageal sphincter, stops acid reflux, and can repair a hiatal hernia. This surgery may be a good choice for those for patients who haven’t been helped by lifestyle changes and medication.
Nissen fundoplication can be done with a laparoscope, a lighted tube with a tiny camera inserted through a small cut in the abdomen. The doctor can then do the surgery through that minimally invasive incision, which heals faster than a large cut.
- National Sleep Foundation, GERD and Sleep
- American Academy of Otolaryngology—Head and Neck Surgery: Fact Sheet: Laryngopharyngeal Reflux and Children
- National Digestive Diseases Information Clearinghouse (NDDIC): Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD)
- PubMed Health: Gastroesophageal reflux disease
- National Sleep Foundation: GERD and sleep
- International Foundation for Functional Gastrointestinal Disorders (IFFGD): About GERD
- American College of Gastroenterology: Acid reflux
- American Gastroenterological Association: Patient center: understanding heartburn and reflux disease
- American Academy of Otolaryngology—Head and Neck Surgery: Fact Sheet: Gastroesophageal Reflux (GERD)
- WebMD: Heartburn/GERD health center: How acid reducers can help treat heartburn
- Ohio State, Wexner Medical Center: Treating GERD