GERD (acid reflux disease) occurs when stomach acid flows up into the esophagus (the tube connecting the mouth with the stomach). The stomach can handle stomach acid, but the throat and esophagus can’t. As a result, stomach acid in these areas may cause damage. To some extent, everyone has acid reflux. Normal reflux usually happens after meals, is brief and without symptoms, and rarely happens during sleep. Normal reflux becomes GERD when symptoms occur frequently (generally at least two or three times a week) or the esophagus becomes damaged.
Abnormalities of the lower esophageal sphincter (LES), a muscle at the bottom of the esophagus, cause GERD. Other causes include hiatal hernias and other pressures on the stomach, such as pregnancy and being overweight. A hiatal hernia is the bulging of the upper part of the stomach into the chest through an enlarged opening in the diaphragm (the sheet of muscle separating the bottom of the ribcage from the abdomen).
The most common symptom is heartburn, a burning feeling in the middle of the chest. It sometimes spreads to the throat. An acid taste may occur. Heartburn affects about 10 million adults in the United States daily. Other symptoms include chronic cough, hoarseness, upset stomach, stomach bloating, and wheezing. More serious symptoms are bleeding, weight loss, and difficulty swallowing.
The health care provider relies on symptoms and the response to treatment for diagnosis. Life-threatening diseases, such as heart disease, that can cause symptoms similar to those of GERD must be ruled out. Specific tests are needed for an unclear diagnosis or more serious symptoms. These tests may include upper GI (gastrointestinal) x-ray series, endoscopy (using a scope to look at your esophagus and stomach directly), 24- hour esophageal pH study (measurement of acidity), and esophageal manometry (measures esophageal muscle pressure).
First options for mild reflux include eating smaller portions and changing the diet. Certain foods, such as tomatoes and fatty foods, and medicines, such as aspirin, can make symptoms worse. Over-the-counter drugs, including antacids and acidblocking medicines called H2-blockers, may help. Antacids neutralize stomach acid. H2-blockers (e.g., ranitidine or famotidine) prevent or block production of stomach acid. These drugs can be taken before eating to prevent heartburn. Omeprazole is another over-the-counter drug now available, which blocks the action of stomach cells responsible for making acid. It is generally more effective than antacids and H2- blockers.
People with severe or frequent symptoms may need prescription drugs. In resistant cases, your health care provider may refer you to a surgeon to perform an operation called fundoplication to strengthen the LES.
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