Acid reflux in adults

1/17/2019

What is GER?

Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus.

Stomach acid that touches the lining of your esophagus can cause heartburn, also called acid indigestion.

Does GER have another name?

Doctors also refer to GER as:
  • acid indigestion
  • acid reflux
  • acid regurgitation
  • heartburn
  • reflux

What is GERD?

Having GER once in a while is common. Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER.

What is the difference between GER and GERD?

GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time. If you think you have GERD, you should see your doctor.

How common is GERD?

GERD affects about 20 percent of the U.S. population.

Anyone can develop GERD, some for unknown reasons. You are more likely to have GERD if you are:
  • overweight or obese
  • a pregnant woman
  • taking certain medicines
  • a smoker or regularly exposed to secondhand smoke

What are the complications of GERD?

Without treatment, GERD can sometimes cause serious complications over time, such as:

Esophagitis

Esophagitis is inflammation in the esophagus. Adults who have chronic esophagitis over many years are more likely to develop precancerous changes in the esophagus.

Esophageal stricture

An esophageal stricture happens when your esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

Respiratory problems

With GERD you might breathe stomach acid into your lungs. The stomach acid can then irritate your throat and lungs, causing respiratory problems, such as:
  • asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
  • chest congestion, or extra fluid in your lungs
  • a dry, long-lasting cough or a sore throat
  • hoarseness—the partial loss of your voice
  • laryngitis—the swelling of your voice box that can lead to a short-term loss of your voice
  • pneumonia—an infection in one or both of your lungs—that keeps coming back
  • wheezing—a high-pitched whistling sound when you breathe

Barrett’s esophagus

GERD can sometimes cause Barrett’s esophagus. A small number of people with Barrett’s esophagus develop a rare yet often deadly type of cancer of the esophagus.

If you have GERD, talk with your doctor about how to prevent or treat long-term problems.

Symptoms & Causes

If you have gastroesophageal reflux (GER), you may taste food or stomach acid in the back of your mouth.

The most common symptom of gastroesophageal reflux disease (GERD) is regular heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, and in the middle of your abdomen. Not all adults with GERD have heartburn.

Other common GERD symptoms include"
  • bad breath
  • nausea
  • pain in your chest or the upper part of your abdomen
  • problems swallowing or painful swallowing
  • respiratory problems
  • vomiting
  • the wearing away of your teeth
Some symptoms of GERD come from its complications, including those that affect your lungs.

What causes GER and GERD?

GER and GERD happen when your lower esophageal sphincter becomes weak or relaxes when it shouldn’t, causing stomach contents to rise up into the esophagus. The lower esophageal sphincter becomes weak or relaxes due to certain things, such as:
  • increased pressure on your abdomen from being overweight, obese, or pregnant
  • certain medicines, including
    • those that doctors use to treat asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
    • calcium channel blockers—medicines that treat high blood pressure
    • antihistamines—medicines that treat allergy symptoms
    • painkillers
    • sedatives—medicines that help put you to sleep
    • antidepressants—medicines that treat depression
  • smoking, or inhaling secondhand smoke
A hiatal hernia can also cause GERD. Hiatal hernia is a condition in which the opening in your diaphragm lets the upper part of the stomach move up into your chest, which lowers the pressure in the esophageal sphincter.

When should I seek a doctor’s help?

You should see a doctor if you have persistent GER symptoms that do not get better with over-the-counter medications or change in your diet.

Call a doctor right away if you:
  • vomit large amounts
  • have regular projectile, or forceful, vomiting
  • vomit fluid that is
  • green or yellow
  • looks like coffee grounds
  • contains blood
  • have problems breathing after vomiting
  • have pain in the mouth or throat when you eat
  • have problems swallowing or painful swallowing

Diagnosis

In most cases, your doctor diagnoses gastroesophageal reflux (GER) by reviewing your symptoms and medical history. If your symptoms don’t improve with lifestyle changes and medications, you may need testing.

If your GER symptoms don’t improve, if they come back frequently, or if you have trouble swallowing, your doctor may recommend testing you for gastroesophageal reflux disease (GERD).

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Several tests can help a doctor diagnose GERD. Your doctor may order more than one test to make a diagnosis.

Upper gastrointestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside your upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. You will be given a liquid anesthetic to gargle or spray anesthetic on the back of your throat. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if you have moderate to severe symptoms.

Upper GI series

An upper GI series looks at the shape of your upper GI tract. An x-ray technician performs this procedure at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. You don’t need anesthesia. A health care professional will tell you how to prepare for the procedure, including when to stop eating and drinking.

During the procedure, you will stand or sit in front of an x-ray machine and drink barium to coat the inner lining of your upper GI tract. The x-ray technician takes several x-rays as the barium moves through your GI tract. The upper GI series can’t show GERD in your esophagus; rather, the barium shows up on the x-ray and can find problems related to GERD, such as:
  • hiatal hernias
  • esophageal strictures
  • ulcers
You may have bloating and nausea for a short time after the procedure. For several days afterward, you may have white or light-colored stools from the barium. A health care professional will give you instructions about eating, drinking, and taking your medicines after the procedure.

How do you control GER and GERD?

You may be able to control gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by:
  • not eating or drinking items that may cause GER, such as greasy or spicy foods and alcoholic drinks
  • not overeating
  • not eating 2 to 3 hours before bedtime
  • losing weight if you’re overweight or obese
  • quitting smoking and avoiding secondhand smoke
  • taking over-the-counter medicines, such as Maalox, or Rolaids

How do doctors treat GERD?

Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medicines, surgery, or a combination.

Lifestyle changes

Making lifestyle changes can reduce your GER and GERD symptoms. You should
lose weight, if needed.

You should also:
  • wear loose-fitting clothing around your abdomen. Tight clothing can squeeze your stomach area and push acid up into your esophagus.
  • stay upright for 3 hours after meals. Avoid reclining and slouching when sitting.
  • sleep on a slight angle. Raise the head of your bed 6 to 8 inches by safely putting blocks under the bedposts. Just using extra pillows will not help.
  • quit smoking and avoid secondhand smoke.

Over-the-counter and prescription medicines

You can buy many GERD medicines without a prescription. However, if you have symptoms that will not go away, you should see your doctor.

All GERD medicines work in different ways. You may need a combination of GERD medicines to control your symptoms.

Antacids

Doctors often first recommend antacids to relieve heartburn and other mild GER and GERD symptoms. Antacids include over-the-counter medicines such as
  • Maalox
  • Mylanta
  • Riopan
  • Rolaids
Antacids can have side effects, including diarrhea and constipation.

H2 blockers

H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GER and GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. You can buy H2 blockers over-the-counter or your doctor can prescribe one. Types of H2 blockers include:
  • cimetidine (Tagamet HB)
  • famotidine (Pepcid AC)
  • nizatidine (Axid AR)
  • ranitidine (Zantac 75)
If you get heartburn after eating, your doctor may recommend that you take an antacid and an H2 blocker. The antacid neutralizes stomach acid, and the H2 blocker stops your stomach from creating acid. By the time the antacid stops working, the H2 blocker has stopped the acid.

Proton pump inhibitors (PPIs)

PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers. They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.

However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. You need to take these medicines on an empty stomach so that your stomach acid can make them work.

Several types of PPIs are available by a doctor’s prescription, including
  • esomeprazole (Nexium)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec, Zegerid)
  • pantoprazole (Protonix)
  • rabeprazole (AcipHex)
Talk with your doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter.

Prokinetics

Prokinetics help your stomach empty faster. Prescription prokinetics include
  • bethanechol (Urecholine)
  • metoclopramide (Reglan)
Both of these medicines have side effects, including
  • nausea
  • diarrhea
  • fatigue, or feeling tired
  • depression
  • anxiety
  • delayed or abnormal physical movement
Prokinetics can cause problems if you mix them with other medicines, so tell your doctor about all the medicines you’re taking.

Antibiotics

Antibiotics, including erythromycin, can help your stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

Surgical options

Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes or medicines. You’re more likely to develop complications from surgery than from medicines.

Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.

A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of your stomach around your esophagus to add pressure to the lower end of your esophagus and reduce reflux. The surgeon performs the operation at a hospital. You receive general anesthesia and can leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks.

Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten your sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten your sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and you receive general anesthesia.

The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques often.

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