Gastroesophageal Reflux Disease (GERD)

What Is Gastroesophageal Reflux (GER)?

Gastroesophageal reflux (GER), also called acid reflux, is a common problem that causes heartburn. Many people have heartburn (or acid indigestion) regularly and it's not usually a cause for concern. This uncomfortable, burning pain in the lower chest area happens to many people after eating a big meal or spicy foods.

But with GER, reflux happens after nearly every meal and causes noticeable discomfort. After eating, people with GER feel a burning sensation in the chest, neck, and throat.

While it's more common in adults, kids, teens, and even babies can have gastroesophageal (gas-tro-ih-sah-fuh-JEE-ul) reflux.

What Is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease (GERD) is when someone has acid reflux more than twice a week. It's a more serious condition than GER. Doctors usually treat it with medicine.

GERD can be a problem if it's not treated because, over time, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. In adults, long-lasting, untreated GERD can lead to permanent damage of the esophagus and sometimes even cancer.

What Are the Signs & Symptoms of GERD?

Often, people who have GERD notice that they regularly have the pain of heartburn in the chest or stomach. This can last up to a couple of hours. Many notice their heartburn is worse after eating.

Regurgitation — when food and liquid containing stomach acid comes back up into the throat or mouth — is also a sign of GERD. But, like heartburn, occasional regurgitation is common for everyone.

Other symptoms of GERD include:

• a sore, raw throat or hoarse voice
• a frequent sour taste of acid, especially when lying down
• a feeling of burping acid into the mouth
• trouble swallowing
• a feeling that food is stuck in the throat
• a feeling of choking that may wake someone up
• a dry cough
• bad breath

What Causes GERD?

GERD happens when acidic stomach contents move backward into the esophagus. The esophagus is a tube that carries food and liquids from the mouth to the stomach. It is separated from the stomach by a small muscle (the esophageal sphincter). This muscle opens and lets food and liquid enter the stomach and closes to prevent the food and liquid from leaking back into the esophagus.

GER and GERD happen when the muscle relaxes at the wrong time or doesn't close as it should.

This can happen for different reasons:

• In some people, the muscle doesn't tighten properly.
• In others, it doesn't close quickly enough or at the right time, letting stomach contents wash back up.
• If a person eats way too much, the stomach may be so stretched the muscle can't work as it should.

No one knows for sure why people get GERD. Doctors do know that some things can make GERD worse, including obesity, drinking alcohol, and pregnancy.

Some foods and medicines can make GERD symptoms worse. In many people, these foods bring on symptoms:

• citrus fruits
• chocolate
• drinks or foods with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

How Is GERD Diagnosed?

Tell your parents and visit your doctor if you've had heartburn that doesn't seem to go away or any other symptoms of GERD for a while.

The doctor will do an exam and ask about your symptoms. If the doctor suspects GERD, you might go see a pediatric gastroenterologist. This is a doctor who treats kids and teens who have problems of the gastrointestinal system.

Doctors sometimes order these tests to diagnose GERD or rule out other possible problems:

• A special X-ray called a barium swallow radiograph can help doctors see whether liquid is refluxing into the esophagus. It can also show whether the esophagus is irritated or whether there are other abnormalities in the esophagus or the stomach that can make it easier for someone to reflux. With this test, the person drinks a special solution (barium, a kind of chalky liquid); this liquid then shows up on the X-rays.
• A gastric emptying scan can help show whether a person’s stomach is emptying too slowly, which can make reflux more likely to happen. This test is done either by drinking milk that has a tracer in it or eating scrambled eggs that have a tracer mixed in. A special machine that doesn’t use radiation can detect the tracer to see where it goes and how fast it empties the stomach.
• An upper endoscopy (pronounced: en-DAS-ko-pee) allows the doctor to look at the esophagus, stomach, and part of the small intestines using a tiny camera. For this test, the doctor may give the patient a medicine to help him or her relax, and may spray the throat to numb it. This makes the test more comfortable. Most patients are given anesthesia and are "asleep" when this procedure is done.
  
  The doctor then slides a thin, flexible plastic tube called an endoscope down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. During the endoscopy, the doctor also may use small tweezers (forceps) to remove a piece of tissue for biopsy. A biopsy can reveal damage caused by acid reflux or infection and help rule out other problems.
• In another kind of test, called a 24-hour impedance-probe study, the doctor puts a tiny tube through the nose and down into the esophagus until the tip is just above the opening to the stomach. The tube will stay there for 24 hours. The tube is connected to a device that monitors the acid levels in the esophagus as the person goes about normal daily activities. It also monitors how many acid and non-acid reflux episodes take place.
  
  This test is useful for diagnosing people who have symptoms of GERD but have no damage to the esophagus. It also can detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing.

How Is GERD Treated?

Treatment for GERD depends on how severe symptoms are. For some people, treatment may just include lifestyle changes, such as changing what they eat or drink. Others will need to take medicines. In very rare cases, when GERD is particularly severe, a doctor will recommend surgery.

The following lifestyle changes can help ease the symptoms of GERD or even prevent the condition:

• quitting smoking
• avoiding alcohol
• losing weight if you are overweight
• eating small meals
• wearing loose-fitting clothes
• avoiding carbonated beverages
• avoiding foods that trigger reflux

It also can help to not lie down for 3 hours after a meal and to not eat 2 to 3 hours before going to bed. Doctors sometimes also recommend raising the head of the bed about 6 to 8 inches. Before you start a major bedroom makeover, though, talk to your doctor and your parents about the best sleeping position for you.

A doctor may also recommend different medications to relieve symptoms. Over-the-counter antacids, such as Alka-Seltzer or Maalox, work by neutralizing stomach acid and can help with mild symptoms. Other medicines called H₂ blockers are available over the counter and by prescription and help by blocking the production of stomach acid. If your doctor thinks you should take these, he or she will recommend certain over-the-counter medications or write you a prescription.

More powerful prescription drugs called proton pump inhibitors also reduce the amount of acid the stomach produces. Some of these are also available over-the-counter. Doctors also prescribe these for people with more severe or persistent GERD.

Medications that belong to a class called prokinetics also can be used to help reduce the frequency of reflux by strengthening the lower esophageal sphincter muscle and also helping the stomach empty faster.

For some teens, doctors advise combining medicines to control different symptoms. For example, people who get heartburn after eating can try taking both antacids and H₂ blockers. The antacid goes to work first to neutralize the acid in the stomach, while the H₂ blocker acts on acid production. By the time the antacid stops working, the H₂ blocker will have stopped acid production.

Surgery is a last resort for people with GERD and is rarely needed in healthy teens. The typical surgical treatment for GERD is called fundoplication (pronounced: fun-doh-plih-KAY-shun). During the surgery, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent reflux. Fundoplication has been used in people of all ages, even babies with severe GERD.

Living With GERD

The key to living with GERD is to not ignore it. Early diagnosis and treatment can help reduce or even stop uncomfortable symptoms. Left untreated, however, GERD can cause permanent damage to the esophagus.

One possible long-term effect of GERD is something called Barrett's esophagus. In this condition, the cells in the esophagus change and become precancerous because they have been irritated by stomach acid for so long. Eventually, it may lead to cancer of the esophagus. Barrett's esophagus is mostly found in adults who have had GERD for many years. But you can help avoid it by dealing with your GERD now.

You'll probably find that one of the simplest ways to make living with GERD easier is to avoid the things that trigger your symptoms. Some people will have to limit certain foods; others may have to give them up entirely. It all depends on your individual symptoms.

It can be hard to give up sodas or favorite foods at first. But after a while, lots of people discover that they feel so much better that they don't miss the problem foods as much as they thought they would.