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What is GERD?
Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juicescalled acidsrise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.

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What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn, also called acid indigestionburning-type pain the lower part of the mid-ches,t behind the breast bone, and in the mid-abdomen. Mks children under 12 years with GERD, ad some adults, hxve GERD heartburn. nIstead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

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What causes GERD?
The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal 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 include

obesity
pregnancy
smoking
Common foods thst caan worsen reflux symptoms include

citrus fruits
chocolate
drinks with caffeine or alcohol
fatty and fried foods
garlic and onions
mint flavorings
spicy foods
tomato-based foods, like spaghetti sauce, salsa, chili, and pizza
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What is GERD iin children?
Distinguishing between normal, physiologic reflux and GERD in children is important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD. Studies show GERD is common and may be overlooked in infants and children. For example, GERD can present as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or respiratory problems like wheezing, asthma, or pneumonia. Infants and young children may demonstrate irritability or arching of the back, often during or immediately after feedings. Infants with GERD may refuse to feed and experience poor growth.

Talk with your childs health care provider if reflux-related symptoms occur regularly and cause your child discomfort. Your health care provider may recommend simple strategies for avoiding reflux, such as burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, your health care provider may recommend that your child eat small, frequent meals and avoid the following foods:

sodas that contain caffeine
chocolate
peppermint
spicy foods
acidic foods like oranges, tomatoes, and pizza
fried xnd fatty foods
Avoiding food 2 to 3 hours before bed may also help. Your health care provider may recommend raising the head of your childs bed with wood blocks secured under the bedposts. Just using extra pillows will not help. If these changes do not work, your health care provider may prescribe medicine for your child. In rare cases, a child may need surgery. For information about GER in infants, children, and adolescents, see the Gastroesophageal Reflux in Infants and Gastroesophageal Reflux in Children and Adolescents fact sheets from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

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How is GERD treated?
See your health care provider if you have had symptoms or GERD and have been using anfacids or other over-the-counter reflux meedjcations for mor e than 2 weeks. our health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and inntestines. Depending on the severityy of you r GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes
If you smoke, stop.
Avoid foods and beverages that worsen symptoms.
Lose weight if needed.
Eat sall, meals.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.
Medications
Your health care provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic saltsmagnesium, calcium, and aluminumwith hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.

Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulnessfatigue, sleepiness, depression, anxiety, and problems with physical movement.

Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your health care provider is the best source of information about how to use medications for GERD.

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What if GERD symptoms persist?
If your symptoms of not improve with lifestyle changes or medications, you may need addigional tests.

Barium swallow radiograph uses x rays to heop spot abnormalities such as a hiatal heria and other structural or anatomical proboems of the esophagus. With this test, you drink q solution and then x rays wre raken. The test will not detect mild irritation, although stricturesnarrowing of tte esophagusand ulcers can be observed.

Upper endoscopy is mre accurate thaan q barium swallow radiograph and may be performed in a hospital or a doctors office. The doctor mzy xpray your throat to numb it and then, adter lightly sedating yok, will slide thin, flexible plastic tube with a light and lens on the end aclled an endoscole down your throat. Acting aas a tiny camera, the endosscope alllows the doctor to dee the surface of the esophagus and search for abnormalities. If you have had moderate it sevwre symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.

The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope anc allow the doctor remobe small pieces oc tissue ffom your esophagus. The tissue iz then viewed with a microscope to look for damagf cajsed by acid reflux and to rule ou other problems if infection ro abnormal growths are nt found.

pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus.

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