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Getting a Grasp on Gastroesophageal Reflux Disease (GERD)

Your friends have invited you to go to the hottest new restaurant in town — and you couldn’t be less excited. It’s not that you don’t love your friends, but you just don’t want to go out to eat.

If you have acid reflux — or it’s more severe form, called gastroesophageal reflux disease (GERD) — you might be all too familiar with this feeling. You may be afraid to dine out because you don’t know when the pain, nausea, or burning feeling in your chest will strike. In fact, you often avoid going to any social events that involve food. And you may also feel as if no one in your friend circle knows what it’s like to live with the pain.

However, you’re not alone. About 60 million Americans suffer from GERD.

Here’s what you should know about its causes and symptoms — and Stormont Vail Health’s approach to treating it.

Acid Reflux, Heartburn, and More — What Exactly Is GERD?

When you swallow food, it travels down to your stomach by passing through your feeding tube, the esophagus. At the end of your esophagus is a muscle valve called the lower esophageal sphincter, which can open and close to keep food and fluids in the stomach without flowing back to the esophagus.

But if this muscle doesn’t close properly, food and stomach fluids can flow back into your esophagus. This is called acid reflux, or gastroesophageal reflux (GER). You may taste the digested food and stomach acid in the back of your mouth.

The stomach acid is important for digestion because it helps your body break down food. When it stays inside the stomach, it’s generally harmless — there is a thick coating of mucus that keeps the acid from breaking down your stomach lining tissue. However, acid can cause harm if it reaches tissue outside of the stomach, where there isn’t the strong protective coating of mucus.

With acid reflux, the acid goes into the esophagus, where the lining isn’t as strong as it is in the stomach. This “burns” the esophagus, which is why heartburn — the burning sensation you may feel in your chest or throat — is a symptom of acid reflux.

Most adults experience acid reflux once in a while. But if you experience it more than twice a week, or if you have moderate or severe acid reflux at least once a week, you may have a more serious digestive disorder called gastroesophageal reflux disease (GERD).

What Are the Common Symptoms of Complications GERD?

Common symptoms of GERD include:

  • Nausea
  • Heartburn, usually after eating
  • Difficulty swallowing
  • Vomiting

GERD can also cause other digestive issues and health problems, such as:

  • Inflammation (swelling) of the esophagus: Chronic inflammation can cause esophagus tissues to change to a type similar to intestine tissues and increase the risk of esophageal cancer.
  • Narrowing of the esophagus: This can cause difficulty with swallowing
  • Barrett’s esophagus: Long-lasting GERD damages the tissue in the lining of the esophagus. When the tissue tries to repair itself, the new tissue may evolve into a type that is similar to your intestinal lining — which can increase your risk of developing a type of esophageal cancer called adenocarcinoma.

Respiratory Problems Caused by GERD

When stomach acids reflux back up, you may breathe them into your lungs, which can irritate your throat and lungs. This can cause you to:

  • Temporarily lose your voice
  • Develop asthma
  • Have a long-lasting cough
  • Develop pneumonia

Sleep Problems Caused by GERD

Sometimes GERD happens at night — and oftentimes, the severity of symptoms is worse when you are sleeping. You could wake up coughing, choking, or having heartburn. Many people with GERD also tend to have sleep issues, such as insomnia or daytime sleepiness from not getting enough sleep at night.

Who’s at Risk for GERD?

    Common Causes of GERD

  1. Overweight: Excess fat in the abdomen (belly) can squeeze your stomach and make food and fluids in the stomach press harder on your esophageal sphincter. This increases the chances of acid rising back up into the esophagus.
  2. Pregnancy: As your baby grows inside you, they may squeeze your stomach and cause stomach acid to rise and flow back up into the esophagus.
  3. Medications: Includes asthma medicine, painkillers, and antidepressants. These drugs can relax the esophageal sphincter and cause reflux.
  4. Smoking: This can relax the esophageal sphincter and cause reflux.
  5. Hiatal hernia: This is a condition where the top part of stomach pushes up into the chest. When this happens, it increases pressure on the stomach and causes acid to rise up and leak back into the esophagus.

You can lower your risk for GERD if you:

  • Maintain a healthy weight
  • Don’t lie down for 3 hours after eating
  • Avoid eating too much food that can cause acid reflux, such as coffee and fatty foods
  • Quit smoking
  • Reduce the size of your food portions

While some over-the-counter medications — such as acid reducers — can relieve some of the symptoms of GERD, if your symptoms last longer than 4 weeks and do not improve, it’s time to see a health care provider.

You should seek medical treatment immediately if:

  • You are vomiting more than twice a week and in large amounts
  • You are short of breath after vomiting
  • The color of your vomit is yellow, green, dark, or bloody
  • You have problems swallowing

How Is GERD Diagnosed?

At your first appointment, a digestive health specialist (gastroenterologist) will examine your symptoms and go over your medical history. They may ask you if you have been taking over-the-counter medications, if you are taking medications for other conditions, and if your lifestyle (diet, etc.) seems to worsen symptoms.

Your gastroenterologist may also recommend you undergo testing to receive an accurate diagnosis. These tests may include:

  • Upper endoscopy: Your provider will insert a thin tube with a camera attached down your esophagus to examine the inside of your esophagus and stomach. They will look for inflammation or complications, such as Barrett’s esophagus.
  • X-ray of the stomach and esophagus: X-ray images can check the shape of your stomach and esophagus, and can help detect hiatal hernias, a narrowed esophagus, and ulcers (sores in your esophagus, stomach, or small intestine caused by tissue damage from stomach acid). You may need to drink barium — a liquid that coats the lining of your esophagus, stomach, and upper intestine. Barium can reveal more details of the lining than a normal X-ray and can make the images easier for the provider to see.
  • Esophageal pH and impedance monitoring: This is the most accurate test to diagnose acid reflux. A gastroenterologist will place a thin tube in your esophagus through your nose to measure the amount of acid reflux while you are eating and sleeping. The other end of the tube is connected to a monitor to record results. You may need to wear the monitor for 24 hours before returning to the hospital to have it removed.
  • Esophageal manometry: A gastroenterologist will place a thin tube through your nose into your esophagus to check muscle contraction –– your muscle’s ability to generate tension –– in different parts of your esophagus. This test can help your provider check if your lower esophageal sphincter is working properly.

For all of these tests, you may need to fast for up to 8 hours before the procedure. Your doctor will give you specific instructions on when the fast should start.

How Is GERD Treated?

GERD isn’t a life-threatening disease, but leaving acid reflux untreated can cause bigger problems in the long run. It can cause complications such as inflammation in the esophagus or lungs, esophagus ulcers, and narrowing of the esophagus.

Fortunately, there are many easy to manage treatment options for you and your provider to consider.

Over-the-Counter Medications

Talk to your health care provider before adding or changing any medications in your routine — including over-the-counter medications — to ensure that they do not interact with one another or with any other medications you may be taking.

  • Antacids

    Antacids can relieve heartburn by reducing the acidity of stomach acid, which is the cause of burning sensation. It won’t stop acid reflux but when the reflux happens, you won’t feel the sour, hot, burning fluid in your throat and chest. Antacids come in liquid form and in tablets.

    Common antacids include Maalox, Mylanta, and Tums. If you’d prefer to purchase a generic brand antacid, look for the common ingredients found in antacids, which include:

    • Sodium bicarbonate
    • Aluminum hydroxide
    • Magnesium carbonate
    • Magnesium hydroxide

    All of these antacids work to reduce the acid strength in your stomach. However, they can only work on existing acid — they can’t prevent heartburn in the future. When new stomach acid is produced, the heartburn may come back.

    Side effects of antacids include:

    • Nausea
    • Constipation
    • Diarrhea
    • Headache
  • H-2 Blockers

    H-2 blockers decrease acid production in your stomach. They can also help heal your esophagus. If you get heartburn after eating, your provider may recommend you take antacids together with H-2 blockers.

    Common over-the-counter H-2 blockers include:

    • Cimetidine (Tagamet HB)
    • Famotidine (Pepcid AC)
    • Nizatidine (Axid AR)
    • Ranitidine (Zantac 75)

    Side effects of H-2 blockers include:

    • Headache
    • Diarrhea
    • Dizziness
    • Rashes
  • Proton Pump Inhibitors (PPIs)

    These medications are used to treat frequent heartburn by reducing the amount of acid in the stomach.

    Common over-the-counter PPIs include:

    • lansoprazole
    • Esomeprazole
    • Omeprazole magnesium
    • Omeprazole and sodium bicarbonate

    Side effects of PPIs are rare, but can include:

    • Headache
    • Diarrhea
    • Constipation
    • Nausea
    • Itching

    Make sure to talk to your provider before using PPIs if you’re also taking blood thinners or antiseizure medications, as PPIs can change how those drugs work.

Prescription Medications

If over-the-counter medications don’t work, your provider may prescribe stronger medications to combine with your antacids. Here are some common prescriptions for GERD.

  • Prescription-Strength H-2 Blockers

    These medications are stronger than over-the-counter H-2 blockers.

    Common prescription H-2 blockers include:

    • Cimetidine (Tagamet HB)
    • Famotidine (Pepcid AC)
    • Nizatidine (Axid AR)
    • Ranitidine (Zantac 75)

    Side effects of H-2 blockers include:

    • Headache
    • Diarrhea
    • Dizziness
    • Rashes

    H-2 blockers are generally safe to use, but if you take them long-term, you could be at higher risk for vitamin B12 deficiency and bone fractures.

  • Prescription-Strength Proton Pump Inhibitors (PPIs)

    Prescription PPIs are stronger than over-the-counter versions. These medications are similar to H-2 blockers, but they treat GERD more effectively because PPIs can block several triggers for acid production while H-2 blockers blocks only one — histamine 2. In this sense, PPIs have a stronger prescription strength than H-2 blockers.

    Because proton pump inhibitors are a stronger acid reducer, they have the potential to cause side effects that should be discussed with your medical provider.

    Common prescription proton pump inhibitors include:

    • Esomeprazole (Nexium)
    • lansoprazole (Prevacid)
    • Omeprazole (Prilosec, Zegerid)
    • Pantoprazole (Protonix)
    • Rabeprazole (AcipHex)

    Although not very common, side effects include:

    • Diarrhea
    • Headache
    • Nausea
  • Prokinetics

    Prokinetics can help speed up digestion by increasing stomach muscle contractions.

    If you are taking other medications, let your provider know. Prokinetics can interact with many other medications and cause dangerous side effects.

    Common prokinetics include:

    • Bethanechol (Urecholine)
    • Metoclopramide (Reglan)

    Side effects of prokinetics include:

    • Nausea
    • Diarrhea
    • Fatigue

Lifestyle Changes

Whether or not you’re taking medication, your provider can help you adopt a healthy lifestyle to keep symptoms under control. For example, they may recommend that you:

  • Avoid tight clothes that put pressure on your stomach area.
  • Sit or stand upright for 3 hours after meals, and not eat 2 to 3 hours before going to bed. The food in your stomach can press harder on the esophageal sphincter when you are lying down, causing reflux.
  • Quit smoking, as smoking can relax the esophageal sphincter and cause reflux.

You may also want to try giving up foods that trigger heartburn, such as:

  • Coffee
  • Citrus fruits and juices
  • Tomatoes
  • Chocolate
  • Soda or fizzy drinks
  • Peppermint
  • Garlic
  • Onions
  • Fatty, spicy, or fried foods

Also, keep track of when the acid reflux happens, the specific symptoms, how long the symptoms last, and which foods you ate before having reflux. This information can help your provider adjust any prescriptions or treatment plans.

Surgery

Your provider will likely try to control your symptoms with medications as the first line of defense against GERD. But if these treatments stop working or you have been taking them for years — which increases your risks for conditions such as bone fracture and pneumonia — your gastroenterologist may refer you to a surgeon to talk about surgical treatment options. For example, you may need to have the lower esophageal sphincter reinforced by wrapping the upper stomach around the lower esophagus.

Why Choose Stormont Vail

Located in Topeka, Kansas, Stormont Vail Health is a community-driven organization. It offers close to home care and with limited travel requirements, it will be easier for you to get the care you need in a community you trust.

In 2018, Stormont Vail achieved Magnet designation for a third time. Magnet designation is one of the highest awards in nursing excellence and high-quality patient care. Only 9% of US hospitals have earned this recognition. The Joint Commission — with more than 50 years of accrediting hospitals in high-quality standards — has also accredited Stormont Vail Hospital.

The Cotton O’Neil Digestive Health Center has a dedicated Endoscopy Center for procedures like upper endoscopy. You can meet with providers, be tested in our Endoscopy Center, and learn how to manage digestive health conditions – all under one roof.

We are committed to treating the entire person, not just the condition. Your digestive health team and primary care provider will work closely with one another to make sure you have a seamless care experience.


Next Steps

Make an Appointment

  • To make an appointment at the Digestive Health Center, call (785) 270-4800.

See a Primary Care Provider

  • Call (785) 270-4440 to schedule an appointment with your Stormont Vail primary care provider.
  • Not a Stormont Vail patient? Call (785) 270-4440 to set up your first appointment with one of our primary care providers.