Gastroesophageal Reflux Disease (GERD)

What Is Gastroesophageal Reflux (GER)?

Gastroesophageal reflux (GER), also called reflux, is when food and acid from the stomach go back up into the esophagus. This causes an uncomfortable feeling in the chest, often called heartburn.

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 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.

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
• peppermint
• 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:

• Upper GI radiology study. This special X-ray can show liquid backing into the esophagus, irritation or narrowing of the esophagus, and any upper digestive tract problems. For the test, you'll swallow a small amount of a chalky liquid (barium). This liquid appears on the X-ray and shows the swallowing process.
• Gastric emptying scan (milk scan). This 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.
• Upper endoscopy (pronounced: en-DAS-ko-pee). Doctors look at the esophagus, stomach, and part of the small intestines using a tiny fiber-optic camera. They also may take a small tissue sample (a biopsy) of the lining of the esophagus to rule out or find other problems. Most patients are given anesthesia and are "asleep" when this procedure is done.
  
• 24-hour impedance-ph probe study. This is the most accurate way to detect reflux and how often it’s happening. A thin, flexible tube goes through the nose into the esophagus. The tip rests just above the esophageal sphincter for 24 hours to check acid levels in the esophagus and to detect any reflux.

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.

These 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.

If symptoms continue, doctors might prescribe medicine, such as:

• H₂ blockers, which can help block the production of stomach acid
• proton pump inhibitors, which reduce the amount of acid the stomach makes
• prokinetics, which help the esophageal sphincter work better and the stomach empty faster. This can prevent reflux episodes.

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 rarely needed in healthy teens. If it is, 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.

What Else Should I Know?

Early diagnosis and treatment can help reduce or even stop uncomfortable GERD symptoms. Untreated GERD can cause permanent damage to the esophagus.

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 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.