Gastroesophageal reflux disease (GERD) is caused by the backup of stomach acid into the esophagus. Normally, when you swallow food or liquid it travels down the esophagus and the lower esophageal sphincter, a band of muscle around the bottom of the esophagus, relaxes to allow the food or liquid to continue on into your stomach. When the lower esophageal sphincter weakens or begins relaxing abnormally, stomach acid can begin moving back into your esophagus. This causes heartburn. Over time, the lining of your esophagus will become inflamed and can wear away, causing bleeding, narrowing or even a precancerous condition.
Those with GERD will experience a burning sensation in their chest (commonly known as heartburn), difficultly swallowing, chest pain, regurgitation of food or bile and hoarseness. If you are taking over-the-counter heartburn medication more the twice a week or are experiencing chest pain, consult a doctor.
Your doctor will review your medical history and complete a physical exam. GERD is usually able to be diagnosed with only a description of your symptoms. An endoscopy may be performed in order for your doctor to get a better look at your esophagus. An endoscope, a flexible tube with a light and a camera, is threaded down your throat into the esophagus.
If your doctor thinks it is helpful, they may order a test to monitor the amount of acid in your esophagus. An ambulatory acid (pH) probe test measures the amount of acid in your esophagus over a 24-hour period. One variety of this test uses a thin plastic tube that is threaded through your nose into your esophagus and connects to a portable computer worn around the waist. Another version uses a clip that is inserted in your esophagus during an endoscopy. The probe stays in your system for two days and then falls out and is passed on its own.
An x-ray of your upper digestive system (also known as a barium swallow) helps your doctor see an outline of your whole digestive system. You will be asked to drink a chalky liquid which will coat the lining of your upper digestive track. This liquid is what stands out on the x-ray.
Over-the-counter antacids are the initial treatment for GERD. They will only provide fast-acting, temporary relief of the symptoms, but will not treat the inflamed esophagus. Next, medications that aim to reduce acid production should be used. They provide longer-lasting relief. The final over-the-counter medication to try is proton pump inhibitors, which block stomach acid production and heal the esophagus.
If the over-the-counter medications do not provide you with relief from your symptoms, the prescription strength may. If you are one of the few individuals who continues to experience symptoms, surgery may be needed. Nissen fundoplication is a surgical procedure that tightens the lower esophageal sphincter to prevent stomach acid from traveling back up. A new version of this procedure, called Linx, involves magnets that are strong enough to prevent acid backwash but weak enough to allow food to pass through.