Gastroesophageal Reflux Disorder

Excess weight puts extra pressure on your stomach and diaphragm, the large muscle that separates your chest and abdomen, forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.

In this condition, also called diaphragmatic hernia, part of your stomach protrudes into your lower chest. If the protrusion is large, a hiatal hernia can worsen heartburn by further weakening the lower esophageal sphincter muscle.

Pregnancy results in greater pressure on the stomach and higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.

Doctors aren’t certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering the regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of digestive juices from your esophagus and pharynx, damaging lung airways.

One of the many complications of diabetes is gastroparesis, an uncommon disorder in which your stomach takes too long to empty. Left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.

An open sore or scar near the valve (pylorus) in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food. Food doesn’t empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus.

In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay the emptying of your stomach, causing acid back up into the esophagus.

Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.

One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.

This procedure requires you to drink a chalky liquid that coats and fills the hollows of your digestive tract. The coating allows your doctor to get a clear silhouette of the shape and condition of your esophagus, stomach, and upper intestine (duodenum). X-rays can then reveal whether a hiatal hernia may be contributing to your heartburn. They can also reveal an esophageal narrowing or stricture, or growth, which may cause difficulty swallowing.

This test measures acid levels in your upper and lower esophagus and can help determine the frequency and duration of acid reflux. While you’re sitting, a nurse or technician sprays your throat with a numbing medication. Then a thin, flexible tube (catheter) is threaded through your nose into your esophagus. This probe is positioned just above the lower esophageal sphincter. A second probe may be placed in your upper esophagus. Attached to the other end of the catheter is a small computer, which you wear around your waist and which records acid measurements. Once the device is attached, you go about your business and then come back the next day to have the device removed. Knowing the frequency and duration of acid reflux can help your doctor determine how best to treat the condition.

A more direct test for diagnosing the cause of heartburn is esophagogastroduodenoscopy (EGD). In this test, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to see if you have an ulcerated or inflamed esophagus or stomach (esophagitis or gastritis, respectively). It can also reveal a peptic ulcer. During an EGD your doctor can take tissue samples to test for Barrett’s esophagus a condition in which precancerous changes occur in cells in your esophagus or esophageal cancer, two potential complications of severe heartburn. Analysis of these samples may also reveal the presence of a bacterium that may cause peptic ulcers.

Stomach acid can severely erode tissues in the esophagus, causing an open sore. The esophageal ulcer may bleed, cause pain and make swallowing difficult.

Strictures occur in some people with GERD. Damage to cells in the lower esophagus from acid exposure leads to the formation of scar tissue. The scar tissue narrows the food pathway, causing large chunks of food to get caught up in the narrowing, and can interfere with swallowing.

This is a serious, though uncommon, a complication of GERD. In Barrett’s esophagus, the color, and composition of the tissue lining the lower esophagus change. Instead of pink, the tissue turns a salmon color. Under a microscope, the tissue resembles that of the small intestine. This cellular change is called metaplasia. Metaplasia is brought on by repeated and long-term exposure to stomach acid and is associated with an increased risk of esophageal cancer.

Antacids, such as Maalox, Mylanta, Gelusil, Rolaids, and Tums, neutralize stomach acid and can provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea or constipation.

H-2-receptor blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), or ranitidine (Zantac 75), are available at half the strength of their prescription versions. Instead of neutralizing the acid, these medications reduce the production of acid. They don’t act as quickly as antacids, but they provide longer relief. Take these medications before a meal that you think may cause heartburn because it takes them about 30 minutes to work. They’re also effective in reducing reflux at night if taken at bedtime. H-2-receptor blockers cause infrequent side effects, including bowel changes, dry mouth, dizziness, or drowsiness. In rare instances, they can also react dangerously with other medications.

These medications block acid production and allow time for damaged esophageal tissue to heal. Omeprazole (Prilosec) was previously available only by prescription but now is available in an over-the-counter form for the treatment of heartburn.

These significantly reduce acid production and have few side effects. They include prescription-strength Axid, Pepcid, Tagamet, and Zantac.

These are long-acting and are the most effective medications for suppressing acid production. They’re safe and have few side effects for long-term treatment (at least 10 years). To prevent possible side effects, such as stomach or abdominal pain, diarrhea, or headaches, your doctor will likely prescribe the lowest effective dose. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex).

These don’t reduce acid production. Instead, they help your stomach empty more rapidly and may help tighten the valve between the stomach and the esophagus. Because the prokinetic agents thus far sometimes cause serious side effects, researchers are working to develop safer versions.

This procedure uses a tool that’s like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers (plications) to prevent stomach acid from washing into your esophagus. The barriers are located at and just below the junction of the esophagus and stomach. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.

This approach uses controlled radiofrequency energy to heat and melt (coagulate) tissues within the portion of the esophagus that contains the malfunctioning valve and at the junction of the esophagus and upper stomach. The procedure appears to work by creating scar tissue and altering the sensory nerves that respond to refluxed acid. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.

This procedure involves the injection of a compound called ethylene polyvinyl alcohol into the lower esophageal sphincter, just within the stomach. The injection is done with guidance from real-time X-ray. The compound is in liquid form outside the body, but when it comes into contact with the tissues inside the body, it turns into an expanding, spongy material. The procedure may cause a sore throat or chest pain, and the long-term effectiveness of the procedure is still unknown.

Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

Three smaller meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.

Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine, and nicotine may make heartburn worse.

Tying your shoes is OK. Bending over for longer periods to weed your garden isn’t, especially soon after eating.

Wait at least three to four hours after eating before going to bed, and don’t lie down right after eating.

An elevation of about 6 inches puts gravity to work for you. You can do this by placing wooden or cement blocks under the feet at the head of your bed. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head only by using pillows is not a good alternative.

Smoking may increase stomach acid. The swallowing of air during smoking may also aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.