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GERD (Heartburn)

GERD (Heartburn)

Overview of GERD (Heartburn)
Symptoms of GERD
Causes of GERD
GERD in children
Long-term complications of GERD
Key points to remember
Treatment

Overview of GERD (Heartburn)

Gastroesophageal reflux (GER) is a common condition also known as acid reflux or acid regurgitation, namely because digestive juices – called acids – rise up with the food. Gastroesophageal reflux disease (GERD) is a more serious form of GER. The lower esophageal sphincter (LES) is a ring of muscle at the bottom of the esophagus, the tube that carries food from the mouth to the stomach. The LES acts as a valve between the esophagus and stomach. GER occurs when the LES either opens spontaneously, for varying periods of time, or does not close properly, thus allowing stomach contents to rise up into the esophagus.

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid rises and touches the lining of the esophagus, one may feel a burning sensation in the chest or throat, commonly referred to as heartburn or acid indigestion. Occasional GER is common and does not necessarily mean that one has GERD. However, persistent reflux that occurs more than twice per week is considered GERD, and can eventually lead to more serious health problems. GERD can occur in individuals of all ages.

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Symptoms of GERD

The main symptom of GERD in adults is frequent heartburn, also known as acid indigestion. This is generally described as a burning-type pain in the lower part of the mid-chest behind the breastbone, and in the mid-abdomen. Most children younger than 12, as well as some adults, experience GERD without heartburn. For these individuals, symptoms may include difficulty swallowing, a dry cough, or asthma symptoms.

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Causes of GERD

The reason why certain individuals develop GERD is still unclear, but research shows that in patients 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 separating the stomach from the chest. When a hiatal hernia is present, acid reflux is able to occur more easily because the diaphragm cannot help the LES prevent acid from rising up into the esophagus. A hiatal hernia can occur in individuals of any age and is most often a normal finding in otherwise healthy adults over age 50. Most of the time, a hiatal hernia does not produce any symptoms.

Other factors that may contribute to GERD include:

  • Smoking
  • Obesity
  • Pregnancy

Common foods that can worsen reflux symptoms include:

  • Spicy foods
  • Tomato-based foods like salsa, pizza, spaghetti sauce, and chili
  • Garlic and onions
  • Fatty and fried foods
  • Chocolate
  • Drinks containing caffeine or alcohol
  • Mint flavorings
  • Citrus fruits

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GERD in children

It is important to distinguish between normal, physiologic reflux and GERD when dealing with children. Studies show that GERD is common and may be overlooked in infants and children. Most infants that have GER are happy and healthy even if they frequently spit up or vomit, and babies typically outgrow GER by the time they turn one year old. Reflux that continues to occur after the infant’s first birthday may be GERD. When overlooked, GERD can present as repeated regurgitation, laryngitis, coughing, nausea, heartburn, or respiratory problems such as asthma, wheezing, or pneumonia. Infants and young children may exhibit irritability or arch their back, often during or immediately after feedings. Infants with GERD may refuse to eat and experience poor growth.

If reflux-related symptoms occur regularly and cause your child discomfort, speak with your child's doctor. The doctor may recommend simple strategies for avoiding reflux. These strategies can include burping an infant several times during feeding, or keeping an infant in an upright position for 30 minutes after feeding. If your child is older, your doctor may recommend that your child eat small, frequent meals and avoid the following foods:

  • Spicy foods
  • Acidic foods like oranges, tomatoes, and pizza
  • Sodas that contain caffeine
  • Chocolate
  • Fried and fatty foods
  • Peppermint

Making sure that your child avoids food two to three hours before bed may also help. Your doctor may also recommend raising the head of your child's bed with wood blocks secured under the bedposts (just using extra pillows will not help). If these changes do not lead to sufficient improvement, your doctor 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 fact sheet and the gastroesophageal reflux in children and adolescents fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

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Long-term complications of GERD

When left untreated, chronic GERD can cause serious complications. Refluxed stomach acid can cause inflammation of the esophagus and can in turn damage the lining and cause bleeding or ulcers – also known as esophagitis. Scarring due to tissue damage can lead to strictures – narrowing of the esophagus – that make it difficult to swallow. Some people develop Barrett's esophagus, in which cells in the esophageal lining acquire an abnormal shape and color. These cells can eventually lead to esophageal cancer, which is often fatal. Individuals with GERD and its complications should be monitored closely by a physician.

Studies have shown that GERD may worsen or contribute to chronic cough, pulmonary fibrosis, and asthma in individuals.

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Key points to remember

  • Frequent heartburn, also referred to as acid indigestion, is the most common symptom of GERD in adults. Any individual experiencing heartburn two or more times a week may have GERD.
  • You can have GERD without experiencing heartburn. Other symptoms could include a dry cough, asthma symptoms, or difficulty swallowing.
  • If you have been using antacids for over two weeks, it is time to see your doctor. While most primary care physicians can treat GERD, your doctor may refer you to a gastroenterologist, a specialist who treats diseases of the stomach and intestines.
  • Lifestyle and dietary changes are typically recommended by doctors to relieve symptoms of GERD. Many individuals with GERD also require medication. Surgery may be considered as a treatment option.
  • Most infants that have GER are healthy even though they may frequently spit up or vomit. Most infants outgrow GER by the time they turn one year old. Reflux that continues to occur after the infant’s first birthday may be GERD.
  • The persistence of GER in addition to other symptoms – such as irritability and arching in infants, or chest and abdominal pain in older children – is GERD. GERD results from frequent and persistent GER in infants and children and may cause repeated regurgitation, coughing, and respiratory problems.

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Treatment

Find out more information about GERD Treatments.

To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].

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Sources:

National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) - NIH Publication No. 07–0882, May 2007

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