Gastroesophageal Reflux
Sutter Davis Hospital Gastroenterology

Definition
Gastroesophageal reflux disease is also called GERD. GERD occurs when the lower muscle of the esophagus does not close properly. The esophagus is the tube that carries food and liquid from the throat to the stomach. This makes the stomach acid and food in the stomach reflux (back up) into the esophagus. When the acid irritates and damages the esophagus, it may cause a burning feeling called heartburn.

Causes
The main cause of GERD is having a weak lower esophageal sphincter. The sphincter relaxes too often, causing stomach acid to back up into the esophagus. The following increases your risk of having GERD:

• Alcohol: Drinking too much alcohol may also cause GERD. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks. Talk to your caregiver if you drink alcohol.
• Diet: The following may also weaken the muscles of the esophagus: Foods and beverages, such as chocolate, peppermint, fried or fatty foods, and coffee, frequently eating large meals, and lying down after eating.
• Hiatal hernia: This occurs when a part of the stomach moves up into the chest through a small hole.
• Medicines: Medicines that may irritate the esophagus include aspirin and antibiotics.
• Obesity: Weighing more than what your caregiver suggests may put pressure on your stomach. This pressure causes stomach acid reflux and heartburn.
• Pregnancy: Being pregnant makes your stomach work more slowly due to changes in hormone levels. Your enlarged uterus (womb) may also crowd your stomach, pushing stomach acids upward.
• Smoking: This makes the sphincter relax more than usual.

Symptoms
Heartburn is the most common symptom of GERD. It is a feeling of burning pain in your chest or below the sternum (chest bone). This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have one or more of the following signs and symptoms:

• Bitter or acid taste in your mouth.
• Choking, coughing, or shortness of breath.
• Dysphagia (trouble or difficulty swallowing).
• Frequent burping or hiccups.
• Vomiting (throwing up) blood or having black, tarry stools.
• Weight loss.
• Vomiting (throwing up) blood or having black, tarry stools.
• Weight loss.

Treatment

• Medicines:
• Antacids: This medicine group decreases the stomach acid that can irritate your esophagus and stomach.
• Histamine type-2 receptor blocker: H2 blockers is another name for this group of medicines which blocks acid production in the stomach.
• Promotility agents: These medicines cause the lower esophageal sphincter and stomach to contract (tighten) more.
• Proton pump inhibitor: This medicine group is also called a PPI. This medicine blocks acid from forming in the stomach. These medicines may cause miscarriages and should not be used by pregnant women.
  
• Surgery: This may be done when your medicines cannot control your symptoms or other problems are present. Fundoplication is surgery to wrap the upper part of the stomach around the esophageal sphincter to strengthen it. Ask your caregiver for more information about fundoplication.

Complications
GERD may cause any of the following:

• Bleeding: A small blood vessel in your esophagus may get weak and burst. This may cause blood to appear in your vomit (throw up) or bowel movement (stool).
• Esophagitis and esophageal ulcers: These problems occur when the lining of the esophagus becomes irritated and swollen.
• Stricture: Scarring can cause the esophagus to become narrow.
• Barrett's esophagus: This is a problem of the lower esophagus. Cells lining the esophagus may change and lead to cancer.