The muscle (lower esophageal sphincter) located between the esophagus and stomach normally opens after swallowing allowing food to pass into the stomach. This sphincter muscle then closes quickly to prevent the return (reflux) of food and stomach juices back into the esophagus. When the muscle either relaxes inappropriately or is very weak, the acid contents of the stomach can back up, into the esophagus. This is called gastro-esophageal reflux and typically produces heartburn, a burning sensation below the sternum where your ribs come together.
Several factors influence the occurrence and severity of gastroesophageal reflux including:
- The ability of the lower gastroesophageal sphincter muscle to open and close properly.
- The amount of stomach juices that are backed up into the esophagus.
- The clearing action of the esophagus.
- The neutralizing effect of saliva and other factors.
People experience GERD in a variety of ways. Heartburn usually begins as a burning pain that starts behind the breastbone and radiates upward toward the neck. Often there is a sensation of food coming back into the mouth, accompanied by an acid or bitter taste. This often occurs following meals.
In addition to heartburn, symptoms may include a persistent sore throat, hoarseness, chronic cough, chest pain and a feeling of a lump in the throat.
Diagnosis of GERD is based on:
- Your symptoms, ie. Heartburn, sore throat, etc.
- A test to monitor the amount of acid in your esophagus. Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your esophagus. The probe transmits a signal to a small computer that you wear. Your doctor may ask that you stop taking GERD medications to prepare for this test.
- An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract.
- Endoscopy is a way to visually examine the inside of your esophagus and stomach. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. This procedure allows your doctor to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett's esophagus, presence of H. pylori, etc.
- Esophageal motility testing (manometry) measures movement and pressure in the esophagus. This exam is useful in determining if esophagel dysmotility is contributing to your symptoms.
Treatment of GERD usually begins with over-the-counter medications that control acid. If you don't experience relief within a few weeks, your doctor may recommend other treatments, including new or combination medication regimens, behavior and dietary changes and in some cases surgery.
Over-the-counter treatments that may help control heartburn include:
- Antacids that neutralize stomach acid
- Medications to reduce acid production
- Medications that block acid production and heal the esophagus
Contact your doctor if you need to take these medications for longer than two to three weeks or your symptoms are not relieved with use.
If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:
- Prescription-strength H-2-receptor blockers
- Prescription-strength proton pump inhibitors
These medications are generally well-tolerated, but long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency. Talk to your doctor to learn more.
Most GERD can be controlled through medications. In situations where medications aren't helpful or you wish to avoid long-term medication use, your doctor may recommend more-invasive procedures, such as:
- Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication)
- Surgery to strengthen the lower esophageal sphincter (Linx)