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Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults

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Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults National Digestive Diseases Information Clearinghouse What is GER? Read more about over-the-counter medications in the section “How is GERD Gastroesophageal reflux (GER) occurs treated?” when stomach contents flow back up into the esophagus—the muscular tube that carries food and liquids from the mouth to the What is GERD? stomach. Gastroesophageal reflux disease (GERD) is GER is also called acid reflux or acid a more serious, chronic––or long lasting–– regurgitation because the stomach’s digestive form of GER. GER that occurs more juices contain acid. Sometimes people with than twice a week for a few weeks could GER can taste food or acidic fluid in the be GERD, which over time can lead to back of the mouth. Refluxed stomach acid more serious health problems. People with that touches the lining of the esophagus suspected GERD should see a health care can cause heartburn. Also called acid provider. indigestion, heartburn is an uncomfortable, burning feeling in the midchest, behind What causes GERD? the breastbone, or in the upper part of the Gastroesophageal reflux disease results when abdomen—the area between the chest and the lower esophageal sphincter—the muscle the hips. that acts as a valve between the esophagus Occasional GER is common. People may be and stomach—becomes weak or relaxes able to control GER by when it should not, causing stomach contents to rise up into the esophagus. • avoiding foods and beverages that contribute to heartburn, such as Abnormalities in the body such as hiatal chocolate, coffee, peppermint, greasy hernias may also cause GERD. Hiatal or spicy foods, tomato products, and hernias occur when the upper part of the alcoholic beverages stomach moves up into the chest. The stomach can slip through an opening found • avoiding overeating in the diaphragm. The diaphragm is the • quitting smoking muscle wall that separates the stomach from the chest. Hiatal hernias may cause GERD • losing weight if they are overweight because of stomach acid flowing back up • not eating 2 to 3 hours before sleep through the opening; however, most produce no symptoms. • taking over-the-counter medications Other factors that can contribute to GERD What is the gastrointestinal include (GI) tract? • obesity The GI tract is a series of hollow organs • pregnancy joined in a long, twisting tube from the mouth to the anus. The movement of • certain medications, such as asthma muscles in the GI tract, along with the medications, calcium channel blockers, release of hormones and enzymes, starts and many antihistamines, pain killers, the digestion of food. The upper GI tract sedatives, and antidepressants includes the mouth, esophagus, stomach, • smoking, or inhaling secondhand smoke small intestine, and duodenum, which is the first part of the small intestine. People of all ages can develop GERD, some for unknown reasons. Stomach Mouth Esophagus Lower Esophagus esophageal sphincter Acid Lower Small esophageal intestine sphincter Stomach Small intestine Anus GERD results when the lower esophageal sphincter—the muscle that acts as a valve between the esophagus and stomach—becomes weak or relaxes when it should not, causing stomach contents to rise up into the esophagus. 2 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults What are the symptoms of a look at the shape of the upper GI tract. An x-ray technician performs this test at GERD? a hospital or an outpatient center, and a The main symptom of GERD is frequent radiologist—a doctor who specializes in heartburn, though some adults with GERD medical imaging—interprets the images. do not have heartburn. Other common This test does not require anesthesia. No GERD symptoms include eating or drinking is allowed before the • a dry, chronic cough procedure, as directed by the health care staff. People should check with their • wheezing gastroenterologist about what to do to • asthma and recurrent pneumonia prepare for an upper GI series. • nausea During the procedure, the person will stand or sit in front of an x-ray machine and drink • vomiting barium, a chalky liquid. Barium coats the • a sore throat, hoarseness, or laryngitis— esophagus, stomach, and small intestine so swelling and irritation of the voice box the radiologist and gastroenterologist can see theses organs’ shapes more clearly on • difficulty swallowing or painful x rays. The barium shows problems related swallowing to GERD, such as hiatal hernias. While an • pain in the chest or the upper part of upper GI series cannot detect mild irritation, the abdomen the test can detect esophageal strictures— • dental erosion and bad breath narrowing of the esophagus that can result from GERD—as well as ulcers, or sores. How is GERD diagnosed? A person may experience bloating and nausea for a short time after the test. For A health care provider may refer people with several days afterward, barium liquid in suspected GERD to a gastroenterologist—a the GI tract causes white or light-colored doctor who specializes in digestive diseases— stools. A health care provider will give the for diagnosis and treatment. person specific instructions about eating and Lifestyle changes and medications are often drinking after the test. the first lines of treatment for suspected Upper endoscopy. A gastroenterologist GERD. If symptoms improve with these may use an upper endoscopy, also known treatment methods, a GERD diagnosis as an esophagogastroduodenoscopy, if a often does not require testing. However, person continues to have GERD symptoms to confirm a diagnosis, a person may need despite lifestyle changes and treatment testing if symptoms do not improve. People with medications. An upper endoscopy is a with possible GERD who have trouble common test used to evaluate the severity swallowing also may require testing. of GERD. This procedure involves using A completely accurate test for diagnosing an endoscope—a small, flexible tube with a GERD does not exist. However, several light—to see the upper GI tract. tests can help with diagnosis: A gastroenterologist performs this test at Upper GI series. While a gastroenterologist a hospital or an outpatient center. The does not use an upper GI series to diagnose person may receive a liquid anesthetic that is acid reflux or GERD, the test can provide gargled or sprayed on the back of the throat. 3 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults If sedation is used, a health care provider This test is most useful when combined with will place an intravenous (IV) needle in the a carefully kept diary of when, what, and person’s vein. how much food the person eats and GERD symptoms that result. The gastroenterologist After the person receives sedation, the can see correlations between symptoms and gastroenterologist carefully feeds an certain foods or times of day. The procedure endoscope through the mouth and down can also help show whether reflux triggers the esophagus, then into the stomach and respiratory symptoms. duodenum. A small camera mounted on the endoscope transmits a video image to a Esophageal manometry. Esophageal monitor, allowing close examination of the manometry measures muscle contractions intestinal lining. The gastroenterologist uses in the esophagus. A gastroenterologist may the endoscope to take a biopsy, a procedure order this test when considering a person for that involves taking a small piece of anti-reflux surgery. The gastroenterologist esophageal tissue. A pathologist—a doctor performs this test during an office visit. A who specializes in diagnosing diseases—will person may receive anesthetic spray on examine the tissue with a microscope and the inside of the nostrils or back of the determine the extent of inflammation. throat. The gastroenterologist passes a soft, thin tube through the person’s nose A gastroenterologist diagnoses GERD when into the stomach. The person swallows as the test shows injury to the esophagus in the gastroenterologist pulls the tube slowly a person who has had moderate to severe back into the esophagus. A computer GERD symptoms. measures and records the pressure of the Esophageal pH monitoring. The most muscle contractions in different parts of the accurate test to detect acid reflux, esophageal esophagus. The test can show if symptoms pH monitoring measures the amount of are due to a weak sphincter muscle. A liquid or acid in the esophagus as the person health care provider can also use the test to goes about normal activities, including eating diagnose other disorders of the esophagus and sleeping. A gastroenterologist performs that might have similar symptoms as this test at a hospital or an outpatient center heartburn. Most people can resume regular as a part of an upper endoscopy. The person activity, eating, and medications right after can remain awake during the test. Sedation the test. is not required for the test; however, it can be used if necessary. How is GERD treated? A gastroenterologist will pass a thin tube, Treatment for GERD may involve one or called a nasogastric probe, through the more of the following, depending on the person’s nose or mouth to the stomach. The severity of symptoms: lifestyle changes, gastroenterologist will then pull the tube medications, or surgery. back into the esophagus, where it will be taped to the person’s cheek and remain in Lifestyle Changes place for 24 hours. The end of the tube in Some people can reduce GERD symptoms by the esophagus has a small probe to measure when and how much liquid or acid comes up • losing weight, if needed into the esophagus. The other end of the • wearing loose-fitting clothing around tube, attached to a monitor outside the body, the stomach area, as tight clothing can shows the measurements taken. constrict the area and increase reflux 4 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults • remaining upright for 3 hours after with GERD.
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