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Gastroesophagealrefluxdisease:MedlinePlusMedicalEncyclopedia

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Gastroesophagealrefluxdisease
Gastroesophagealrefluxdisease(GERD)isaconditioninwhichthestomachcontentsleakbackwards
fromthestomachintotheesophagus(thetubefromthemouthtothestomach).Thiscanirritatethe
esophagusandcauseheartburnandothersymptoms.

Causes
Whenyoueat,foodpassesfromthethroattothestomachthroughtheesophagus.Aringofmuscle
fibersintheloweresophaguspreventsswallowedfoodfrommovingbackup.Thesemusclefibersare
calledtheloweresophagealsphincter(LES).
Whenthisringofmuscledoesnotclosealltheway,stomachcontentscanleakbackintothe
esophagus.Thisiscalledrefluxorgastroesophagealreflux.Refluxmaycausesymptoms.Harsh
stomachacidscanalsodamagetheliningoftheesophagus.

Theriskfactorsforrefluxinclude:
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Useofalcohol(possibly)
Hiatalhernia(aconditioninwhichpartofthestomachmovesabovethediaphragm,whichisthe
musclethatseparatesthechestandabdominalcavities)
Obesity
Pregnancy
Scleroderma
Smoking
Heartburnandgastroesophagealrefluxcanbebroughtonormadeworsebypregnancy.Symptoms
canalsobecausedbycertainmedicines,suchas:
Anticholinergics(e.g.,forseasickness)
Betablockersforhighbloodpressureorheartdisease
Bronchodilatorsforasthma
Calciumchannelblockersforhighbloodpressure
DopamineactivedrugsforParkinsondisease
Progestinforabnormalmenstrualbleedingorbirthcontrol
Sedativesforinsomniaoranxiety
Tricyclicantidepressants
Talktoyourhealthcareproviderifyouthinkoneofyourmedicinesmaybecausingheartburn.Never
changeorstoptakingamedicinewithoutfirsttalkingtoyourprovider.

Watchthisvideoabout:
Heartburn

Symptoms
CommonsymptomsofGERDinclude:
Feelingthatfoodisstuckbehindthebreastbone
Heartburnoraburningpaininthechest
Nauseaaftereating

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Lesscommonsymptomsare:
Bringingfoodbackup(regurgitation)
Coughorwheezing
Difficultyswallowing
Hiccups
Hoarsenessorchangeinvoice
Sorethroat
Symptomsmaygetworsewhenyoubendoverorliedown,orafteryoueat.Symptomsmayalsobe
worseatnight.

ExamsandTests
Youmaynotneedanytestsifyoursymptomsaremild.
Ifyoursymptomsaresevereortheycomebackafteryouhavebeentreated,yourdoctormayperform
atestcalledanupperendoscopy(EGD)
Thisisatesttoexaminetheliningoftheesophagus(thetubethatconnectsyourthroattoyour
stomach),stomach,andfirstpartofthesmallintestine.
Itisdonewithasmallcamera(flexibleendoscope)thatisinserteddownthethroat.
Youmayalsoneedoneormoreofthefollowingtests:
Atestthatmeasureshowoftenstomachacidentersthetubethatleadsfromthemouthtothe
stomach(calledtheesophagus)
Atesttomeasurethepressureinsidethelowerpartoftheesophagus(esophagealmanometry)
Apositivestooloccultbloodtestmaydiagnosebleedingthatiscomingfromtheirritationinthe
esophagus,stomach,orintestines.

Treatment
Youcanmakemanylifestylechangestohelptreatyoursymptoms.
Othertipsinclude:
Ifyouareoverweightorobese,inmanycases,losingweightcanhelp.
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Avoiddrugssuchasaspirin,ibuprofen(Advil,Motrin),ornaproxen(Aleve,Naprosyn).Take
acetaminophen(Tylenol)torelievepain.
Takeallofyourmedicineswithplentyofwater.Whenyourdoctorgivesyouanewmedicine,ask
whetheritwillmakeyourheartburnworse.
Youmayuseoverthecounterantacidsaftermealsandatbedtime,althoughthereliefmaynotlast
verylong.Commonsideeffectsofantacidsincludediarrheaorconstipation.
OtheroverthecounterandprescriptiondrugscantreatGERD.Theyworkmoreslowlythanantacids,
butgiveyoulongerrelief.Yourpharmacist,doctor,ornursecantellyouhowtotakethesedrugs.
Protonpumpinhibitors(PPIs)decreasetheamountofacidproducedinyourstomach
H2blockersalsolowertheamountofacidreleasedinthestomach
Antirefluxsurgerymaybeanoptionforpeoplewhosesymptomsdonotgoawaywithlifestylechanges
andmedicines.Heartburnandothersymptomsshouldimproveaftersurgery.Butyoumaystillneedto
takedrugsforyourheartburn.
Therearealsonewtherapiesforrefluxthatcanbeperformedthroughanendoscope(aflexibletube
passedthroughthemouthintothestomach).

Outlook(Prognosis)
Mostpeoplerespondtolifestylechangesandmedicines.However,manypeopleneedtocontinue
takingmedicinestocontroltheirsymptoms.

PossibleComplications
Complicationsmayinclude:
Worseningofasthma
Achangeintheliningoftheesophagusthatcanincreasetheriskofcancer(Barrett'sesophagus)
Bronchospasm(irritationandspasmoftheairwaysduetoacid)
Chroniccoughorhoarseness
Dentalproblems
Ulcerintheesophagus
Stricture(anarrowingoftheesophagusduetoscarring)

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WhentoContactaMedicalProfessional
Callyourhealthcareproviderifsymptomsdonotimprovewithlifestylechangesormedicine.
Alsocallifyouhave:
Bleeding
Choking(coughing,shortnessofbreath)
Feelingfilledupquicklywheneating
Frequentvomiting
Hoarseness
Lossofappetite
Troubleswallowing(dysphagia)orpainwithswallowing(odynophagia)
Weightloss

Prevention
Followingheartburnpreventiontechniquesmayhelppreventsymptoms.ObesityislinkedtoGERD,so
maintainingahealthybodyweightmayhelppreventthecondition.

AlternativeNames
PepticesophagitisRefluxesophagitisGERDHeartburnchronicDyspepsiaGERD

References
GalmicheJP,HatlebakkJ,AttwoodS,etal.Laparoscopicantirefluxsurgeryvsesomeprazole
treatmentforchronicGERD:theLOTUSrandomizedcontrolledtrial.JAMA.2011305:196977.PMID:
21586712www.ncbi.nlm.nih.gov/pubmed/21586712[https://www.ncbi.nlm.nih.gov/pubmed/21586712].
KatzPO,GersonLB,VelaMF.Guidelinesforthediagnosisandmanagementofgastroesophageal
refluxdisease.AmJGastroenterol.2013108:30828.PMID:23419381
www.ncbi.nlm.nih.gov/pubmed/23419381[https://www.ncbi.nlm.nih.gov/pubmed/23419381].
RichterJE,FriedenbergFK.Gastroesophagealrefluxdisease.In:FeldmanM,FriedmanLS,BrandtLJ,
eds.Sleisenger&Fordtran'sGastrointestinalandLiverDisease.9thed.Philadelphia,PA:Elsevier
Saunders2010:chap43.

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WangKK,SamplinerRE.Updatedguidelines2008forthediagnosis,surveillanceandtherapyof
Barrett'sesophagus.AmJGastroenterol.2008103(3):78897.PMID:18341497
www.ncbi.nlm.nih.gov/pubmed/18341497[https://www.ncbi.nlm.nih.gov/pubmed/18341497].

UpdateDate1/22/2015
Updatedby:SubodhK.Lal,MD,gastroenterologistatGastrointestinalSpecialistsofGeorgia,Austell,
GA.ReviewprovidedbyVeriMedHealthcareNetwork.AlsoreviewedbyDavidZieve,MD,MHA,Isla
Ogilvie,PhD,andtheA.D.A.M.Editorialteam.

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