GERD

Gastroesophageal reflux disease, or GERD, occurs when stomach acid frequently flows back into your esophagus, which is the tube connecting your mouth and stomach. This backwash, called acid reflux, can irritate the lining of your esophagus.

Many people experience mild acid reflux from time to time. They usually can manage with lifestyle changes and over-the-counter medications. But some people with more frequent acid reflux (occurring several times a week) may need stronger medications or surgery to ease symptoms.

Common signs and symptoms of GERD include:

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid

Causes

GERD is caused by frequent acid reflux. When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again. If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

Risk factors

Conditions that can increase your risk of GERD include:

• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying
• Factors that can aggravate acid reflux include:
• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers), such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee

Complications

It's important to seek medical attention if you experience chronic GERD or inflammation of your esophagus.

Over time, chronic GERD can cause:

• Narrowing of the esophagus
  Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
• An open sore in the esophagus or esophageal ulcer
  Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult.
• Precancerous changes to the esophagus or Barrett's esophagus
  Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.

Treatment

Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don't experience relief within a few weeks, your doctor might recommend prescription medication or surgery.

Medications typically prescribed reduce stomach acid production. They are effective and safe, even with long-term use. They usually are taken once or twice a day.

Surgery and other procedures

GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend fundoplication. In this procedure, the surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.