Normally, the esophageal sphincter keeps the stomach contents contained with the stomach (left). However, with gastroesophageal reflux disease, the sphincter opens, allowing the acidic contents to flow up the esophagus.
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Gastroesophageal reflux disease occurs when stomach contents such as stomach acid and bile come up from the stomach into the esophagus, causing irritation to the esophageal lining. It is a very common digestive disorder.
Elizabeth is a 79-year-old woman who visits her doctor because she is frequently awakened at night by a burning pain in her stomach and chest area. She tells the doctor that she feels like she is going to vomit. This happens most often when she has eaten dinner late in the evening. She is afraid that she is having a heart attack.
Gastroesophageal (gas-TRO-e-so-fa-GEEL) reflux (RE-flux) disease, more commonly called GERD, is a disease of the digestive (gastrointestinal) system where stomach contents such as stomach acid and enzymes * , including bile * (a fluid secreted by the liver that moves through the gallbladder into the intestine that helps digest food), flow from the stomach (refluxes) into the esophagus * (food pipe) causing irritation to the esophageal wall, or lining. The stomach is lined to protect it against the acids and enzymes. The esophagus does not have the same protective lining and therefore may be damaged by regurgitation * of the stomach contents. GERD may also be called heartburn, acid reflux * , dyspepsia (dis-pep-cya), reflux esophagitis, or peptic esophagitis.
GERD is very common and occurs in 10 to 20 percent of adults, with approximately three million cases each year in the United States. It is also estimated to occur in more than 12 percent of children.
When eating, food passes from the mouth through the esophagus (food pipe) to the stomach where it is partially digested by stomach acids and bile (from the gallbladder and liver). Between the lower esophagus and the stomach is a ring of muscle called the lower esophageal sphincter (LES). This ring of muscle prevents food from flowing backward from the stomach into the esophagus. In GERD, the sphincter does not close completely, allowing stomach contents to reflux, or flow backward into the stomach.
Risk factors for GERD include the following:
People who have GERD often say that they feel like their food is stuck behind their breast bone. They may describe having heartburn or a burning pain in their chest (they may think they are having a heart attack). They may say they feel nauseous (or like they might vomit) after eating. They may feel food coming up into the food pipe or mouth (regurgitation).
Other less frequent signs are difficulty swallowing, hiccups, sore (burning) throat, coughing or wheezing, and change in voice or hoarseness.
Initial treatment usually consists of making changes in one's lifestyle, including the following:
If lifestyle measures do not relieve the problem, over-the-counter medications that counter or oppose the effect of the stomach acids may be recommended.
In severe cases, where all other recommended treatments have not been effective, antireflux * surgery may be done. In cases where esophageal narrowing has occurred, esophageal dilation using special medical balloons may be done.
Prevention of GERD includes the same interventions or lifestyle changes that are recommended for treatment of GERD.
See also Hernia, Gastrointestinal • Obesity • Pregnancy
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* enzyme (EN-zime) is a protein that helps speed up a chemical reaction in cells or organisms.
* bile is a greenish-brown fluid manufactured in the liver that is essential for digesting food. Bile is stored in the gallbladder, which contracts and discharges bile into the intestine to aid digestion of fats after a person eats.
* esophagus (eh-SAH-fuh-gus) is the soft tube that, with swallowing, carries food from the throat to the stomach.
* regurgitation is the sensation of food or acid backing up into the throat or mouth. Another definition for regurgitation is vomiting.
* acid reflux is a condition in which stomach acid flows upward into the esophagus, often causing a burning sensation (so-called heartburn) in the upper abdomen or chest.
* over-the-counter medications are medications or treatments that can be purchased without a doctor's prescription or order.
* antireflux is a treatment for reflux; can include diet modification or surgery.