Acid Reflux/GERD

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Acid Reflux/GERD

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Overview
Gastroesophageal reflux disease (GERD) happens
when a muscle at the end of your esophagus does
not close properly. This allows stomach contents to
leak back, or reflux, into the esophagus and irritate
it.

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Overview
You may feel a burning in the chest or throat
called heartburn. Sometimes, you can taste
stomach fluid in the back of the mouth. This is
acid indigestion. If you have these symptoms more
than twice a week, you may have GERD.


Overview
Anyone, including infants and children, can have
GERD. If not treated, it can lead to more serious
health problems. In some cases, you might need
medicines or surgery. However, many people can
improve their symptoms by:
-- Avoiding alcohol and spicy, fatty or acidic foods
that trigger heartburn
-- Eating smaller meals


Overview
-- Not eating close to bedtime
-- Losing weight if needed
-- Wearing loose-fitting clothes


Symptoms
Common symptoms of GERD include
heartburn, regurgitation and dyspepsia.
Heartburn is a feeling of burning pain that can
arise when acid from the stomach makes its way
up the esophagus. This pain can sometimes occur
in the throat. While heart is in its name this pain
does not affect the heart.


Symptoms
Regurgitation is the feeling of stomach acid being
brought up to the mouth. This can often feel like a
small amount of vomit in the mouth, a wet burp or
a sour taste in the mouth.
Dyspepsia is a medical term for general stomach
pain. This can include nausea after
meals, burping, bloating, a feeling of fullness and
abdominal pain.


Symptoms
Acid reflex and GERD is very common and
generally can be controlled with dietary changes
and the use of prescribed and over the counter
medicines. However, this does not mean you
should ignore your symptoms.


Diagnosis
People usually decide to see a doctor because they
have symptoms like severe heartburn or
regurgitation. Sometimes an inflamed food pipe is
discovered by chance during an examination that is
being done because of other symptoms, but that is
less common.


Diagnosis
Symptoms play an important role in the diagnosis
of GERD, so it can be helpful if you describe your
symptoms in as much detail as possible:
•What symptoms do you have?
•Where exactly are they?
•How often do you have them?


Diagnosis
•Do you have the symptoms after eating or when
your stomach is empty?
•Do they get worse when you lie down?
This information can help your doctor to find out
whether you have GERD or whether it is more
likely that your symptoms are being caused by
something else.


Diagnosis
The symptoms caused by GERD are not always the
typical ones. For instance, someone might have
GERD without having heartburn or
regurgitation, or these symptoms may only be very
mild. Or they might have different or more
symptoms, such as problems swallowing, a sore
throat or a cough.


Diagnosis
If it is thought that someone might have
GERD, doctors sometimes suggest that they have a
“trial treatment” for GERD to see if they respond.
In what is known as a “PPI test”, the patient takes
proton pump inhibitors (PPIs) for about two weeks.
Proton pump inhibitors are drugs that reduce the
production of acidic stomach juices. If the
medication relieves the symptoms, then it is very
likely that GERD is causing the symptoms. In that
case the treatment with proton pump inhibitors is
typic

Treatment
You may need to make changes to your lifestyle
such as maintaining a healthy weight, quitting
smoking, drinking less alcohol, or not eating foods
that make GERD worse.
Treatment options for GERD may be different for
each person.
-- Medicine


Treatment
Taking medicine for GERD is the option most
people choose first.
-- Surgery
For some people, surgery can improve GERD
symptoms and lower the amount of medicine they
need.
Endoscopic Treatments


Treatment
Endoscopic treatments for GERD are newer and
are still being studied, so less is known about how
well they work or how safe they are.
In the next few pages, you can find more
information about these types of treatment.
Medicine


Treatment
Different medicines can help control problems
caused by GERD.
Some relieve heartburn symptoms when they
happen, and some help keep heartburn and other
problems from happening.
Some medicines are taken only when needed and
some are taken every day for a few weeks or
months. Others must be taken every day for years.


Treatment
Some medicines can be bought over the counter
without a prescription, and others need a
prescription. Some are available both over the
counter and by prescription.
The three main types of medicines to treat GERD
are antacids, H2RAs (histamine type 2 receptor
antagonists), and PPIs (proton pump inhibitors).
Antacids


Treatment
Antacids stop heartburn by neutralizing
(weakening) the acid in your stomach.
They work quickly to treat mild GERD symptoms.
Antacids go by many names, such as
Mylanta®, Rolaids®, or Tums®, and they are
available without a prescription.
They are taken as pills or liquids.


Treatment
You may need to continue taking antacids along
with an H2RA or PPI to control symptoms.
H2RAs and PPIs work for a longer time than fast-
acting antacids, but they do not start working as
fast.
Histamine type 2 receptor antagonists (H2RAs)


Treatment
H2RAs cause your stomach to produce less acid.
Less acid in your stomach lowers your chance of
getting heartburn.
All H2RAs are available both by prescription and
over the counter.
They are taken as pills.
Surgery


Treatment
For some people, surgery to strengthen the barrier
between the stomach and esophagus may be a
treatment option for acid reflux. This surgery to
treat GERD is called a “fundoplication”
(pronounced fun-doe-ply-KAY-shun). Your doctor
can tell you if surgery might help you.
How does surgery for GERD work?


Treatment
In a fundoplication, the top part of your stomach is
wrapped around the bottom of your esophagus
and attached there.
This helps strengthen the muscle at the bottom of
your esophagus that closes to keep food and acid
from coming back up.


Treatment
The surgeon may be able to do the surgery with a
tool called a “laparoscope” (pronounced LAH-pruh-
skohp). A laparoscope is a thin tube with a tiny
camera that the surgeon puts through small cuts in
your belly along with other small tools to do the
surgery.
It usually takes less time to recover from surgery
with a laporascope than if the surgeon has to make
a large cut in your belly to do the surgery.


Treatment
There are two types of surgery: total
fundoplication and partial fundoplication
What are the side effects?
Fundoplication surgery can cause you to feel
bloated and make it hard to swallow. These side
effects may last for 30 days or longer, and some
side effects may require a second surgery to fix.


Treatment
Serious side effects, such as infection and heart
attack, may be more common with surgery than
with medicine. These side effects are rare.
Endoscopic treatments


Treatment
Endoscopic (pronounced en-doh-SKAHP-ik)
treatments help strengthen the muscle that keeps
food and acid from going up into your esophagus.
These treatments are not considered surgery
because no cuts are made in your belly. Instead, a
doctor puts a thin tube called an endoscope
through your mouth and down your esophagus to
do the treatment.


Treatment
Three types of endoscopic treatments are
EndoCinch™, Stretta®, and EsophyX™. These
treatments are very new and are not as common
as medicines or surgery to treat GERD. People
receiving one of these treatments may be in a
study to see how well it works.
What does research say about endoscopic
treatments?


Treatment
There are not enough studies to say how well
endoscopic treatments (EndoCinch™, Stretta®, and
EsophyX™) work to control the symptoms of GERD.
What are the side effects of endoscopic
treatments?
Endoscopic treatments can cause pain in your
chest or abdomen (belly) and bleeding.


Treatment
They can also cause you to feel bloated and make
it hard to swallow. These side effects may last for
30 days or longer.
Because these treatments are new, not enough
research has been done to know how safe they
are.
Lifestyle changes


Treatment
Your doctor may suggest some lifestyle changes
that can help control your GERD symptoms. These
include:
Maintain a healthy weight.
Quit smoking.
Limit alcohol.
Avoid eating 3 hours before lying down.


Treatment
Raise the head of your bed.
Avoid foods that can make GERD symptoms worse
(spicy foods, fatty foods, mint, chocolate, tomato-
based foods, coffee, and citrus fruits).


Causes
Acid reflux / GERD is the result of the weakening or
unusual relaxing of the lower esophageal
sphincter. This is the band of muscle around the
bottom of the esophagus that normally prevents a
backflow of stomach acid into the esophagus.
When esophageal sphincter doesn’t close properly
a constant flow of acid can move freely up the
esophagus and over time erode tissues.


Prevention
Prevention often involves making simple healthy
choices. If you smoke, quitting now will reduce
reflux. Alcohol, caffeinated beverages, fatty
foods, chocolate, and mint relax the lower
sphincter. Avoid these foods to reduce reflux.
Citrus fruits and juices, spicy food, tomato sauce
and carbonated drinks can irritate the esophageal
lining. Some are able to reduce reflux by wearing
loose fitting clothes and eating smaller meals.
Other methods include not lying down after
eating, sleeping with a we

Top Treatment Centers
Top 10 treatment centers according to US News
Mayo Clinic – Rochester, Mn
Cleveland Clinic - Cleveland, Oh
John’s Hopkins Hospital – Baltimore, Md


Massachuttes General Hospital – Boston, Ma
University of Pittsburgh Medical Center –
Pittsburgh, Pa
Cedars-Sinai Medical Center – Los
Angeles, Ca
Mount Sinai Medical Center – New York, Ny


Ronald Regan UCLA Medical Center – Los
Angeles, Ca
New York-Presbyterian University Hospital –
New York, NY
Ochsner Medical Center – New Orleans, La


Acid Reflux/GERD

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