A ring of muscle keeps the end of your esophagus closed. GERD happens when that muscle doesn't work properly. When the muscle is weak or relaxes at the wrong time, or if there is too much pressure in your stomach, your stomach contents can flow back up into your esophagus.
GERD is not usually caused by having too much acid in your stomach. The problem is the acid backing up into the esophagus. The esophagus doesn't have a lining like the stomach to protect it from the acid. Abnormal cells in your esophagus that may become cancer called Barrett esophagus Complications of gastroesophageal reflux In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom Rarely, doctors will need to measure the amount of acid in your esophagus using a thin, flexible tube with a sensor at the end esophageal pH test.
Sometimes, doctors may test the muscle at the end of your esophagus to see if it's working esophageal manometry. Don't eat foods that make GERD worse, such as chocolate, tomato sauce, fatty or deep-fried foods, and salad dressings made with vinegar. The surgery is called fundoplication. The surgeon wraps part of your stomach around the bottom of your esophagus, which stops stomach contents from flowing back up.
From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Merck Manual was first published in as a service to the community.
Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Opting for loose-fitting clothes with elastic bands can be a huge help in reducing heartburn and other symptoms. There are several types of medication that can reduce stomach acid and prevent more frequent GERD symptoms.
Talk to your doctor about which medications might be right for you, from over-the-counter meds to prescribed proton pump inhibitors or histamine-2 blockers. For overweight sufferers of GERD, the single most effective way to find relief is to lose the weight.
Research has shown that patients who treat their GERD through weight loss have higher life satisfaction scores and better quality of life than those on medication. Common Health Topics. Commonly searched drugs. Commentary: What is Here are five tips that can help: 1.
Skip the Tight Yoga Pants Tight clothes can spell trouble when it comes to reflux. Find a Medication that Works There are several types of medication that can reduce stomach acid and prevent more frequent GERD symptoms. Test your knowledge. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia It is done by passing a catheter containing solid-state or liquid-filled pressure transducers through Management of uncomplicated GERD consists of elevating the head of the bed about 15 cm 6 in and avoiding the following:.
Drug therapy is often with a proton pump inhibitor; all appear equally effective. For example, adults can be given oral omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, or esomeprazole 40 mg 30 minutes before breakfast. In some cases eg, only partial response to once-a-day dosing , proton pump inhibitors may be given twice daily. These drugs may be continued long-term, but the dose should be adjusted to the minimum required to prevent symptoms, including intermittent or as-needed dosing.
H2 blockers are also an effective treatment option for mildly symptomatic GERD. Promotility agents eg, metoclopramide 10 mg orally 30 minutes before meals and at bedtime are less effective but may be added to a proton pump inhibitor regimen. Antireflux surgery usually fundoplication via laparoscopy is done in patients with grades C and D esophagitis, large hiatal hernias, hemorrhage, stricture, ulcers, large amounts of symptomatic nonacid reflux, or who cannot tolerate drug therapy.
Esophageal strictures are most often managed by repeated endoscopic dilation. Barrett esophagus may or may not regress with medical or surgical therapy. Because Barrett esophagus is a precursor to adenocarcinoma, endoscopic surveillance for malignant transformation is recommended every 3 to 5 years in nondysplastic disease. The American College of Gastroenterology's guidelines recommend endoscopic ablative therapy for patients with confirmed low-grade dysplasia and without life-limiting comorbidity; however, endoscopic surveillance every 12 months is an acceptable alternative.
Patients with Barrett esophagus and confirmed high-grade dysplasia should be managed with endoscopic ablative therapy unless they have life-limiting comorbidity. Endoscopic ablative techniques for Barrett esophagus include mucosal resection, photodynamic therapy, cryotherapy, and laser ablation. Lower esophageal sphincter incompetence and transient relaxations allow gastric contents to reflux into the esophagus and sometimes into the larynx or lungs. Complications include esophagitis, peptic esophageal ulcer, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma.
The main symptom in adults is heartburn, and infants present with vomiting, irritability, anorexia, and sometimes symptoms of chronic aspiration; at any age, chronic aspiration may cause cough, hoarseness, or wheezing. Diagnose clinically; do endoscopy in patients not responding to empiric treatment and hour pH monitoring if endoscopy is normal in patients with typical symptoms. Treat with lifestyle changes eg, head of bed elevation, weight loss, dietary trigger avoidance and acid-suppressing therapy.
Antireflux surgery can help patients with severe esophagitis, complications of esophagitis, intolerance to drug therapy, or a large amount of symptomatic nonacid reflux. The following are English-language resources that may be useful. American College of Gastroenterology: Guidelines for the diagnosis and treatment of gastroesophageal reflux disease.
From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Merck Manual was first published in as a service to the community.
Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics.
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