Gastroesophageal reflux disease (GERD) is a chronic condition that affects the digestive system. While most people experience heartburn or indigestion from time to time, if you feel that burning sensation in your chest more than twice a week, you might have GERD.
The condition is a more serious and long-lasting form of acid reflux. Most people can manage GERD with over-the-counter (OTC) medications and a few lifestyle changes.
Who gets GERD?
Anyone can develop GERD. It occurs across every age group and ethnicity. However, you’re more likely to have GERD if:
- You’re overweight or obese.
- You’re pregnant.
- You take certain medications, including antihistamines, painkillers, and antidepressants
- You smoke or are regularly exposed to secondhand smoke.
One of the biggest challenges in determining the number of people living with GERD is identifying who actually has the disease. Many people with GERD symptoms don’t consult a healthcare provider. A 2014 systematic review estimates from 15.1 to 30 percent[DS1] of the U.S. population has GERD.
According to the Healthcare Cost and Utilization Project (HCUP), there were 995,402 hospitalizations for GERD in 1998. In 2005, there were 3.14 million, an increase of 216 percent. In both years, approximately 62 percent of all GERD hospital discharges involved women.
The same study showed that the number of adults hospitalized for GERD decreased by 2.4 percent between 1998 and 2005. During the same period, the rate increased by 42 percent for babies. It increased by 84 percent for children aged two to 17.
In 2010, 4.7 million hospitalizations and 1,653 deaths were a result of GERD, reports the National Institute of Diabetes and Digestive and Kidney Diseases.
What causes GERD?
GERD is a result of a weak lower esophageal sphincter. That weakness allows the contents of your stomach to flow back up into your esophagus.
There are a variety of factors that can weaken your esophageal sphincter, including:
- being overweight
- smoking or regular exposure to secondhand smoke
- hiatal hernia (part of the stomach protrudes into the diaphragm muscle)
Certain foods and beverages can trigger GERD. Some of the more common food triggers include:
- fried or fatty foods
- carbonated beverages
- drinks containing alcohol
Some medications can cause GERD, too. Among them are:
- alpha blockers
If you take medication and have symptoms of GERD, speak to your doctor or pharmacist. They can discuss switching or stopping the medication with you. Don’t stop taking a prescribed medication without consulting your doctor first, though.
The most common symptoms of GERD are acid indigestion and heartburn. You may frequently burp and feel bloated.
Acid in your esophagus can make it spasm. That causes pain and a feeling of tightness in the chest.
Other symptoms of GERD include:
- nausea and vomiting
- difficulty swallowing
- tooth erosion and bad breath
- problems swallowing (dysphagia)
- respiratory problems
- abdominal pain
Some cases of heartburn may be a sign of a more serious condition. See your doctor if your heartburn:
- occurs more frequently than once a week
- becomes more severe
- occurs at night and wakes you from sleep
Diagnosis and treatment
Seek immediate medical attention if you have difficulty swallowing or breathing.
Consider it an emergency if:
- you’re vomiting large amounts
- you have projectile vomiting
- your vomit contains green or yellow fluid
- your vomit looks like coffee grounds
In most cases, doctors diagnose acid reflux by reviewing symptoms and medical history. If you often have heartburn or acid indigestion that won’t go away, testing for GERD may be recommended.
Diagnostic testing may include:
- Endoscopy. A fiber-optic tube is passed down your throat so your doctor can view your esophagus and stomach. Tissue samples can be taken for biopsy.
- Upper GI series X-rays. These are taken after you drink a barium solution. This procedure can find ulcers, hiatal hernias, and other abnormalities.
- Esophageal monitoring. This is a way to measure acid levels in your lower esophagus for 24 hours.
- Manometry. A manometry measures the rhythmic muscle contractions that occur in your esophagus when you swallow.
GERD can usually be managed with OTC medications, such as the following:
- Antacids can neutralize stomach acid.
- An H2 receptor blocker, like cimetidine, treats excess stomach acid.
- Proton pump inhibitors reduce the amount of acid your stomach produces.
If OTC drugs aren’t working well, your doctor can prescribe alternative medications:
- Sucralfate forms a protective film on the surface of your esophagus and stomach.
- Metoclopramide helps your esophagus contract efficiently and your stomach to empty faster.
Lifestyle changes to ease symptoms
You may be able to ease your symptoms by making a few simple changes:
- Avoid smoking and being around secondhand smoke.
- Maintain a healthy weight, and avoid tight clothing around your middle.
- Eat smaller meals. Keep a food diary so you can pinpoint and avoid the foods that trigger your symptoms.
- Try to move around a little after you eat, staying upright for three hours after meals. A short walk may go a long way.
If you don’t find relief from medication and lifestyle changes, surgery may be an option. The most common surgical treatment options include:
- Fundoplication. This is the most common surgery for GERD. Your 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.
- LINX reflux management system. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX system can be implanted using minimally invasive surgery. The U.S. Food and Drug Administration approved the LINX system in 2012 for people with GERD who haven’t been helped by other treatments.
Living with GERD
For most people, GERD is a manageable condition. If left untreated, though, GERD can lead to serious complications.
Scar tissue can cause the esophagus to become too narrow (esophageal stricture). This can make swallowing difficult and painful.
Stomach acid entering into your lungs can cause serious harm. Lung damage can make you more likely to have chest congestion and wheezing. This puts you at increased risk for recurrent pneumonia or asthma.
Long-term inflammation of the esophagus (esophagitis) increases the risk of precancerous cells in the esophagus. Severe cases of GERD can lead to a condition called Barrett’s esophagus. That’s when your esophagus grows tissue resembling the tissue found in the lining of your intestine. Barrett’s esophagus increases your risk of esophageal adenocarcinoma, a rare type of cancer.
According to the HCUP, 4.2 percent of GERD hospitalizations involved an esophageal disorder in 2005. Cases of dysphagia grew by 264 percent between 1998 and 2005. Esophageal adenocarcinoma rose by 195 percent. Esophagitis increased by 94 percent.
If you need to be hospitalized, GERD can be costly. In 1998, a hospital stay for GERD averaged $5,616 in the United States, reports HCUP. By 2005, it had risen to $6,545.
Nationally, total hospital costs for GERD were $509 million in 1998. By 2005, costs rose to $622 million, an increase of 22 percent.
In the United States alone, overall spending on all gastrointestinal diseases was estimated to be $142 billion per year in direct and indirect costs in 2009, notes a . Researchers note GERD accounts for approximately $15 to $20 billion of these direct and indirect costs.
Jen Thomas is a journalist and media strategist based in San Francisco. When she’s not dreaming of new places to visit and photograph, she can be found around the Bay Area struggling to wrangle her blind Jack Russell Terrier or looking lost because she insists on walking everywhere. Jen is also a competitive Ultimate Frisbee player, a decent rock climber, a lapsed runner, and an aspiring aerial performer.