Gastro-esophageal reflux disease (GERD) is a medical term for acid that moves into the “food swallowing tube” (esophagus) from the stomach. Sometimes acid moves up the swallowing tube, into the nose or mouth. The strong acid can burn and irritate the swallowing tube, throat, and vocal cords or cause a bad taste in your mouth. GERD symptoms are not the same for everyone. You may feel burning in your chest or throat called “heartburn” or you may have no symptoms at all.

GERD and Breathing Problems

Acid reflux into the upper portion of the swallowing tube can cause cough (especially when sleeping or during exercise), shortness of breath, wheezing, and vocal cord spasm.  Uncontrolled acid reflux can mimic asthma.

What Causes GERD?

Acid can move into the swallowing tube if the muscle at the top of the stomach opens or relaxes. Many foods and medicines can cause the muscle to relax. Acid can also move into the swallowing tube if there is pressure in the belly. This is caused by:

• Overweight
• Pregnancy
• Heavy lifting
• Bending over with full stomach
• Lying down after eating
• Wearing clothes too tight around the belly

How is GERD Diagnosed?

Often GERD is diagnosed by your symptoms. Your provider may give you a trial of medicine to see if your symptoms go away. At other times, the only way and most accurate way to diagnose GERD is with a pH probe test. The pH probe is a tiny tube that is threaded into the nose to the lower swallowing tube. It measures the acid in the swallowing tube. After 24 hours it is taken out, and the readings are checked. If acid levels are high (GERD), then medicine is started.

How is GERD Treated?

“Lifestyle” Changes:

• Lose weight if you are overweight.
• Do not lie down for 3 hours after you eat.
• Do not eat large meals.
• Put 6 inch blocks under the legs at the head of your bed.
• Do not wear tight clothes around your belly.
• Bend at your knees instead of bending over at the waist.
• Do not smoke.
• Avoid food or drinks that make your symptoms worse. Common triggers include:
  • Caffeine
  • Peppermint
  • Spearmint
  • Alcohol
  • Citrus foods
  • Spicy or fried foods
  • Onions
  • Tomatoes
  • Pop
  • Chocolate

Medicines:

Treatment is based on symptoms. Many people start treatment on their own using over-the-counter medicines. If you need medicine for indigestion or heartburn more than several times a week or your symptoms are getting worse, see your provider.

Based on your symptoms, your provider will guide treatment by “stepping” up the dose or frequency of medicine every few weeks until symptoms are gone. One the symptoms are gone, the medicine should be continued at the same dose for at least 8 weeks. After 8 weeks, your provider may try to “step down” the dose or frequency or have you stop taking the medicine. The goal is to use the least amount of medicine to control symptoms. You should continue the lifestyle changes while you are taking the medicine.

There are several types of medicines available to relieve heart burn symptoms:

1. Antacids are alkaline medicines that neutralize the acid in the stomach. They do not stop or reduce production of stomach acid.  The most common antacids are made of aluminum hydroxide (Amphojel®, AlternaGEL®); magnesium hydroxide (Phillips Milk of Magnesia®) or calcium carbonate (Tums®, Quick-Eze®, Rolaids® ). They are taken as needed and sold over-the-counter. They provide quick but temporary relief.
2. H2 blockers cut down the amount of acid made in the stomach. The most common H2 blockers include: Tagamet® (cimetidine); Zantac® (ranitidine); Axid® (nizatidine); or Pepcid® (famotidine). They are taken 1 or 2 times a day and are sold over-the-counter and by prescription.
3. Proton pump inhibitors (PPI) block acid from being made in the stomach and are the strongest of all the acid medicines. PPI include: AcipHex® (rabeprazole); Nexium® (esomepraole); Prevacid® (lansoprazole); Prilosec® (omeprazole); Protonix® (Pantoprazole). They are taken 1 or 2 times a day. Some are sold over-the-counter, but the majority require a prescription.

If you do not get better on treatment or you develop worrisome symptoms such as weight loss, problems swallowing, blood in your vomit or stools, or painful swallowing, your provider will likely send you to a stomach specialist (gastroenterologist).

When to Call Your Provider:

Call your provider if you notice:

• Side effects to the medicine
• The medicine is not working
• Problems swallowing food
• Choking (often) on food or drinks
• Blood in your bowel movement or vomit
• Losing weight without trying

 

For more information:

Go to the Gastroesophageal Reflux Disease (GERD) health topic.