Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is the backward flow (reflux) of acid from the stomach into the esophagus. The valve between the stomach and the esophagus (the tube that connects the stomach to your mouth) becomes weak and allows stomach acid to flow upward. This can cause irritation to the lining of the esophagus. Sometimes the damage to the lining is called erosive esophagitis or esophagitis. Complications include esophagitis, strictures and Barrett’s esophagus. Barrett’s is a change of the lining of the esophagus to look like the lining of the stomach and can lead to cancer in a small number of patients. Yet, most reflux is not this severe. This handout will help explain GERD. If you have any questions, please ask your nurse or doctor.
What can you do?
Avoid things that make GERD worse
- Cut down or quit smoking.
- Do not use belts or clothes that are tight fitting around the waist.
- Raise the head of your bed so it is 6 to 8 inches higher than the foot of the bed (using extra pillows is not enough).
- Do not use a stack of pillows that causes bending at the waist.
- Exercise, but not close to bedtime as it may make the symptoms worse.
- Bending over or lying down may cause GERD symptoms to worsen in some people.
- Do not eat too much food at one time. Four to five small meals are better than three big meals.
- Chew your food well.
- If you are going to use alcohol, drink a small amount with a meal. Alcohol makes your stomach put out more acid. Drinking it with food helps to buffer the stomach acid.
- Do not eat or drink within 3 hours of bedtime.
- Being overweight makes the symptoms worse. If you need to lose weight, please ask your doctor or nurse for advice.
- Do not eat meals that are high in fat and low in fiber.
- Avoid foods and drinks that cause heartburn and indigestion. Some people report that all foods or drinks cause symptoms and others are not bothered by any. Some examples are:
- hot spicy food
- orange juice, grapefruit juice
- peppermint and spearmint
- tomato products
- caffeinated or decaffeinated coffee, soda, chocolate
- Tell your doctor or health care provider the medicines that you are taking.
- Do not stop taking your medicines without first talking to your doctor.
- The following can cause or worsen GERD symptoms:
- Alendronate (Fosamax®), Pamidronate (Aredia®), Risedronate (Actonel®)
- Anticholinergic agents such as dicyclomine, clidinium, belladonna alkaloids, atropine, hyoscyamine, propantheline
- Albuterol tablets and syrup
- Clindamycin (Cleocin®), Doxycycline (Vibramycin®), Tetracycline
- Ferrous sulfate (Iron supplements)
- Nicotine replacement
- Anti-inflammatory medications such as aspirin, ibuprofen
- Nifedipine (Adalat®, Procardia®)
- Potassium Supplements (Slow K®)
- Warfarin (Coumadin®)
Signs and Symptoms of GERD
- Heartburn or other symptoms 2 or more times per week
- Acid or sour taste in your mouth
- Food from the stomach backing up into your mouth
- In more severe cases
- Weight loss without trying to lose weight
- Trouble swallowing
- Feeling that food is trapped in your chest behind the breast bone
- Burning chest pain that moves up toward the neck and throat
- Symptoms lasting up to several hours and often worsened by eating
- Vomiting blood or having tarry black bowel movements
- Feeling of acid backing up into the windpipe causing shortness of breath, dry cough or hoarseness
Your doctor may want you to have an endoscopy to help make a diagnosis. A doctor passes a flexible tube that has a light on one end and an eyepiece at the other down your throat and into your esophagus and stomach to look at the lining of your stomach. You will receive drugs before the procedure so that you may not even remember it after it is over. For more details ask for Health Facts for You #4330.
The goal in treating GERD is to stop the symptoms, heal esophagitis, prevent it from coming back, and avoid further problems. Along with making changes in diet and habits, the drugs listed below may be used:
- Antacids such as Tums®, Rolaids®, Maalox®, or Mylanta® may stop or help mild symptoms and are used as needed for quick relief. They neutralize stomach acid. Antacids that contain alginic acid like Gaviscon® may be more effective in GERD. You can buy these without a prescription and they can be used with newer medicines to treat GERD.
- H2 blockers such as ranitidine (Zantac®), cimetidine (Tagamet®), famotidine (Pepcid®) and nizatidine (Axid®) reduce the amount of stomach acid. They decrease the backflow of stomach acid into the esophagus and help relieve symptoms. Low doses of H2 blockers can be bought without a prescription and work well for mild reflux. With a prescription, you can get larger doses. When taken twice a day, they work well in treating GERD and are used to prevent the return of symptoms.
- Proton pump inhibitors (PPIs) such as esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec, Prilosec OTC®) pantoprazole (Protonix®), and rabeprazole (Aciphex®) stop the production of acid in the stomach. These medicines work to heal more serious forms of GERD and are used to prevent symptoms from coming back.
- Promotility agents such as metoclopramide (Reglan®) help prevent the backflow of stomach acid by making the valve between the stomach and esophagus stronger. Metoclopramide also moves food and gastric juices through the stomach more quickly. It can treat mild to moderate GERD when the stomach and intestines move too slowly and cause the symptoms.
More information can be found at the following internet addresses:
- The American Gastroenterological Association at: http://www.gastro.org/
- The National Digestive Diseases Information Clearinghouse at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 09/21/2011
Copyright © 11/23/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5694
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