What causes Gastroesophageal Reflux Disease? Gastroesophageal reflux disease (GERD) occurs when acid flows back up (refluxes) into the esophagus. The most common causes of GERD are abnormal relaxation of the muscle at the lower end of the esophagus (called the lower esophageal sphincter) and the presence of a hiatal hernia (displacement of part of the stomach into the chest). Obesity, smoking, excess alcohol use, pregnancy and consumption of certain foods and beverages may also contribute to reflux symptoms.

How is GERD diagnosed? When a patient has symptoms of GERD, namely heartburn, it is usually not necessary to perform additional tests before starting treatment. If GERD symptoms do not respond to treatment, or if other symptoms such as weight loss, trouble swallowing or

internal bleeding are present, then additional testing may be necessary. Additional studies might include an upper endoscopy or testing the amount of acid that refluxes into your esophagus (pH test). During upper endoscopy, a thin, flexible tube with a camera and a light on it is passed down your throat to allow the physician to visually examine your digestive tract.

How are the symptoms of GERD treated? Reflux symptoms often improve with dietary or lifestyle changes. Avoiding the following foods and beverages might reduce your heartburn:

• coffee, tea

• citrus drinks (such as orange or lemon juice)

• tomato-based products

• carbonated beverages

• chocolate

• peppermint

• fatty or spicy foods

• eating before bedtime

• smoking

• alcohol consumption

• weight gain

Why is it important to treat GERD? For some people, frequent heartburn reduces their quality of life. In addition, having GERD for a long time can cause inflammation, ulcers, scarring with narrowing (called a stricture) in the esophagus. It can also lead to Barrett’s esophagus, which is a rare condition that increases the risk of cancer of the esophagus.

Understanding Gastroesophageal Reflux Disease

IMPROVING DIGESTIVE HEALTH THROUGH EXCELLENCE IN ENDOSCOPY

What is Gastroesophageal Reflux Disease (GERD)?GERD occurs when stomach acid flows back up (refluxes) into the esophagus. This happens when the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.

What are the symptoms of Gastroesophageal Reflux Disease?Heartburn is the most common symptom of gastroesophageal reflux disease. Heartburn is a burning sensation felt behind the breastbone that happens when stomach acid irritates the lining of the esophagus. There also may be an acid taste in your throat. Less common symptoms include chest pain, wheezing, sore throat, hoarseness and cough.

Gastroesophageal reflux occurs when contents in the stomach flow back up into the esophagus because the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.

When GERD symptoms do not respond to treatment or if there are other symptoms, your physician might recommend an upper endoscopy. During an upper endoscopy, the physician uses an endoscope to look at the lining of the esophagus, stomach and duodenum (the first part of the small intestine). An endoscope is a thin, flexible tube with a camera and a light on the end of it.

What treatments can help GERD? Antacids are commonly used for short-term relief of heartburn. They have a limited role in treating reflux disease because they only work for a brief time.

Histamine receptor blockers (such as ranitidine) decrease acid production in the stomach. These medications work well for treating mild reflux symptoms. They are safe and have few side effects.

Proton pump inhibitors (such as omeprazole), also called PPIs, are highly effective in treating both GERD and often the inflammation it causes. They are typically taken once or twice every day before meals. These medications are safe, but may have some side effects that you should discuss with your doctor.

Surgery should be considered in patients with well-documented (or long-term) reflux disease who cannot take medications or who have tried other treatments but continue to have symptoms. A comprehensive medical evaluation should be completed before considering surgery. The most common surgery for treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is corrected and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach.

When should I see my doctor? Most patients will first try to control symptoms by lifestyle changes or over the counter medication. Patients should consult their doctor if symptoms persist or they develop unexplained weight loss, trouble swallowing or internal bleeding.

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Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

GERD (gastroesophageal reflux disease) can be related to hiatal hernia (displacement of part of the stomach into the chest), obesity, pregnancy, smoking, excess alcohol use and consumption of certain foods or beverages such as coffee, citrus drinks, tomato-based products, chocolate, peppermint and fatty or greasy foods.

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Since its founding in 1941, ASGE has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. This information is the opinion of and provided by the American Society for Gastrointestinal Endoscopy.

Gastrointestinal endoscopy helps patients through screening, diagnosis and treatment of digestive diseases. Visit www.asge.org to learn how you can support GI endoscopic research, education and public outreach through a donation to the ASGE Foundation.

Copyright © 2014 American Society for Gastrointestinal Endoscopy

For more information, visit www.asge.org or www.screen4coloncancer.org

Symptoms of gastroesophageal reflux disease sometimes disappear if certain items are eliminated from the diet.

SMALL INTESTINE

ESOPHAGUS

LOWER ESOPHAGEAL

SPHINCTER

STOMACHDUODENUM

In an upper endoscopy, the physician passes a thin, flexible tube called an endoscope through your mouth and into the esophagus, stomach and duodenum.