This common ailment—caused by acid reflux—results in a burning sensation toward the center of the breastbone (which can range from feelings of mild discomfort to searing pain). If you’re frequently getting heartburn, however, it could be a sign of a more persistent problem, known as gastroesophageal reflux disease, or GERD. So, what is GERD? How can you distinguish it from acid reflux, and is there anything you can do if you suspect your acid reflux is a more chronic issue? In the spirit of better understanding what GERD is (and hopefully getting rid of it!) here’s everything you need to know about GERD, from causes and how it’s diagnosed to the treatment options available to you.
What is GERD?
Acid reflux and GERD are caused by the same underlying factors, but GERD is the more chronic and persistent form of acid reflux. And heartburn? That’s what’s caused by the two. Douglas Drossman, M.D., founder of Drossman Gastroenterology and the Drossman Center for the Education and Practice of Biopsychosocial Care, and author of Gut Feelings, notes that experiencing acid reflux from time to time is normal and often caused by overeating, bending down or even eating foods (such as chocolate) that weaken the “gastroesophageal sphincter.” If you’re experiencing it daily, however, then you could have GERD. “GERD is a disease where gastric acid flows backwards from the stomach into the esophagus and causes damage in the lining,” Drossman explains. “The damage can be irritation, erosions or even ulcers. When the symptoms are prolonged it can cause scarring and strictures.” According to an article published in the Cleveland Clinic Journal of Medicine, GERD can actually be a precursor to other conditions including asthma, cough, sinusitis and more (all of which affect extraesophageal structures). Because this condition is more than just the occasional bout of heartburn, if you think you have GERD it is advised to see a specialist who can offer a definitive diagnosis and treatment.
What Causes GERD?
As Dr. Drossman explained, GERD is caused by frequent reflux of gastric acid and can lead to more serious issues. He adds that the root cause of this is a weakness in the gastroesophageal sphincter, “a muscle that acts as a barrier preventing the acid from rising up into the esophagus.” There are a few things known to weaken this muscle and cause the acid to rise back up, including certain foods—chocolate and tomatoes are known for this—a history of smoking and even certain medications (including Advil and Motrin). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) specifies the following medications can cause or exacerbate GERD:
Benzodiazepinescalcium channel blockers for high blood pressurecertain asthma medicinesnonsteroidal anti-inflammatory drugs (NSAIDs)and tricyclic antidepressants.
Because there are a number of root causes, Sue Mitchell, M.D., gastroenterologist at Gastroenterology Associates of Colorado Springs (GACS) and cofounder of GutWell Medical, notes that taking down a patient’s history alone may not be enough to diagnose someone with GERD. In that case, an upper endoscopy is often used, which means a doctor takes a tube with a light and lens to view your throat, esophagus and stomach, specifically. According to the American Society for Gastrointestinal Endoscopy, this is often performed with a local anesthetic or sedative, and is more accurate than an x-ray to detect things such as ulcers or inflammation. Dr. Drossman adds that there are “pH studies” that can also be done, used to test how much reflux occurs overnight.
How to Prevent GERD
There are a number of lifestyle approaches to preventing GERD that Dr. Mitchell stresses, she often approaches gastroenterology from a functional medicine standpoint that seeks to avoid medications longterm (this may be a goal as some medications such as Prilosec have been found to have long term side effects). Many of these are things you’d heard from mindful eating: chew your food well, sitting down for a meal (eating quickly and stress can impair digestion), stopping a meal when you are 75 percent full and even avoiding drinking a lot of water with your meal (she notes this dilutes your digestive enzymes). “One of the most important things you can do is really chew your food,” Dr. Mitchell advises. “When your food enters your stomach in more of a liquid form, that means your stomach doesn’t need to work as hard to break it down. The quicker it leaves your stomach the less likely you are to have heartburn.” Dr. Drossman adds to this, noting that you should avoid meals before you go to bed, as lying down can cause more reflux. If you do eat before bed, he notes you may find relief raising your head 6-8 inches (either by raising the head of the bed or by using pillows), “thereby using gravity to prevent reflux.”
How to Treat GERD
Should your endoscopy or other testing come back with a diagnosis of GERD, there are a few common treatment options. For Dr. Mitchell, should you not have any severe symptoms, a functional approach that may consist of something like high-quality digestive enzymes and some apple cider vinegar mixed with water is appropriate. However, a functional approach may not always be indicated, and in that case, a more traditional approach may be necessary. This may range from over-the-counter antacids to surgery, depending on the severity. “When the symptoms are more frequent, H2 blockers that reduce acid production have intermediate benefits,” explains Dr. Drossman. “These include Tagamet (cimetidine), Pepcid (famotidine) which can take effect within 30 minutes and last up to 6-8 hours. The most potent treatments are the Proton Pump Inhibitors (PPIs) which block acid production more effectively than H2 blockers and can rapidly heal ulcers. These include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole).” Again, recent research has noted that there are long term effects associated with PPIs, which you may want to discuss with your doctor. Dr. Drossman notes that surgery—“a fundoplication operation where the upper stomach is tightened up around the bottom of the esophagus can be done to prevent reflux”—may even be necessary depending on the level of acid damage, ulcers and strictures. In some cases, surgery has actually been found to be more successful than medication to treat GERD. Next up, read up on two simple diet changes that can ease heartburn.
Sources
American College of Gastroenterology, “Acid Reflux.”American Society for Gastrointestinal Endoscopy, “Understanding Upper Endoscopy.”Cleveland Clinic Journal of Medicine (November 2003), “Extraesophageal symptoms of GERD.”Douglas Drossman, M.D., founder of Drossman Gastroenterology and the Drossman Center for the Education and Practice of Biopsychosocial Care, and author of Gut FeelingsNational Institute of Diabetes and Digestive and Kidney Diseases, “Symptoms & Causes of GER & GERD.”New England Journal of Medicine (October 2019), “Randomized Trial of Medical versus Surgical Treatment for Refractory Heartburn.”Sue Mitchell, M.D., gastroenterologist at Gastroenterology Associates of Colorado Springs (GACS) and cofounder of GutWell MedicalU.S. Pharmacist, “Long-Term Consequences of Chronic Proton Pump Inhibitor Use.”
