What is GERD or Heartburn?

Gastro esophageal reflux refers to the backward flow of acid from the stomach up into the esophagus. People will experience heartburn, also known as acid indigestion, when excessive amounts of acid reflux into the esophagus. Most people describe heartburn as a feeling of burning chest pain, localized behind the breastbone that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last as long as 2 hours and are often worsened by eating food.

How does reflux occur?

The Lower Esophageal Sphincter (LES) is an anatomically and physiologically complex group of muscles at the lower esophagus. This sphincter is supposed to stay tightly closed, unless you are swallowing, to prevent stomach contents from refluxing up into the esophagus. If this sphincter becomes weak, or if it frequently relaxes while you are not swallowing, stomach contents reflux up into the esophagus. Certain foods may cause this sphincter to become weak, for example: caffeine, mint, chocolate, onion, tomatoes, and many others. Smoking also causes the LES to relax frequently.

How common is GERD?

Over 60 million Americans experience acid indigestion at least once a month and some studies have suggested that over 15 million Americans experience acid indigestion daily. Symptoms of acid indigestion are more common among the elderly and women during pregnancy.

How are GERD’s symptoms treated?

In many cases, acid indigestion can be controlled by modifying lifestyles and proper use of over-the-counter medicines:

• Avoid foods and beverages which contribute to acid indigestion: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages.
• Stop smoking. Tobacco stimulates stomach acid production and relaxes the Lower Esophageal Sphincter, permitting acid reflux to occur.

• Reduce weight if obese.
• Avoid eating 2-3 hours before sleep.
• Raise the head of the bed using a 6-inch block.
• Take an over-the-counter antacid or an H2 blocker (e.g. Zantac or Pepcid), some of which are now available without a prescription.  You may also try a Proton Pump Inhibitor (PPI), for example Prilosec OTC.

When Should You See a Doctor about GERD?

When symptoms of acid indigestion are not controlled with modifications in lifestyle, and over-the-counter medicines are needed more often than twice a week, you should see your doctor.

You should also see you doctor if you develop any of the following “alarming” symptoms:

• Dysphagia: A feeling that food is trapped behind the breast bone; this may indicate the presence of an esophageal stricture (a narrowing or obstruction of the esophagus).
• Bleeding: Vomiting blood or tarry, black bowel movements; this may indicate esophagitis (inflammation of the esophagus).
• Choking: Sensation of acid refluxed into the windpipe causing shortness of breath, coughing and hoarseness of the voice.
• If you have had frequent GERD symptoms (3 times per week or more) for 3 years or more. An EGD may be indicated to rule out Barrett’s esophagus.

What is the role of endoscopy in GERD?

EsophagoGastroDuodenoscopy (EGD) is the single best test to evaluate the esophagus for damage from GERD. It may show:

• Esophagitis: inflammation of the mucosal lining of the esophagus. In most cases, mucosal erosions will be seen. In more severe cases, esophageal ulcers are present. Bleeding may occur. Tissue biopsies may be obtained during endoscopy. This helps to confirm the diagnosis.

Endoscopic view of a normal lower esophagus


Endoscopic view of esophagitis as shown using Narrow Band Imaging

• Strictures: narrowing of the esophagus. This may occur as a result of ongoing, untreated esophagitis which may result in scarring of the esophagus. Scarring may lead to narrowing of the lumen of the esophagus. Food may get caught above the stricture resulting in difficulty swallowing (Dysphagia). During endoscopy, the esophageal lumen may be dilated (stretched) to help restore its normal diameter thus facilitating normal swallowing again.

Endoscopic view of a lower esophageal stricture


A balloon is used, during endoscopy, to dilate the stricture

• Barrett’s esophagus:  is a condition in which an abnormal, intestinal type epithelium, replaces the squamous epithelium that normally lines the lower part of the esophagus. This is an important condition because people who have it have a small increased risk of developing esophageal adenocarcinoma (cancer). Barrett’s esophagus occurs more commonly in Caucasian males. During endoscopy, tissue biopsy may be obtained to evaluate for dysplasia (an abnormal cell that may change to cancer).

Endoscopic view of Barrett’s esophagus