Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults
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Gastroesophageal Reflux (GER)
and Gastroesophageal Reflux
Disease (GERD) in Adults
National Digestive Diseases Information Clearinghouse
What is GER? Read more about over-the-counter
medications in the section “How is GERD
Gastroesophageal reflux (GER) occurs
treated?”
when stomach contents flow back up into the
esophagus—the muscular tube that carries
food and liquids from the mouth to the What is GERD?
stomach. Gastroesophageal reflux disease (GERD) is
GER is also called acid reflux or acid a more serious, chronic––or long lasting––
regurgitation because the stomach’s digestive form of GER. GER that occurs more
juices contain acid. Sometimes people with than twice a week for a few weeks could
GER can taste food or acidic fluid in the be GERD, which over time can lead to
back of the mouth. Refluxed stomach acid more serious health problems. People with
that touches the lining of the esophagus suspected GERD should see a health care
can cause heartburn. Also called acid provider.
indigestion, heartburn is an uncomfortable,
burning feeling in the midchest, behind What causes GERD?
the breastbone, or in the upper part of the Gastroesophageal reflux disease results when
abdomen—the area between the chest and the lower esophageal sphincter—the muscle
the hips. that acts as a valve between the esophagus
Occasional GER is common. People may be and stomach—becomes weak or relaxes
able to control GER by when it should not, causing stomach contents
to rise up into the esophagus.
• avoiding foods and beverages that
contribute to heartburn, such as Abnormalities in the body such as hiatal
chocolate, coffee, peppermint, greasy hernias may also cause GERD. Hiatal
or spicy foods, tomato products, and hernias occur when the upper part of the
alcoholic beverages stomach moves up into the chest. The
stomach can slip through an opening found
• avoiding overeating in the diaphragm. The diaphragm is the
• quitting smoking muscle wall that separates the stomach from
the chest. Hiatal hernias may cause GERD
• losing weight if they are overweight
because of stomach acid flowing back up
• not eating 2 to 3 hours before sleep through the opening; however, most produce
no symptoms.
• taking over-the-counter medicationsOther factors that can contribute to GERD What is the gastrointestinal
include
(GI) tract?
• obesity The GI tract is a series of hollow organs
• pregnancy joined in a long, twisting tube from the
mouth to the anus. The movement of
• certain medications, such as asthma muscles in the GI tract, along with the
medications, calcium channel blockers, release of hormones and enzymes, starts
and many antihistamines, pain killers, the digestion of food. The upper GI tract
sedatives, and antidepressants includes the mouth, esophagus, stomach,
• smoking, or inhaling secondhand smoke small intestine, and duodenum, which is the
first part of the small intestine.
People of all ages can develop GERD, some
for unknown reasons.
Stomach
Mouth Esophagus
Lower
Esophagus esophageal
sphincter
Acid
Lower Small
esophageal intestine
sphincter
Stomach
Small
intestine
Anus
GERD results when the lower esophageal sphincter—the muscle that acts as a valve between the esophagus and
stomach—becomes weak or relaxes when it should not, causing stomach contents to rise up into the esophagus.
2 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in AdultsWhat are the symptoms of a look at the shape of the upper GI tract.
An x-ray technician performs this test at
GERD? a hospital or an outpatient center, and a
The main symptom of GERD is frequent radiologist—a doctor who specializes in
heartburn, though some adults with GERD medical imaging—interprets the images.
do not have heartburn. Other common This test does not require anesthesia. No
GERD symptoms include eating or drinking is allowed before the
• a dry, chronic cough procedure, as directed by the health care
staff. People should check with their
• wheezing gastroenterologist about what to do to
• asthma and recurrent pneumonia prepare for an upper GI series.
• nausea During the procedure, the person will stand
or sit in front of an x-ray machine and drink
• vomiting
barium, a chalky liquid. Barium coats the
• a sore throat, hoarseness, or laryngitis— esophagus, stomach, and small intestine so
swelling and irritation of the voice box the radiologist and gastroenterologist can
see theses organs’ shapes more clearly on
• difficulty swallowing or painful
x rays. The barium shows problems related
swallowing
to GERD, such as hiatal hernias. While an
• pain in the chest or the upper part of upper GI series cannot detect mild irritation,
the abdomen the test can detect esophageal strictures—
• dental erosion and bad breath narrowing of the esophagus that can result
from GERD—as well as ulcers, or sores.
How is GERD diagnosed? A person may experience bloating and
nausea for a short time after the test. For
A health care provider may refer people with
several days afterward, barium liquid in
suspected GERD to a gastroenterologist—a
the GI tract causes white or light-colored
doctor who specializes in digestive diseases—
stools. A health care provider will give the
for diagnosis and treatment.
person specific instructions about eating and
Lifestyle changes and medications are often drinking after the test.
the first lines of treatment for suspected
Upper endoscopy. A gastroenterologist
GERD. If symptoms improve with these
may use an upper endoscopy, also known
treatment methods, a GERD diagnosis
as an esophagogastroduodenoscopy, if a
often does not require testing. However,
person continues to have GERD symptoms
to confirm a diagnosis, a person may need
despite lifestyle changes and treatment
testing if symptoms do not improve. People
with medications. An upper endoscopy is a
with possible GERD who have trouble
common test used to evaluate the severity
swallowing also may require testing.
of GERD. This procedure involves using
A completely accurate test for diagnosing an endoscope—a small, flexible tube with a
GERD does not exist. However, several light—to see the upper GI tract.
tests can help with diagnosis:
A gastroenterologist performs this test at
Upper GI series. While a gastroenterologist a hospital or an outpatient center. The
does not use an upper GI series to diagnose person may receive a liquid anesthetic that is
acid reflux or GERD, the test can provide gargled or sprayed on the back of the throat.
3 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in AdultsIf sedation is used, a health care provider This test is most useful when combined with
will place an intravenous (IV) needle in the a carefully kept diary of when, what, and
person’s vein. how much food the person eats and GERD
symptoms that result. The gastroenterologist
After the person receives sedation, the
can see correlations between symptoms and
gastroenterologist carefully feeds an
certain foods or times of day. The procedure
endoscope through the mouth and down
can also help show whether reflux triggers
the esophagus, then into the stomach and
respiratory symptoms.
duodenum. A small camera mounted on
the endoscope transmits a video image to a Esophageal manometry. Esophageal
monitor, allowing close examination of the manometry measures muscle contractions
intestinal lining. The gastroenterologist uses in the esophagus. A gastroenterologist may
the endoscope to take a biopsy, a procedure order this test when considering a person for
that involves taking a small piece of anti-reflux surgery. The gastroenterologist
esophageal tissue. A pathologist—a doctor performs this test during an office visit. A
who specializes in diagnosing diseases—will person may receive anesthetic spray on
examine the tissue with a microscope and the inside of the nostrils or back of the
determine the extent of inflammation. throat. The gastroenterologist passes a
soft, thin tube through the person’s nose
A gastroenterologist diagnoses GERD when
into the stomach. The person swallows as
the test shows injury to the esophagus in
the gastroenterologist pulls the tube slowly
a person who has had moderate to severe
back into the esophagus. A computer
GERD symptoms.
measures and records the pressure of the
Esophageal pH monitoring. The most muscle contractions in different parts of the
accurate test to detect acid reflux, esophageal esophagus. The test can show if symptoms
pH monitoring measures the amount of are due to a weak sphincter muscle. A
liquid or acid in the esophagus as the person health care provider can also use the test to
goes about normal activities, including eating diagnose other disorders of the esophagus
and sleeping. A gastroenterologist performs that might have similar symptoms as
this test at a hospital or an outpatient center heartburn. Most people can resume regular
as a part of an upper endoscopy. The person activity, eating, and medications right after
can remain awake during the test. Sedation the test.
is not required for the test; however, it can
be used if necessary. How is GERD treated?
A gastroenterologist will pass a thin tube, Treatment for GERD may involve one or
called a nasogastric probe, through the more of the following, depending on the
person’s nose or mouth to the stomach. The severity of symptoms: lifestyle changes,
gastroenterologist will then pull the tube medications, or surgery.
back into the esophagus, where it will be
taped to the person’s cheek and remain in Lifestyle Changes
place for 24 hours. The end of the tube in Some people can reduce GERD symptoms by
the esophagus has a small probe to measure
when and how much liquid or acid comes up • losing weight, if needed
into the esophagus. The other end of the • wearing loose-fitting clothing around
tube, attached to a monitor outside the body, the stomach area, as tight clothing can
shows the measurements taken. constrict the area and increase reflux
4 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults• remaining upright for 3 hours after with GERD. Health care providers most
meals commonly prescribe PPIs for long-term
management of GERD. However, studies
• raising the head of the bed 6 to 8 inches
show people who take PPIs long term or in
by securing wood blocks under the
high doses are more likely to have hip, wrist,
bedposts––just using extra pillows will
and spinal fractures. People should take
not help
these medications on an empty stomach in
• avoiding smoking and being around order for stomach acid to activate them.
others who are smoking
Prokinetics, which include bethanechol
Medications (Urecholine) and metoclopramide
People can purchase many GERD (Reglan), help make the stomach empty
medications without a prescription; however, faster. However, both bethanechol and
people with persistent symptoms should still metoclopramide have side effects that often
see a health care provider. limit their use, including nausea, diarrhea,
tiredness, depression, anxiety, and problems
Antacids, which include over-the-counter with physical movement. Prokinetics can
medications such as Alka-Seltzer, Maalox, interact with other medications, so people
Mylanta, Rolaids, and Riopan, are a first- taking prokinetic agents should tell their
line approach health care providers usually health care provider about all medications
recommend to relieve heartburn and other they are taking.
mild GERD symptoms. Antacids, however,
can have side effects, including diarrhea and Antibiotics, including one called
constipation. erythromycin, have been shown to
improve gastric emptying. Erythromycin
H2 blockers, such as cimetidine (Tagamet has fewer side effects than bethanechol
HB), famotidine (Pepcid AC), nizatidine and metoclopramide; however, like all
(Axid AR), and ranitidine (Zantac 75), antibiotics, it can cause diarrhea.
decrease acid production. These medications
are available in both over-the-counter and All of these medications work in different
prescription strengths. H2 blockers provide ways, so combinations of medications may
short-term or on-demand relief and are help control symptoms. People who get
effective for many people with GERD heartburn after eating may take antacids
symptoms. They can also help heal the and H2 blockers. The antacids neutralize
esophagus, although not as well as proton stomach acid, and the H2 blockers stop acid
pump inhibitors (PPIs). production. By the time the antacids stop
working, the H2 blockers have stopped acid
PPIs include omeprazole (Prilosec, Zegerid), production.
lansoprazole (Prevacid), pantoprazole
(Protonix), rabeprazole (Aciphex), and Surgery
esomeprazole (Nexium), which are When a person cannot manage severe
available by prescription. Omeprazole and GERD symptoms through medication or
lansoprazole also come in over-the-counter lifestyle changes, a health care provider may
strength. PPIs are more effective than recommend surgery. A health care provider
H2 blockers and can relieve symptoms and may also recommend surgery for GERD
heal the esophageal lining in most people that results from a physical abnormality or
5 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adultsfor GERD symptoms that lead to severe What are the long-term
respiratory problems. Fundoplication is the
standard surgical treatment for GERD and
complications of GERD?
leads to long-term reflux control in most Untreated GERD can sometimes cause
cases. A gastroenterologist or surgeon may serious complications over time, including
also use endoscopic techniques to treat • esophagitis—irritation of the esophagus
GERD. However, the success rates of from refluxed stomach acid that
endoscopic techniques are not completely damages the lining and causes bleeding
known, as researchers have not tested them or ulcers. Adults who have chronic
enough in clinical trials. People are more esophagitis over many years are more
likely to develop complications from surgery likely to develop precancerous changes
than from medications. Anti-reflux surgery in the esophagus.
is most successful in people younger than 50.
• strictures that lead to swallowing
Fundoplication is an operation to sew the difficulties.
top of the stomach around the esophagus
to add pressure to the lower end of the • respiratory problems, such as trouble
esophagus and reduce reflux. A surgeon breathing.
performs fundoplication using a laparoscope, • Barrett’s esophagus, a condition in
a thin tube with a tiny video camera attached which the tissue lining the esophagus
used to look inside the body. The surgeon is replaced by tissue similar to the
performs the operation at a hospital or an lining of the intestine. A small number
outpatient center, and the person receives of people with Barrett’s esophagus
general anesthesia. People can leave the develop a rare yet often deadly type
hospital or outpatient center in 1 to 3 days of cancer of the esophagus. Read
and return to their daily activities in 2 to more in Barrett’s Esophagus at
3 weeks. www.digestive.niddk.nih.gov.
Endoscopic techniques, such as A health care provider should monitor a
endoscopic sewing and radiofrequency, person with GERD to prevent or treat long-
help control GERD in a small number term complications.
of people. Endoscopic sewing uses small
stitches to tighten the sphincter muscle.
Radiofrequency creates heat lesions that
Eating, Diet, and Nutrition
help tighten the sphincter muscle. Surgery People with GERD can often reduce reflux
for both techniques requires an endoscope. by avoiding foods and drinks that worsen
A surgeon performs the operation at a symptoms. Other dietary changes that can
hospital or an outpatient center, and the help reduce symptoms include decreasing
person receives anesthesia. Although the fat intake and eating small, frequent meals
devices for these procedures are approved, instead of three large meals. People who
results may not be as good as laparoscopic are overweight can talk with a health care
surgery, and these procedures are not provider about dietary changes that can
commonly used. help them lose weight, which may decrease
GERD symptoms.
6 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in AdultsHope through Research
Points to Remember The Division of Digestive Diseases and
• Gastroesophageal reflux (GER) Nutrition at the National Institute of
occurs when stomach contents flow Diabetes and Digestive and Kidney Diseases
back up into the esophagus. (NIDDK) supports basic and clinical
research into GI diseases, including GER
• GER is also called acid reflux or and GERD.
acid regurgitation because the
stomach’s digestive juices contain Clinical trials are research studies involving
acid. people. Clinical trials look at safe and
effective new ways to prevent, detect, or
• Gastroesophageal reflux disease treat disease. Researchers also use clinical
(GERD) is a more serious, chronic trials to look at other aspects of care, such
form of GER. as improving the quality of life for people
• GERD results when the lower with chronic illnesses. To learn more about
esophageal sphincter becomes clinical trials, why they matter, and how to
weak or relaxes when it should not, participate, visit the NIH Clinical Research
causing stomach contents to rise up Trials and You website at www.nih.gov/health/
into the esophagus. clinicaltrials. For information about current
studies, visit www.ClinicalTrials.gov.
• The main symptom of GERD is
frequent heartburn, though some
adults with GERD do not have For More Information
heartburn. American College of Gastroenterology
• Other common GERD symptoms 6400 Goldsboro Road, Suite 200
include asthma or recurrent Bethesda, MD 20817–5846
pneumonia, difficulty swallowing or Phone: 301–263–9000
painful swallowing, and pain in the Fax: 301–263–9025
chest. Email: info@acg.gi.org
Internet: www.gi.org
• A health care provider may refer
people with suspected GERD to American Gastroenterological Association
a gastroenterologist for diagnosis 4930 Del Ray Avenue
and treatment. Bethesda, MD 20814
Phone: 301–654–2055
• Treatment for GERD may involve Fax: 301–654–5920
one or more of the following, Email: member@gastro.org
depending on the severity of Internet: www.gastro.org
symptoms: lifestyle changes,
medications, or surgery. International Foundation for Functional
Gastrointestinal Disorders
• A health care provider should
700 West Virginia Street, Suite 201
monitor a person with GERD
Milwaukee, WI 53204
to prevent or treat long-term
Phone: 1–888–964–2001 or 414–964–1799
complications.
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org
7 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in AdultsAcknowledgments National Digestive Diseases
Publications produced by the Clearinghouse Information Clearinghouse
are carefully reviewed by both NIDDK 2 Information Way
scientists and outside experts. This Bethesda, MD 20892–3570
publication was originally reviewed by M. Phone: 1–800–891–5389
Brian Fennerty, M.D., Oregon Health and TTY: 1–866–569–1162
Science University, and Benjamin D. Gold, Fax: 703–738–4929
M.D., Emory University School of Medicine. Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
You may also find additional information about this The National Digestive Diseases Information
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the conditions they treat. When prepared, this
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NIH Publication No. 13–0882
September 2013
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