Reflux means that stomach acid and juices flow from the stomach back up into the tube that leads from the throat to the stomach (esophagus). This causes heartburn. When you have heartburn that bothers you often, it is called gastroesophageal reflux disease, or GERD.
Eating too much or bending forward after eating sometimes causes heartburn and a sour taste in the mouth. But having heartburn from time to time doesn't mean that you have GERD. With GERD, the reflux and heartburn last longer and come more often. If this happens to you, be sure to get it treated, because GERD can cause ulcers and damage to your esophagus.
What causes GERD?
Normally when you swallow your food, it first travels down the food pipe (esophagus). A valve opens to let the food pass into the stomach, and then the valve closes. With GERD, the valve doesn't close tightly enough. Stomach acid and juices from the stomach flow back up (reflux) into the esophagus.
The main symptom is heartburn. It may feel like a burning, warmth, or pain just behind the breastbone. It is common to have symptoms at night when you're trying to sleep. If you have pain behind your breastbone, it is important to make sure that it isn't caused by a problem with your heart. The burning sensation caused by GERD usually occurs after you eat. Pain from the heart usually feels like heaviness, tightness, discomfort, or a dull ache. It occurs most often after you are active.
How is GERD diagnosed?
First, your doctor will do a physical exam and ask you questions about your health. You may or may not need further tests. Your doctor may just treat your symptoms by recommending medicines that reduce or block stomach acid. These include H2 blockers such as famotidine (Pepcid) and proton pump inhibitors such as omeprazole (Prilosec). If your heartburn goes away after you take the medicine, your doctor will likely diagnose GERD.
For mild symptoms, you can try over-the-counter medicines. These include antacids (for example, Tums), H2 blockers (for example, Pepcid), and proton pump inhibitors (for example, Prilosec). Changing your diet, losing weight if needed, and making other lifestyle changes can also help. If you still have symptoms after trying lifestyle changes and over-the-counter medicines, talk to your doctor.
Your doctor might recommend surgery if medicine doesn't work or if you can't take medicine because of the side effects. Fundoplication surgery strengthens the valve between the esophagus and the stomach. But many people continue to need some medicine even after surgery.
GERD is common in pregnant women. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Most nonprescription antacids are safe to use during pregnancy to treat symptoms. Antacids that contain sodium bicarbonate can cause fluid to build up, so they should not be taken by pregnant women. And do not use antacids that have magnesium trisilicate, because they may not be safe for your baby. But it is okay to use antacids that contain calcium carbonate (such as Tums). If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. Most of the time, symptoms get better after the baby is born.
How can you manage GERD?
You might need to take medicine for many years to help control the symptoms. But you can also make changes to your lifestyle to help relieve your symptoms. Here are some things to try:
- Change your eating habits.
- It's best to eat several small meals instead of two or three large meals.
- After you eat, wait two to three hours before you lie down. Late-night snacks aren't a good idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
- Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
- Don't smoke or chew tobacco.
- If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows doesn't work.)
- Don't wear tight clothing around your middle.
- Lose weight if you need to. Losing just five to 10 pounds can help.