Overview

Causes

A ring of muscle controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not fully close, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are many reasons that the ring may not close tightly, including:

  • Problems with the nerves that control the muscles of the ring
  • Problems with muscle tone of the ring
  • Muscles that move food down into the stomach are weak
  • Abnormal pressure on the area
  • The muscles relax more than they should
  • More pressure within the belly that pushes up against the stomach
Heartburn
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Risk Factors

Things that may raise the risk of heartburn or GERD include:

  • Obesity
  • Smoking
  • Alcohol use
  • Exercising or intense activity right after eating
  • Lying down, bending over, or straining after eating
  • Pregnancy
  • Past surgery for heartburn
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube

Foods and drinks that are more likely to cause symptoms include:

  • Caffeinated products
  • Carbonated drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
  • Large or fatty meals

Medicines and supplements that can cause symptoms may include:

  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates

SymptomsandDiagnosis

Symptoms

Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat—most common symptom
  • Regurgitation—a feeling that food is coming back up
  • Sour or bitter taste in the throat
  • Burping
  • Bloating

The repeated, regular episodes can lead to other symptoms such as:

  • Sore throat
  • Hoarseness
  • Chronic laryngitis
  • Chronic cough
  • Feeling of a lump in the throat
  • Waking up with a feeling of choking
  • Problems swallowing

Problems that GERD can cause after a long time may include:

  • Swelling and scarring of the esophagus—esophagitis
  • Bleeding and ulcers in the esophagus
  • Narrowing of the esophagus— esophageal stricture
  • Dental problems, which may happen because stomach acid harms tooth enamel
  • Asthma attacks
  • Vomiting blood
  • Black or tarry stools
  • Precancerous condition that can lead to esophageal cancer— Barrett esophagus
  • Esophageal cancer

When Should I Call My Doctor?

People who have heartburn two or more times a week, every week, should make an appointment to see their doctor.

Diagnosis

The doctor will ask about symptoms and past health. Heartburn or GERD will be suspected based on symptoms. The doctor may do a trial with medicine. If the symptoms are managed with medicine it will confirm GERD.

More testing is not always needed. To better plan treatment the doctor may order:

  • Upper GI series
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
  • Manometry to test muscle strength in the lower esophagus

Treatments

Treatment

The goals of treatment are to prevent more symptoms and heal any damage. How this is done will depend the cause of the heartburn. Some options are:

Lifestyle Changes

Tracking food can help show what may be causing the most problems. Avoiding foods can help prevent heartburn. Reducing pressure on the stomach may also help. This can be done by:

  • Eating smaller portions.
  • Not lying down or exercising for at least two to three hours after a meal.
  • Not wearing tight clothing and belts.

Other steps that may ease heartburn include:

Medication

Medicine may help ease symptoms. Some can also help repair damage. They can treat heartburn that has started or may help stop heartburn from starting. The doctor may advise:

  • Proton-pump inhibitors
  • H2 blockers
  • Antacids

Some medicines should only be used for short periods of time.

Surgery

Heartburn that is severe or does not respond to treatment may need surgery. Options include:

Fundoplication

The most common surgery for GERD is fundoplication . The doctor wraps the stomach around the esophagus. This helps keep the opening to the stomach closed.

Endoscopic Antireflux Procedures

There are many procedures that can be done with an endoscope. The scope passes through the mouth to the stomach. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach. It will help tighten the opening to the stomach.

LINX Reflux Management System

LINX is a small band with magnetic beads. A surgeon places the band around the end of the esophagus where it meets the stomach. The magnets pull together to help close the opening. Swallowed food or drink push apart the beads so that it can move into the stomach.

Some people will be able to stop or reduce medicine after surgery.

Some people will be able to stop or reduce medicine after surgery.

Prevention

There are no current guidelines to prevent GERD.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.