Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
Many people have a little heartburn now and then, but if it happens often and is paired with regurgitation, you may have gastroesophageal reflux disease (GERD).
GERD is a chronic disorder of the digestive system caused by the lower esophageal sphincter not closing properly. This can allow stomach acid into your esophagus, causing inflammation and, in some cases, tooth erosion.
Heartburn and acid regurgitation are the main symptoms of GERD, though some people have GERD without heartburn. When symptoms are chronic, GERD can interfere with sleep and other daily functions, as well as progress to more serious conditions.
GERD is treated with lifestyle changes, such as reducing alcohol intake, quitting smoking, and avoiding trigger foods. Your doctor may also recommend over-the-counter or prescription antacids, or prescription medications such as H2 blockers and proton-pump inhibitors to suppress gastric acids. If these recommendations are diligently followed and fail, surgery may be an option.
GERD is caused by the reflux of stomach acid into the esophagus, which occurs when your lower esophageal sphincter is either weak or it relaxes when it shouldn't. Other potential causes can include obesity, smoking, diet, alcohol intake, and pregnancy. GERD can also be due to various conditions, including abnormal biologic or structural factors.
Though GERD is commonly a chronic condition that must be managed, conservative treatment is typically sufficient to do so. GERD surgery is a one-time procedure, but is generally recommended only in the presence of severe symptoms that do not respond to other treatment.
Acute attacks of GERD and the heartburn associated with it can last several hours to overnight. Pain in the abdomen associated with GERD usually occurs shortly after eating and can last from a few minutes to several hours.
In the acid reflux characteristic of GERD, you might feel a burning sensation in your chest or abdomen and may taste stomach acid in the back of your throat. Other symptoms include chest or abdominal pain that travels up to your throat and radiates to your back. You may also experience hoarseness, difficulty swallowing, a dry cough, nausea, bad breath, or difficulty sleeping or lying down.
An ambulatory acid monitor, a type of pH test, is useful when you have GERD symptoms but no esophageal damage. This test is considered the most accurate in detecting acid reflux. Performed with a thin, plastic tube armed with a sensor, it measures the amount of acid backing up into the esophagus.
Bile is a yellow-green, sticky fluid that helps with food digestion, among other important functions. It breaks down fats into fatty acids, which can then be absorbed by the digestive tract. Bile is made in the liver and stored in the gallbladder, a sort of storage sac organ attached to the underside of the liver. During meals, bile is released from the gallbladder to the liver.
Digestive diseases involve the digestive tract, which begins at the mouth and travels through the stomach, intestines, and bowels. Common examples of diseases and conditions affecting the digestive tract include inflammatory bowel disease, heartburn, and celiac disease.
An endoscopy is a minimally invasive medical procedure used to view the body’s internal organs. It can be performed without the general anesthesia often necessary for surgery, and therefore carries less risk. An endoscope is a flexible tube with a lighted camera attached that allows internal body structures to be visualized on a monitor. Endoscopy is used to diagnose a wide variety of conditions.
Esophageal manometry, also known as an esophageal motility study, is a test used to diagnose problems involving the movement and function of the esophagus. The procedure involves the insertion of a pressure-sensitive tube into your nose that is then fed into your throat, esophagus, and stomach. It is used when you have chronic reflux or swallowing problems that cannot be explained.
The lower esophageal sphincter, or LES, is the muscle that opens and closes between the esophagus and stomach. When the LES doesn't do its job properly, acids from the stomach can pass into the mouth and throat.
Stomach acid, which is also called gastric acid, helps break down food for digestion in the stomach. The stomach has a protective lining that prevents damage from gastric acids. However, if stomach acids reach the throat as a result of heartburn or GERD, they can cause pain and irritation.
Explore an interactive model below that illustrates the consequences of the lower esophageal sphincter not closing properly in GERD, and how, as a result, stomach acid can causes inflammation in the esophagus as well as tooth erosion.