GERD and Acid Reflux

Occasional heartburn is common. Heartburn that keeps coming back is worth having looked at.

Gastroesophageal reflux disease, or GERD, happens when stomach acid repeatedly flows back into the esophagus. The muscle at the bottom of the esophagus is meant to close after food passes through; when it relaxes at the wrong time or weakens, acid comes back up. Over years, that repeated exposure can inflame and damage the lining of the esophagus.

Symptoms

• Burning in the chest, often after meals or when lying down
• Regurgitation of food or a sour or bitter taste
• Difficulty or discomfort swallowing
• Chronic cough, hoarseness, or a persistent sore throat
• A sensation of a lump in the throat
• Chest pain

Chest pain is not something to self-diagnose as reflux. Heart problems can feel similar. If chest pain is new, severe, or comes with shortness of breath, sweating, or pain spreading to the arm or jaw, call 911.

When to See a Gastroenterologist

Reaching for antacids more than a couple of times a week, or taking over-the-counter acid reducers for longer than a few weeks, is a reasonable point to get evaluated. Some symptoms warrant prompt attention regardless of how long they have been going on: difficulty swallowing, food sticking, unintended weight loss, vomiting, black or bloody stools, or anemia.

How We Evaluate It

Many people are diagnosed and treated on symptoms alone. When testing is warranted, we may recommend an upper endoscopy to look directly at the esophagus and stomach and take biopsies if needed, BRAVO pH monitoring to measure how much acid is actually reaching the esophagus, or esophageal manometry to assess how the muscles are working.

Why Long-Standing Reflux Matters

In some people, years of acid exposure change the lining of the esophagus in a condition called Barrett’s esophagus, which carries an increased risk of esophageal cancer. It causes no symptoms of its own and is found on endoscopy. When it is present, we monitor it, and we can treat it endoscopically with radiofrequency ablation or mucosal resection. This is one of the better arguments for having persistent reflux evaluated rather than managed indefinitely with over-the-counter medication.

Treatment

Treatment usually starts with the practical: eating smaller meals, not lying down within a few hours of eating, raising the head of the bed, and identifying the specific foods that set off your symptoms. Weight loss helps many patients meaningfully, since excess abdominal weight increases pressure on the stomach. Medications that reduce acid production are effective and are chosen based on your symptoms and history. A minority of patients benefit from procedural or surgical treatment, and we will discuss that if it applies to you.