GASTROESOPHAGEAL REFLUX DISEASE

General Information

DEFINITION--A reflux (backward or return flow) of fluid of gastric or intestinal contents into the esophagus. Normally, the esophagus transports food from the pharynx to the stomach by coordinated contractions. Heartburn (pyrosis) is a symptom of this disorder, not a disease, and has nothing to do with the heart.

BODY PARTS INVOLVED--Gastrointestinal.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults over 60.

SIGNS & SYMPTOMS--

The following signs may range from mild to severe, infrequent or chronic, and are often worse at night:

• Regurgitation of stomach contents into the mouth, producing an acid taste; belching.
• Sensations of heaviness, warmth, burning or uncomfortable feeling in the chest.
• Swallowing difficulty.
• Mild abdominal pain or vomiting (rarely).

CAUSES--

The lower esophageal sphincter that closes off the upper stomach becomes lax, allowing stomach juices to enter the esophagus and irritate its lining. Causes may include:

• Hiatal hernia (part of stomach protrudes into the chest).
• Pregnancy.
• Scleroderma.
• Ulcer or tumor of the esophagus.
• Delayed gastric emptying.

RISK INCREASES WITH

• Stress; improper diet; overeating, hurried eating, improper chewing.
• Obesity.
• Smoking.
• Excess alcohol consumption.
• Naps after meals; squatting, bending or lifting with a full stomach.
• Use of some medications that can lower the pressure of the lower esophageal sphincter.
• Chest trauma.
• Consumption of coffee.

HOW TO PREVENT

Preventing gastroesophageal reflux disease:

• No specific measures.

Preventing symptoms:

• Avoid smoking.
• Don't bend over, lie down or exercise immediately after eating.
• Don't wear tight, restrictive clothing.
• Elevate the head of the bed 4 to 6 inches with blocks.
• Follow instructions under Diet.
• Lose weight if you are overweight.
• Talk to your doctor about any drugs you take that could cause the problem.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Sometimes tests are done to rule out other disorders. Blood studies, ECG to exclude chance of heart disease; endoscopy, biopsy (See Glossary for all), x-rays of the upper digestive tract.

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.
• Antireflux surgery for severe cases.

POSSIBLE COMPLICATIONS

• Peptic or gastric ulcer.
• Stomach acids can damage the esophagus.

PROBABLE OUTCOME--Symptoms can be controlled with treatment but recurrence is common.

How To Treat

GENERAL MEASURES----The symptoms usually begin within about an hour after eating and may continue for several hours. Usually no medical care is necessary. Self-treatment with antacids and taking preventive measures should control the symptoms.

MEDICATION--

• For minor discomfort, you may use non-prescription liquid antacids. These preparations coat the inside of the esophagus and neutralize stomach acid. Follow instructions on the bottle. Pregnant women should not take any drugs without doctor's approval.
• Avoid aspirin and other nonsteroidal anti-inflammatory drugs. They irritate stomach lining.

ACTIVITY--Resume normal activities as soon as symptoms subside.

DIET--

• Avoid foods and beverages that stimulate heavy stomach-acid secretion, such as spicy dishes, coffee, citrus fruit juice, alcohol, chocolate or peppermint, and reduce your consumption of high-fat foods.
• Eat small, frequent meals, 4 or 5 a day.
• Don't eat close to bedtime.
• Lose weight, if you are overweight (see Weight-Loss Diet in Appendix).

Call Your Doctor If

• Swallowing becomes more difficult.
• You regurgitate blood.
• Symptoms continues despite self-care.