Understanding Gastroesophageal Reflux Disease
-This information was developed by the Publications Committee of the American Society for Gastrointestinal Endoscopy (ASGE). For more information about ASGE, visit www.asge.org.
-This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.
Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus because the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.
What is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus. This happens when the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.
What are the symptoms of Gastroesophageal Reflux Disease?
Common symptoms of gastroesophageal reflux disease are heartburn and/or acid regurgitation. Heartburn is a burning sensation felt behind the breast bone that occurs when stomach contents irritate the normal lining of the esophagus. Acid regurgitation is the sensation of stomach fluid coming up through the chest which may reach the mouth. Less common symptoms that may also be associated with gastroesophageal reflux include unexplained chest pain, wheezing, sore throat and cough, among others.
What causes Gastroesophageal Reflux Disease?
Gastroesophageal reflux disease (GERD) occurs when there is an imbalance between the normal defense mechanisms of the esophagus and offensive factors such as acid and other digestive juices and enzymes in the stomach. Often, the barrier between the stomach and the esophagus is impaired by weakening of the muscle (lower esophageal sphincter) or the presence of a hiatal hernia, where part of the stomach is displaced into the chest. Hiatal hernias, however, are common and not all people with a hiatal hernia have reflux. A major cause of reflux is obesity whereby increased pressure in the abdomen overcomes the barrier between the stomach and the esophagus. Obesity, pregnancy, smoking, excess alcohol use and consumption of a variety of foods such as coffee, citrus drinks, tomato-based products, chocolate, peppermint and fatty foods may also contribute to reflux symptoms.
How is Gastroesophageal Reflux Disease diagnosed?
When a patient experiences common symptoms of gastroesophageal reflux disease, namely heartburn and/or acid regurgitation, additional tests prior to starting treatment are typically unnecessary. If symptoms do not respond to treatment, or if other symptoms such as weight loss, trouble swallowing or internal bleeding are present, additional testing may be necessary.
Upper endoscopy is a test in which a small tube with a light at the end is used to examine the esophagus, stomach and duodenum (the first portion of the small intestine). Before this test, you will receive medications to help you relax and lessen any discomfort you may feel. An upper endoscopy allows your doctor to see the lining of the esophagus and detect any evidence of damage due to GERD. A biopsy of tissue may be done using an instrument similar to tweezers. Obtaining a biopsy does not cause pain or discomfort.
Another test, known as pH testing, measures acid in the esophagus and can be done by either attaching a small sensor into the esophagus at the time of endoscopy or by placing a thin, flexible probe into the esophagus that will stay there for 24 hours while acid content is being measured. This information is transmitted to a small recorder that you wear on your belt. X-ray testing has no role in the initial evaluation of individuals with symptoms of reflux disease.