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Gastroesophageal Reflux Disease (GERD)

  • What You Should Know About Acid Reflux

  • GERD – a funny acronym for that familiar sensation we call “heartburn.” Gastroesophageal Reflux Disease is characterized by that burning sensation in the chest and throat as gastric contents reflux up into the esophagus. Nearly half of adult Americans experience it sporadically either after meals or when sleeping.

    This type of heartburn is not about your heart at all – it’s about your digestive system. But first it’s important to note that a burning sensation in the chest can be one of the signs of a heart attack so it’s important to know the difference.

    GERD isn’t deadly, but it’s painful and actually can lead to damage in your esophagus. According to Gastroenterologist Dr. Neil Stollman, with Alta Bates Summit Medical CenterOpens new window, chronic acid reflux can actually alter your cells in a way that may increase your risk for esophageal cancer.

    Dr. Stollman also alerts us to some new findings about the medications used to treat chronic heartburn, so read on.

  • What Causes GERD?

  • GERD symptoms occur when the acidic contents of your stomach flow upward into the esophagus. Normally, the sphincter at the bottom of the esophagus prevents that from happening, but it may become weak or push open due to increased pressure in the abdomen. A common contributing factor is a hiatal hernia, where the top of the stomach becomes pushed up through the diaphragm.

    Eating certain foods can also contribute to acid reflux. Common culprits include:

    • citrus fruits
    • onions
    • garlic
    • spicy foods
    • peppermint
    • alcohol
    • caffeine

    Fatty foods like cheese, meats or avocados may also contribute, since they slow down digestion, keeping the stomach full longer.

    Pregnancy is also a prime time for heartburn as well, due to the crowding of the abdomen by the growing baby. In addition, some medications can trigger heartburn – for example, a blood pressure medication that relaxes the sphincter.

  • Medications for GERD

  • There are many over-the-counter (OTC) medications to treat the immediate symptoms of heartburn. Antacids such as Tums, Mylanta or Maalox work very quickly, but don’t last long.

    Other OTC mediations take longer to work (15-30 minutes) but will last much longer, from 3-6 hours. Common brands are Zantac, Pepcid and Tagamet.

    Combination OTC medications may include both the fast-acting antacids and the longer-lasting H2 blockers described above. Pepsid Complete and Tums Dual Action are two examples.

    Dr. Stollman notes that the next level of treatment is a class of drug called a Proton Pump Inhibitor (PPI.) These drugs are not for immediate relief, but can help with chronic heartburn if you take them on a regular basis, usually daily. (Read our companion article on GERD Medication Safety.)

  • Treatment Approaches to GERD

  • Dr. Stollman suggests a common sense approach: if your heartburn is infrequent and easily relieved by simple antacids, continue with that approach – and take a look at your habits which may contribute to heartburn.

    If your GERD is chronic and troublesome to you, see your physician. You may be a candidate for an endoscopic exam which evaluates the condition of your esophagus.

    “You should consider an endoscopy if you have had heartburn for a long time – perhaps five years or more,” says Dr. Stollman. “You should also be seen if you have what we call ‘alarm symptoms’ of losing weight, difficulty in swallowing, vomiting or anemia.”

    The endoscope exam helps the doctor to see if there has been cellular damage due to injury from acid. With chronic heartburn, normal esophageal cells may get damaged and new cells are created to replace them. These new cells have a greater tendency to develop into cancer. The change in cells is a condition called Barrett’s Esophagus. Barrett’s Esophagus is more common in men than in women.

    “If you have been having heartburn over a period of years, it’s a good idea to be checked by a physician,” notes Dr. Stollman. “If the cells are normal, no further testing is needed. However, if cellular changes are occurring, regular endoscopy may be needed to monitor for the development of cancer. “

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