Gastroesophageal Reflux Disease (GERD)/Heartburn

What is GERD?

GERD (gastroesophageal reflux disease) is a digestive disorder. It is caused when gastric acid from your stomach flows back up into your food pipe or esophagus.

Heartburn is the most common symptom of GERD.

What causes GERD?

GERD happens when gastric acid from your stomach backs up into your food pipe or esophagus.

A muscle at the bottom of the esophagus opens to let food in and closes to keep food in the stomach. This muscle is called the LES or lower esophageal sphincter. When your LES relaxes too often or for too long, acid backs up into your esophagus. This causes heartburn.

Some lifestyle issues that can cause GERD may include:

  • Being overweight
  • Overeating
  • Eating foods such as citrus, chocolate, and fatty or spicy foods
  • Having caffeine
  • Having alcohol
  • Smoking
  • Using aspirin and over-the-counter pain and fever medicines (nonsteroidal anti-inflammatory drugs or NSAIDs) 

Some health problems that may cause heartburn may include:

  • Gastritis, a redness or swelling (inflammation) of your stomach lining
  • Ulcers, painful sores on the lining of your stomach, esophagus or the first part of your small intestine (duodenum)

Who is at risk for GERD?

You may be more at risk for GERD if you:

  • Have a hiatal hernia
  • Have a weak lower esophageal sphincter or LES
  • Are obese
  • Are pregnant
  • Use some medicines, such as aspirin or over-the-counter pain and fever medicines (nonsteroidal anti-inflammatory drugs or NSAIDs)
  • Smoke or are around secondhand smoke
  • Drink alcohol
  • Are older

What are the symptoms of GERD?

Heartburn, also called acid indigestion, or acid reflux, is the most common symptom of GERD. Heartburn is a burning chest pain that starts behind your breastbone and moves up to your neck and throat. It can last as long as 2 hours. It often feels worse after you eat. Lying down or bending over can also cause heartburn.

Another common symptom of GERD is regurgitation. Some people can have trouble swallowing.

Heartburn is not a GERD symptom for most children younger than 12 years old, and for some adults. They may have a dry cough, asthma symptoms, or trouble swallowing instead

Each person’s symptoms may vary. GERD symptoms may look like other health problems. Always see your healthcare provider to be sure.

How is GERD diagnosed?

To see if you have GERD, your healthcare provider will give you a physical exam and ask about your past health.

Some people with typical symptoms may be treated without further testing.

Other tests for GERD may include the following:

  • Upper GI (gastrointestinal) series, also called a barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of your small intestine (duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. 
  • Upper endoscopy or EGD (esophagogastroduodenoscopy). This test looks at the lining or inside of your esophagus, stomach, and duodenum. This test uses a thin, lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. He or she can also take a small tissue sample (biopsy) if needed.
  • Bernstein test. This test helps to see if your symptoms are caused by acid in your esophagus. The test is performed by dripping a mild acid through a tube placed in your esophagus.
  • Esophageal manometry. This test checks the strength of your esophagus muscles. It can see if you have any problems with backward flow of fluid (reflux) or swallowing. A small tube is put into your nostril, then down your throat and into your esophagus. The tube checks how much pressure your esophageal muscles make when they are at rest.
  • pH monitoring. This test checks the pH or acid level in your esophagus. A thin, plastic tube is placed into your nostril, down your throat, and into your esophagus. The tube has a sensor that measures pH level. The other end of the tube outside your body is attached to a small monitor that records your pH levels for 24 to 48 hours. During this time you can go home and do your normal activities. You will need to keep a diary of any symptoms you feel, and also of the food you eat. Your pH readings are checked and compared to your activity for that time period.

How is GERD treated?

Your healthcare provider will make a care plan for you based on:

  • Your age, overall health, and past health
  • How serious your case is
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • What you would like to do

In many cases making diet and lifestyle changes can help reduce GERD symptoms. Always check with your healthcare provider before making any changes.

If you have GERD, be careful about what you eat and drink. Don’t have too much of the following:

  • Fried and fatty foods
  • Peppermint
  • Chocolate
  • Alcohol
  • Citrus fruit and juices
  • Tomato products
  • Drinks with caffeine, such as coffee, soda, and energy drinks

You should also:

  • Eat smaller portions
  • Not overeat
  • Quit smoking
  • Not drink too much alcohol
  • Wait a few hours after eating before you lie down or go to bed
  • Lose weight if needed
  • Raise the head of your bed 6 inches by putting bricks or cinderblocks or bedrisers under the bed legs under the head of the bed

Be sure to check any medicines you are taking. Some may cause problems with the lining of your stomach or esophagus. You may also want to talk to your healthcare provider about:

  • Taking medicines to reduce your stomach acid (antacids)
  • Taking medicines called H2-blockers and protein pump inhibitors. Taking these medicines before eating may stop heartburn from happening.
  • Taking medicines that help to empty food from your stomach (promotility medicines). You will need a prescription for these. However, these medicines are rarely used to treat reflux disease unless there are other problems, too.
  • Having surgery called fundoplication. This is sometimes done to help keep the esophagus in the right place and to stop the backward flow of fluid (reflux).

What are the complications of GERD?

If GERD is not treated, it can lead to other health problems. These may include:

  • Esophagitis. This is an irritation of the esophagus caused by the acid in your stomach contents.
  • Narrowing of the esophagus, also called strictures. This can make it hard to swallow.
  • Breathing problems. This happens when stomach contents from your esophagus go into your lungs.
  • Barrett’s esophagus. This affects the lining of your esophagus. In some cases it can lead to esophageal cancer.

What can I do to prevent GERD?

Some of the same diet and lifestyle changes that are used to treat GERD can also help to stop it from happening.

Living with GERD

Your healthcare provider will give you advice on how to manage your GERD symptoms. In most cases you will need to make some diet and lifestyle changes so that GERD pain won’t get in the way of your normal activities.

When should I call my healthcare provider?

Call your healthcare provider if your GERD symptoms don’t improve with treatment or they get worse. Also call if you have new symptoms.

Key points

  • GERD (gastroesophageal reflux disease) is a digestive disorder. It is caused by gastric acid flowing from your stomach back up into your food pipe (esophagus).
  • Heartburn is the most common symptom of GERD.
  • Some lifestyle issues that may cause GERD include being overweight, overeating, having caffeine and alcohol, and eating chocolate and spicy foods.
  • There are several tests that can be done to see if you have GERD.
  • If it is not treated, GERD can lead to other health problems.
  • Making diet and lifestyle changes can help reduce GERD symptoms.
  • Some medicines may also help reduce symptoms.

Next steps

Tips to help you get the most from a visit to your healthcare provider:
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Coping with Swallowing Difficulties

As we go through daily life, swallowing is as common as breathing. We rarely give it a second thought as we swallow hundreds of times each day.

Swallowing difficulties can happen for reasons ranging from dehydration to illness. Most cases are short-lived. But sometimes you might need medical treatment or special home care. If you have trouble swallowing, it is important to be evaluated by your healthcare provider. In some cases, swallowing difficulties may be due to serious problems.

Why swallowing problems happen

In most cases, swallowing problems aren’t serious. Swallowing problems have many causes. These include dehydration, or not chewing long enough or taking bites of food that are too big. Other swallowing problems stem from gastroesophageal reflux disease (GERD). This happens when bile or stomach acid flows back into your esophagus, or food pipe. Many medicines, such as nitrates, calcium channel blockers, doxycycline, aspirin, NSAIDs, potassium, iron tablets, and vitamin C, can cause difficulty swallowing. Other causes include allergies and even the common cold.

In rare cases, swallowing problems are tied to a serious illness. For example, a stroke, Parkinson disease, or late-stage Alzheimer disease can make it hard to swallow and possibly lead to choking. Diabetes, thyroid disease, a tumor in the mouth or throat, or high blood pressure could be to blame. Problems with your vocal cords; insertion of a tracheotomy, or breathing, tube, or oral or throat surgery, or radiation treatment can affect the way you swallow. Narrowing of the esophagus, due to cancer, GERD, or other illness, can also cause swallowing difficulties. An allergic condition called eosinophilic esophagitis often causes trouble swallowing. Trouble with how the esophagus contracts can cause the problem, too. 

Symptoms of swallowing problems

Be aware of these signs of swallowing difficulties:

  • Feeling of a lump in your throat

  • Hoarseness

  • Sensation that food or liquid is stuck in your throat or behind your breastbone

  • Pain or tightness in your throat or chest

  • Weight loss or not getting the nutrition you need because of trouble swallowing

  • Choking or coughing caused by bits of food or drink that get caught in your throat

  • Drooling

What are the risk factors?

Risk factors for swallowing difficulties include chronic conditions, such as Parkinson disease, Alzheimer's, a stroke, GERD, or allergies. Other risk factors include damage to your esophagus due to a tracheotomy, throat surgery, or radiation treatment.

How the underlying problem is found

A swallowing problem may be a symptom of an underlying problem. Your healthcare provider will take a thorough history and perform a physical exam. He or she may order tests including an endoscopy. This is an exam performed by a gastroenterologist. He or she inserts a thin tube into your esophagus and stomach to look for changes in your esophagus and to obtain a biopsy if needed. Another way to find out what the problem could be is a barium swallow. For this test, X-rays are taken while a barium solution is swallowed. Additional tests may include motility testing to determine if your esophagus is contracting and relaxing properly.

How the problem is treated

Treatment will be based on the underlying cause of your swallowing difficulty. Treatment may include lifestyle changes, medicines, working with a speech or occupational therapist, or, rarely, surgery. 

When to call the healthcare provider

Swallowing problems are rarely serious, so it can be difficult to know when to seek help. Contact your healthcare provider:

  • If the problem doesn’t clear up quickly

  • If you have food stuck in your throat

  • If swallowing problems cause you to choke, cough, or have trouble breathing

  • If you’re losing weight or having trouble eating 

What you can do about swallowing problems

If your swallowing difficulties are not related to a more serious illness, you can take some simple steps at home to make eating and drinking more effort-free.

If your problems stem from GERD, try taking antacids to control your acid reflux symptoms. Prop up the head of your bed. Eat smaller meals, and avoid food for about 3 hours before going to sleep. Tobacco, alcohol, and caffeine are also linked to GERD. Eliminating them may help, too. Obesity and stress are connected to GERD, so exercise and stress-busting activities like yoga may cut down on your symptoms. 

The way you eat and drink can cause swallowing problems. Take smaller bites and chew thoroughly. Eat more slowly to make swallowing easier.

A speech or occupational therapist can help you relearn how to swallow if your problem was caused by nervous system damage from a stroke. A specialist can also teach feeding techniques for eating difficulties caused by Alzheimer disease. These include a smaller spoon. Also adding a special thickener to liquids, especially water, can make it easier to drink beverages without choking.

If your swallowing problems come from another type of serious illness, such as cancer, you may need a comprehensive treatment plan with medicine or possibly surgery.

Kathleen K. Boynton, MD

Patient Rating:

4.8

4.8 out of 5

Kathleen Boynton, M.D. received her medical degree from the University of Florida. She also served as an Intern, Resident, and Chief Resident while in Florida. Dr. Boynton then came to Utah, and completed her Fellowship at the University of Utah. Her clinical interests include immune related disorders of the GI tract. Dr. Boynton is board certi... Read More

Specialties:

Endoscopy, GI Motility, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-213-9797
University Hospital
Gastroenterology Endoscopy Center
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John C. Fang, MD

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John Fang M.D., is the Division Chief and Professor Medicine of the Division of Gastroenterology at the University of Utah Hospital and Huntsman Cancer Institute. His clinical interests include treatment, diagnosis, and continuing care for gastrointestinal diseases and endoscopy. He specializes in Barrett's Esophagus, Enteral Nutrition, Esophageal... Read More

Specialties:

Barrett's Esophagus, Endoscopy, Enteral Nutrition, Eosinophilic Esophagitis, Esophageal Diseases, GI Motility, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Therapeutic Endoscopy

Locations:

Huntsman Cancer Institute
Endoscopy
801-213-9797
Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Gastroenterology Endoscopy Center
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-213-9797

Andrew J. Gawron, MD, PhD

Dr. Andrew Gawron is an Assistant Professor at the University of Utah and VA Medical Center. His clinical interests include treating patients with esophageal disease (gastroesophageal reflux disease, motility disorders such as achalasia, and eosinophilic esophagitis). He performs colonoscopy, upper endoscopy and interprets esophageal motility and p... Read More

Specialties:

Endoscopy, Eosinophilic Esophagitis, Esophageal Diseases, Esophageal Motility Disorders, Gastroenterology, Gastroesophageal Reflux Disease (GERD)

Locations:

University Hospital
Gastroenterology, Clinic 3
801-213-9797
University Hospital
Gastroenterology Endoscopy Center
801-213-9797
Veterans Administration Medical Center 801-584-1236

Christopher German, APRN

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Christopher German, APRN, NP-C earned his BSN, RN at Westminster College. He worked many years between the Intensive Care Unit and emergency department. He returned to Westminster College and earned his MSN, FNP-C, APRN. Chris practiced as an APRN hospitalist, and transitioned into the GI world because he believes that it is an interesting fie... Read More

Specialties:

Barrett's Esophagus, Constipation, Diarrhea, Eosinophilic Esophagitis, Family Medicine, Fecal Incontinence, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Nurse Practitioner

Locations:

South Jordan Health Center 801-213-9797

Priyanka Kanth, MD, MSCI

Dr. Priyanka Kanth received her Medical Degree from Kasturba Medical College in India. She obtained graduate training in Internal Medicine from St. Mary’s Hospital in the United Kingdom and the University of Connecticut in the United States. Dr. Kanth completed her fellowship in the specialty of Gastroenterology at the University of Utah, after whi... Read More

Specialties:

Barrett's Esophagus, Colon Cancer, Constipation, Diarrhea, Endoscopy, Eosinophilic Esophagitis, Esophageal Diseases, Fecal Incontinence, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome, Polyposis (FAP), Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Gastroenterology Endoscopy Center
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-213-9797

Keisa M. Lynch, APRN, FNP-C, DNP

Patient Rating:

4.9

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Keisa M. Lynch, DNP, APRN, FNP is a family nurse practitioner in the department of Gastroenterology and Hepatology at the University of Utah School of Medicine. Her clinical interests include treatment, diagnosis and continuing care for gastrointestinal diseases and hepatology. Keisa received her Doctor of Nursing Practice (DNP) degree from The U... Read More

Specialties:

Constipation, Diarrhea, Eosinophilic Esophagitis, Esophageal Diseases, Family Nurse Practitioner, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Hepatology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Irritable Bowel Syndrome, Liver Disease, Women's GI Health, Women's Health

Locations:

Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Kidney and Liver Clinic
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University Hospital
Gastroenterology, Clinic 3
801-213-9797

Whitney Mentaberry, APRN, NP-C

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Whitney J. Mentaberry NP-C, BSN-RN, is a family Nurse Practitioner in the department of Gastroenterology, Hepatology, and Nutrition at the University of Utah School of Medicine. Whitney specializes in the diagnosis and continuing care for gastrointestinal diseases. Whitney received her Master of Science in Nursing degree from Westminster College in... Read More

Specialties:

Barrett's Esophagus, Constipation, Diarrhea, Eosinophilic Esophagitis, Esophageal Diseases, Esophageal Motility Disorders, Fecal Incontinence, GI Motility, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Hepatology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Irritable Bowel Syndrome, Liver Biopsies, Liver Disease, Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-213-9797

Talina Skirko, APRN, FNP-C, DNP

Patient Rating:

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Talina R. Skirko, APRN, FNP-C, DNP is a family nurse practitioner in the department of Gastroenterology at the University of Utah School of Medicine. Her clinical interests include treatment, diagnosis and continuing care for gastrointestinal diseases. Her specific interests include general gastroenterology, esophageal diseases, nutrition, and irri... Read More

Specialties:

Constipation, Diarrhea, Esophageal Diseases, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome, Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-213-9797

Michael J. Sossenheimer, MD, PhD, FACP, FACG, FASGE, AGAF

Michael Sossenheimer is a Clinical Track Associate Professor of Medicine in the Division of Gastroenterology. He studied medicine at the University of Düsseldorf and University of Heidelberg, Germany, where he earned his MD-PhD in 1989. Dr. Sossenheimer completed his internships and residency at the University of Düsseldorf and University of Maryla... Read More

Specialties:

Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopy, Esophageal Diseases, Esophageal Motility Disorders, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Pancreatic Cancer, Therapeutic Endoscopy

Locations:

Huntsman Cancer Institute
Endoscopy
801-213-9797
Redwood Health Center
General Endoscopy
801-213-9797
University Hospital
Gastroenterology Endoscopy Center
801-213-9797
University Hospital
Gastroenterology, Clinic 3
801-581-7803

Matthew H. Steenblik, MD

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Dr. Matthew Steenblik completed his medical degree and Internal Medicine residency training at the University of Utah. He then served as chief medical resident in the Department of Medicine before completing his Gastroenterology fellowship at the University of Utah where he also served as chief fellow. He is currently seeing all types of cases i... Read More

Michael J. Walker, MD

Dr. Michael Walker received his Medical Degree from the Chicago Medical School at Rosalind Franklin University of Medicine and Science and completed an Internal Medicine residency at the University of Utah Department of Medicine, where he also served as Chief Medical Resident. He completed his Gastroenterology Fellowship at the University of Cincin... Read More

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