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Gastroesophageal Reflux (GERD)


The valve located at the very bottom of the esophagus just above the stomach is called the lower esophageal sphincter. It generally remains closed unless a person swallows. With swallowing, the valve opens, allowing liquids and food to pass into the stomach and then the valve closes again. In some patients, for reasons we do not understand, the valve is incompetent and does not close properly. When the valve is not closed, acid is allowed to reflux (flow back up) from the stomach into the esophagus. This occurs more often when a person is lying down, because gravity does not keep the food in the stomach as easily as when sitting or standing. It also occurs after meals when the stomach is full, and this is a time when the stomach makes large amounts of acid to begin the process of digestion.

Symptoms and Causes

Certain foods and other substances make this condition worse by further interfering with the valve function. Included are alcohol, peppermint, tobacco, caffeine, and particularly, fatty foods (fried or greasy foods). These all lower the pressure of the valve making it even more incompetent.

Complications of GERD

Some patients who have chronic reflux esophagitis develop a change in the type of cells that line the bottom part of the esophagus. The cells resemble those that line the stomach or even the small intestine. This change within the esophagus is called Barrett's Esophagus. The significance of this is that in some patients with this condition, cancer can develop.


Your doctor will complete an exam on you and take a detailed physical history to see if you are having reflux. There are several tests that can be done which include an endoscopy of your upper gastrointestinal tract to find if you have reflux.


  1. Lifestyle Changes: *Elevate the head of your bed with 6-8" blocks or use a bed wedge to elevate your chest and head. (This allows us to use gravity to keep the acid contents of the stomach in the stomach while sleeping; just using extra pillows is not adequate).

*Nothing to eat for three hours prior to bedtime. (This reduces the volume of stomach contents at bedtime.)

*Do not lie down for at least three hours after meals. (This decreases reflux at a time when the stomach is most full and has the most acid.)

*Limit alcohol, peppermint, caffeine, and particularly, fatty foods (fried or greasy foods). These substances all lower the pressure of the valve making it even more incompetent. Citrus or acid containing foods and beverages may make reflux symptoms worse, but they do not increase reflux.

*Stop smoking. Smoking not only irritates the lining of the esophagus, it interferes with the lower esophageal sphincter valve's function

  1. Medicines: Initial treatment for this problem involves medication. Patients with mild reflux may find relief with over the counter agents ie. Antacids, or hydrogen 2 (H2) receptor blockers ie. Axid, pepcid, zantac, tagamet. Prilosec OTC is the first available over the counter acid pump inhibitor. Stomach acid pump inhibitors are the strongest class of medication available to treat reflux.
  2. Surgery: In some cases medication is not effective in treating this problem. Laparoscopic surgery (Nissen fundoplication) may be required, and certain studies before surgery are needed ie. Esophageal manometry. More recently, innovative endoscopic technology is being used including the endoscopic plicator as well as other treatments.


GERD or heartburn is caused by stomach contents that reflux or flow back up into the throat. This can cause pain and burning. Prolonged reflux can cause damage to the tissue in the throat. Medications have been very successful at controlling GERD.


  1. American Society for Gastrointestinal Endoscopy -
  2. American Gastroenterological Association -
  3. American College of Gastroenterology -

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