Frequent, intense heartburn may be serious if it occurs more than twice a week. Learn about GERD symptoms, causes, and treatment
Heartburn that is frequent or intense may be a sign of gastroesophageal reflux disease (GERD). Contact your doctor if your heartburn:
- Occurs more than twice a week
- Persists despite dietary and lifestyle changes
- Persists despite the use of over-the-counter medications
- Occurs even after taking proton pump inhibitors for more than 8 weeks and you are not currently seeing a gastroenterologist
GERD or esophagitis is a complicated condition with dangerous implications. Heartburn is the most common symptom of the disorder. If left untreated, GERD can cause bleeding and scarring in the esophagus and in some cases increase the risk of esophageal cancer.
What other conditions can cause heartburn?
A gastroenterologist can perform various examinations, including an upper endoscopy, to evaluate potential causes of GERD.
However, since there are other conditions that can mimic a heartburn, it is important to seek medical treatment if your symptoms are severe. These conditions include:
- Myocardial infarction (pain from the heart muscle radiates to the upper abdomen)
- Pancreatitis (severe crampy pain that aggravates with eating)
- Liver dysfunction (severe nausea and upper abdominal fullness may be related to the liver)
- Cholecystitis (gallbladder inflammation with or without gallstones can cause symptoms similar to heartburn)
- Ulcer (can cause similar symptoms, although pain is usually severe and there may be blood-stained vomiting)
What are signs and symptoms of GERD?
Gastroesophageal reflux disease (GERD) can manifest differently in each person. Although GERD can cause a wide range of symptoms, these symptoms can be classified as typical or atypical based on their severity.
Typical or common GERD symptoms include:
- Heartburn
- Difficulty swallowing
- Excessive salivation
- Regurgitation
- Gas and bloating
- Pain or discomfort in the chest
- Intolerance of certain foods and liquids
- Bad breath or a sour taste in the mouth
Atypical GERD symptoms include:
- Hoarse voice
- Frequent swallowing
- Asthma or asthma-like symptoms
- Excessive clearing of the throat
- Chronic dry, irritated, or sore throat
- Persistent cough
- Burning in the mouth or throat (acid taste in the mouth)
- Dental erosions or therapy-resistant gum disease or inflammation
- Discomfort in the ears and nose
- Trouble sleeping
What causes GERD?
Gastroesophageal reflux disease (GERD) is characterized by regurgitation of stomach acid or digestive fluid into the esophagus, resulting in a burning feeling in the chest and frequent burping. Some people may experience cough or chest discomfort.
Causes of GERD may include:
- Irregularities affecting the lower esophageal sphincter: Because of esophageal muscle tone deterioration, it is more common among the elderly. This type of acid reflux can be caused by certain medications, alcohol, or smoking.
- Abnormalities affecting esophageal contractions: In some cases, the esophagus is unable to push the regurgitated acid back into the stomach. As a result, stomach acid remains in the esophagus for a longer period, leading to heartburn symptoms.
- Stomach contracting less frequently: All food that is digested is sent down into the intestines. Food left in the stomach for a lengthy amount of time produces pressure, which opens the esophageal sphincter and allows food and digestive fluids to flow up into the esophagus.
Risk factors for GERD include:
- Smoking
- Stress
- Fatty, acidic, or spicy foods
- Caffeine, alcohol, and peppermint
- Certain medications
- Being overweight
- Pregnancy
How is GERD treated?
Treatment of gastroesophageal reflux disease (GERD) may include one or more of the following options, depending on the severity of the condition:
- Lifestyle changes:
- Medications:
- Antacids:
- Typically, these are the first medicines advised to relieve heartburn and other minor GERD symptoms.
- Many products on the market combine various combinations of three basic salts—magnesium, calcium and aluminum—with hydroxide or bicarbonate ions to neutralize stomach acid.
- Antacids have side effects that may include diarrhea or constipation.
- Foaming agents:
- To avoid irritation of the inner lining of the stomach and esophagus, foaming agents cover the contents of your stomach with foam.
- These medications may be beneficial to people who do not suffer from esophageal injury.
- They can help reduce excessive belching.
- H2 blockers:
- These drugs provide temporary relief but should only be used for a few weeks at a time without medical supervision. They come in prescription and nonprescription strengths.
- They help in about 50% of cases.
- Proton pump inhibitors:
- Proton pump inhibitors are more effective than H2 blockers in treating GERD symptoms and can help practically everyone.
- These drugs should be taken 30 to 60 minutes before eating.
- Because persistent heartburn may indicate more serious illnesses, it is highly advised to consult with your doctor before using these drugs for an extended period of time.
- Prokinetics:
- These help empty the stomach faster.
- Because various medications function in different ways, combining them may help reduce symptoms.
- Surgery: When lifestyle modifications and medications fail, surgery may be a viable option. Surgical options include:
- Fundoplication: To tighten the sphincter, prevent acid reflux and repair a hiatal hernia, the top section of the stomach is wrapped around the lower esophageal sphincter (LES). This technique may be performed with a laparoscope and only requires small incisions in the abdomen. Laparoscopic fundoplication has been used safely and efficiently on people of all ages, including infants. Patients can leave the hospital in 1-3 days and return to work in 2-3 weeks.
- Endoscopic devices: The FDA has authorized numerous endoscopic devices to treat persistent heartburn. The Bard EndoCinch technique uses application of sutures to produce small pleats in the LES, which helps strengthen the muscle. Electrodes are used in the Stretta system to make microscopic incisions on the LES. Scar tissue helps toughen the muscle once the wounds heal. The long-term implication of these are unknown. Endoscopic devices are rarely used to treat GERD.
- Antacids:
