By: Dr. Mohamed Kamel Sabry
Prof. , Head of Dep. of Internal Medicine & Immunology
The doctor might be able to diagnose GERD based on a physical examination and history
of your signs and symptoms.
To confirm a diagnosis of GERD, or to check for complications, your doctor might
•Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and
camera (endoscope) down your throat, to examine the inside of your esophagus and
stomach. Test results can often be normal when reflux is present, but an endoscopy
may detect inflammation of the esophagus (esophagitis) or other complications. An
endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for
complications such as Barrett›s esophagus.
•Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to identify
when, and for how long, stomach acid regurgitates there. The monitor connects to a
small computer that you wear around your waist or with a strap over your shoulder. The
monitor might be a thin, flexible tube (catheter) that›s threaded through your nose into
your esophagus, or a clip that›s placed in your esophagus during an endoscopy and that
gets passed into your stool after about two days.
•Esophageal manometry. This test measures the rhythmic muscle contractions in your
esophagus when you swallow. Esophageal manometry also measures the coordination
and force exerted by the muscles of your esophagus.
•X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that
coats and fills the inside lining of your digestive tract. The coating allows your doctor to
see a silhouette of your esophagus, stomach and upper intestine. You may also be asked
to swallow a barium pill that can help diagnose a narrowing of the esophagus that may
interfere with swallowing.
The doctor is likely to recommend that you first try lifestyle modifications and over-thecounter
medications. If you don›t experience relief within a few weeks, your doctor might
recommend prescription medication or surgery.
The options include:
•Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums,
may provide quick relief. But antacids alone won›t heal an inflamed esophagus damaged
by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or
sometimes kidney problems.
•Medications to reduce acid production. These medications — known as H-2-receptor
blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR)
and ranitidine .H-2-receptor blockers don›t act as quickly as antacids, but they
provide longer relief and may decrease acid production from the stomach for up to 12
hours. Stronger versions are available by prescription.
•Medications that block acid production and heal the esophagus. These medications
— known as proton pump inhibitors — are stronger acid blockers than H-2-receptor
blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton
pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC,
Prescription-strength treatments for GERD include:
•Prescription-strength H-2-receptor blockers. These include prescription-strength
famotidine (Pepcid), nizatidine and ranitidine. These medications are generally
well-tolerated but long-term use may be associated with a slight increase in risk of vitamin
B-12 deficiency and bone fractures.
•Prescription-strength proton pump inhibitors. These include esomeprazole,
lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix),
rabeprazole (Aciphex) and dexlansoprazole. Although generally well-tolerated,
these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency.
Chronic use might increase the risk of hip fracture.
•Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by
decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects
might include fatigue or nausea.
Surgery and other procedures
GERD can usually be controlled with medication. But if medications don›t help or you
wish to avoid long-term medication use, your doctor might recommend:
•Fundoplication. The surgeon wraps the top of your stomach around the lower
esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually
done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of
the stomach can be partial or complete.
•LINX device. A ring of tiny magnetic beads is wrapped around the junction of the
stomach and esophagus. The magnetic attraction between the beads is strong enough
to keep the junction closed to refluxing acid, but weak enough to allow food to pass
through. The Linx device can be implanted using minimally invasive surgery.
Lifestyle and home remedies
Lifestyle changes may help reduce the frequency of acid reflux. Try to:
•Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up
your stomach and causing acid to reflux into your esophagus.
•Stop smoking. Smoking decreases the lower esophageal sphincter›s ability to function
•Elevate the head of your bed. If you regularly experience heartburn while trying to sleep,
place wood or cement blocks under the feet of your bed so that the head end is raised by
6 to 9 inches. If you can›t elevate your bed, you can insert a wedge between your mattress
and box spring to elevate your body from the waist up. Raising your head with additional
pillows isn›t effective.
•Don›t lie down after a meal. Wait at least three hours after eating before lying down or
going to bed.
•Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up
again once you have chewed and swallowed that bite.
•Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods,
tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
•Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on
your abdomen and the lower esophageal sphincter.
No alternative medicine therapies have been proved to treat GERD or reverse damage to
the esophagus. Some complementary and alternative therapies may provide some relief,
when combined with your doctor›s care.
Talk to your doctor about what alternative GERD treatments may be safe for you. The
options might include:
•Herbal remedies. Licorice and chamomile are sometimes used to ease GERD. Herbal
remedies can have serious side effects and might interfere with medications. Ask your
doctor about a safe dosage before beginning any herbal remedy.
•Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and
symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive
muscle relaxation or guided imagery.
Preparing for your appointment
You may be referred to a doctor who specializes in the digestive system
What you can do
•Be aware of any pre-appointment restrictions, such as restricting your diet before your
•Write down your symptoms, including any that may seem unrelated to the reason why
you scheduled the appointment.
•Write down any triggers to your symptoms, such as specific foods.
•Make a list of all your medications, vitamins and supplements.
•Write down your key medical information, including other conditions.
•Write down key personal information, including any recent changes or stressors in your
•Write down questions to ask your doctor.
•Ask a relative or friend to accompany you, to help you remember what the doctor says