Gastroesophageal reflux disease (GERD)

Diagnostic

Your doctor may be able to diagnose GERD based on a physical exam and your history of signs and symptoms.

To confirm a diagnosis or to check for complications of GERD, your doctor may recommend:

  • Upper endoscopy. Your doctor inserts a thin, flexible tube with a light and a camera (endoscope) into your throat to examine the inside of your esophagus and stomach. Test results can often be normal with reflux, but an endoscopy can detect inflammation of the esophagus (esophagitis) or other complications. An endoscopy can also be used to take a sample of tissue (biopsy) to be tested for complications such as Barrett’s esophagus.
  • Ambulatory acid probe test (pH). To identify when and for how long stomach acid is regurgitating there, a monitor is placed in your esophagus. The monitor is connected to a small computer that you wear around your waist or with a strap over your shoulder. The monitor can be a flexible, thin tube (catheter) that is threaded through your nose into your esophagus, or during an endoscopy, a clip that is placed in your esophagus and passed into your stool after about two days.
  • Esophageal manometry. This test measures the rhythmic muscle contractions of your esophagus when you swallow. The coordination and force exerted by the muscles in your esophagus is also measured by esophageal manometry.
  • X-ray of your upper digestive system. After drinking a chalky liquid that coats and fills the inner wall of your digestive tract, X-rays are taken. With the help of the coating, your doctor is able to see a silhouette of your esophagus, stomach, and upper intestine. You may also be asked to swallow a barium pill which can help diagnose a narrowing of the esophagus which may interfere with swallowing.

Treatment

Your doctor is likely to recommend that you try lifestyle modifications and over-the-counter medications first. If you don’t get relief in a few weeks, your doctor may recommend prescription medication or surgery.

Over-the-counter medications

The options include:

  • Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids, and Tums, can provide quick relief. But antacids alone do not cure an inflamed esophagus damaged by stomach acid. Overuse of certain antacids can cause side effects, such as diarrhea or sometimes kidney problems.
  • Medicines to reduce acid production. These H-2 receptor blockers drugs, include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR). Compared to antacids, H-2 receptor blockers work slowly, but they provide longer relief and may decrease stomach acid production for up to 12 hours. Stronger versions are available by prescription.
  • Medicines that block acid production and heal the esophagus. Proton pump inhibitors, are stronger acid inhibitors than H-2 receptor inhibitors and allow time for damaged esophageal tissue to heal. lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC) are included in over-the-counter proton pump inhibitors.