Overview

The most common problem with the esophagus is GERD (gastroesophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it

Symptoms

Common signs and symptoms of GERD include:

If you have nocturnal acid reflux, you may also experience:

Causes

When you swallow, a circular band of muscle around the lower esophagus (the lower esophageal sphincter) relaxes to allow food and fluids to flow into the stomach. Then the sphincter closes again.

When the sphincter relaxes abnormally or becomes weak, stomach acid can flow back into the esophagus. This constant acid flushing irritates the lining of the esophagus and often causes inflammation.

Types

Treatment

Antacids that neutralize stomach acid. Antacids like Mylanta, Rolaids, and Tums can help quickly. But antacids alone will not cure an inflamed esophagus that has been damaged by stomach acid. Excessive use of some antacids can lead to side effects such as diarrhea or sometimes kidney problems.

Medicines to reduce acid production. These drugs, known as H-2 receptor blockers, include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR). H-2 receptor blockers don’t work as quickly as antacids, but they provide longer-lasting relief and can decrease stomach acid production for up to 12 hours. Stronger versions require a prescription.

Drugs that block acid production and heal the esophagus. These drugs, known as proton pump inhibitors, are more powerful acid blockers than H-2 receptor blockers and allow damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).

Prescription drugs

Prescription treatments for GERD include:

Prescription H-2 Receptor Blockers. These include prescription famotidine (Pepcid) and nizatidine. These drugs are generally well tolerated, but long-term use can be associated with a slightly increased risk of vitamin B-12 deficiency and bone fractures.

Prescription proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex), and dexlansoprazole (Dexilant). Although generally well tolerated, these drugs can cause diarrhea, headaches, nausea, and vitamin B-12 deficiency. Chronic use can increase the risk of a hip fracture.

Drugs used to strengthen the lower esophageal sphincter. Baclofen may relieve GERD by reducing the rate at which the lower esophageal sphincter relaxes. Side effects can be tiredness or nausea.

Diagnosis

Your doctor can diagnose GERD based on a physical exam and a history of your signs and symptoms.

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

Upper endoscopy. Your doctor will insert a thin, flexible tube with a light and a camera (endoscope) down your throat to examine the inside of your esophagus and stomach. Test results can often be normal for reflux, but an endoscopy can detect inflammation of the esophagus (esophagitis) or other complications. Endoscopy can also be used to take a sample of tissue (biopsy) and test for complications such as Barrett’s esophagus.

Ambulatory acid test (pH). A monitor is placed in the esophagus to determine when and for how long the stomach acid is being vomited again. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor can be a thin, flexible tube (catheter) that is inserted through the nose and down the esophagus, or a clip that is inserted into the esophagus during an endoscopy and inserted into the stool after about two days.

Esophageal manometry. This test measures the rhythmic muscle contractions of the esophagus when you swallow. Esophageal manometry also measures the coordination and strength exerted by the muscles of the esophagus.

X-ray of your upper digestive system: X-rays are taken after drinking a chalky liquid that covers and fills the inner lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach, and upper intestines. You may also be asked to swallow a barium lozenge to diagnose a narrowing of the esophagus that may affect swallowing.

Risk factor

Conditions that can increase your risk for GERD include:

Tuxedo

When to use the doctor

See a doctor right away if you have chest pain, especially if you also have difficulty breathing or pain in your jaw or arm.

These could be signs and symptoms of a heart attack.

Make an appointment with your doctor if :