When Acid Reflux Is Chronic: What Is GERD?
GERD is acid reflux that occurs regularly. It is estimated that up to 20 percent of the U.S. population has GERD.
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It’s not the case that a person who has occasional reflux will necessarily progress toward having GERD, says Louis Cohen, MD, a gastroenterologist and assistant professor of medicine at Mount Sinai in New York City. But the symptoms of GERD are the same as those of acid reflux, such as the burning feeling in your chest and the sensation that your stomach contents are in your throat. You may also have a dry cough or trouble swallowing, among other symptoms.
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A primary care doctor or gastroenterologist can usually diagnose the condition by evaluating symptom frequency and severity.
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“We may also put a probe into a patient’s esophagus for a day to measure how frequently reflux happens,” says Dr. Cohen. Knowing how often reflux occurs is another way to confirm a diagnosis, beyond evaluating the symptoms.
Treatment for GERD starts with lifestyle modifications, says Hagan: “We’ll ask patients to try these steps before we offer medication, although we understand that it can be hard to do some things, such as quitting smoking.”
One class of medication used to treat GERD is proton pump inhibitors (PPIs), which are available over the counter and by prescription. This class includes:
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- lansoprazole (Prevacid)
- esomeprazole (Nexium)
- omeprazole (Prilosec)
- omeprazole/sodium bicarbonate (Zegerid)
- dexlansoprazole (Dexilant)
- pantoprazole (Protonix)
- rabeprazole (AcipHex)
PPIs work by decreasing the amount of acid that your stomach produces, which allows the esophageal lining to heal. PPIs are typically safe and effective, although they may lead to side effects such as headaches, upset stomach, and diarrhea, among others.
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Some evidence suggests that PPIs are linked to an increased risk of infection from Clostridioides difficile, or C. diff. They’ve also been tied to other potential risks, especially with long-term use, including bone fractures (due to their impact on calcium absorption), kidney disease development or advancement, and magnesium and vitamin B12 deficiencies, though evidence is inconclusive. Make sure to discuss the risks and benefits with your doctor.
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Other drugs called H2 blockers, which inhibit histamine 2 receptors in the stomach, such as famotidine (Pepcid), cimetidine (Tagamet), and nizatidine, may also be effective, says Hagan. H2 blockers lower stomach acid production, though they’re not considered to be as strong as PPIs and are available over the counter and by prescription.
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But sometimes people have GERD symptoms that aren’t caused by reflux. “If we determine that GERD symptoms are caused by hypersensitivity in the esophagus or excessive relaxation of the lower esophagus, we might prescribe tricyclic antidepressants or selective serotonin reuptake inhibitors,” says Cohen.
For people who do not respond well to medication or cannot tolerate it, surgery may be an option. A number of surgical procedures to treat GERD are available to strengthen the barrier between the stomach and the esophagus. If this is an option, your gastroenterologist will help you decide which procedure is best for you.
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