GERD: Esophageal Erosion and Ulcers

Overview

When you have GERD, stomach acids and juices back up into the esophagus. This can irritate and wear away the lining of the esophagus and cause sores. These sores are called ulcers.

What causes GERD?

Normally when you swallow food, it travels down the esophagus. A valve opens to let the food pass into the stomach, and then the valve closes. With GERD, the valve doesn't close tightly enough. Stomach acid and juices from the stomach flow back up (reflux) into the esophagus.

How can you care for yourself when you have it?

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Your doctor may recommend over-the-counter medicine. For mild or occasional indigestion, antacids, such as Tums or Gaviscon, may help. Your doctor also may recommend over-the-counter acid reducers, such as famotidine (Pepcid AC) or omeprazole. Read and follow all instructions on the label. If you use these medicines often, talk with your doctor.
• Change your eating habits.
  • It's best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down.
  • Avoid foods that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
• Do not smoke or chew tobacco. Smoking can make GERD worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• If you have GERD symptoms at night, raise the head of your bed 15 to 20 centimetres (6 to 8 inches) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Do not wear tight clothing around your middle.
• Lose weight if you need to. Losing just 2.5 to 4.5 kilograms (5 to 10 pounds) can help.

How are medicines used to treat GERD?

Antacids, H2 blockers, and proton pump inhibitors (PPIs) are usually tried first to treat GERD and its symptoms. These can be either prescription or over-the-counter.

Medicines can:

• Relieve symptoms (heartburn, sour taste, or pain).
• Allow the esophagus to heal.
• Prevent problems caused by GERD.

You may take:

• Antacids. These include Gaviscon and Tums. Antacids neutralize stomach acid and relieve heartburn. If you want to take medicine only when your symptoms bother you, antacids are a good choice.
• Acid reducers, such as:
  • H2 blockers. These include cimetidine and famotidine (Pepcid). H2 blockers reduce the amount of acid in the stomach. Most are sold in both over-the-counter and prescription strength.
  • PPIs. These include lansoprazole (Prevacid) and omeprazole (Losec). PPIs reduce the amount of acid in the stomach. Some are available over-the-counter.

If your daily medicine doesn't control your GERD symptoms, talk with your doctor. You may need to try a different medicine.

How is surgery used to treat it?

Surgery may be used to treat GERD symptoms that haven't been controlled well by medicines.

The most common surgery used to treat GERD is fundoplication. It strengthens the valve (lower esophageal sphincter) between the esophagus and stomach. This helps keep acid from backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus.

It may be done in one of two ways.

• A partial fundoplication. With this, the stomach is wrapped only partway around the esophagus.
• A full fundoplication. With this, the stomach is wrapped all the way around the esophagus.

Gastropexy is another type of surgery for GERD. With this, the stomach is attached to the diaphragm. It is done so that the stomach can't move through the opening in the diaphragm into the chest.

Surgery for GERD can cause problems with swallowing, burping, and extra gas. You may need other procedures to fix these problems.