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 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, Mylanta, or Maalox, may help. Your doctor also may recommend over-the-counter acid reducers, such as famotidine (Pepcid AC), cimetidine (Tagamet HB), or omeprazole (Prilosec). Read and follow all instructions on the label. If you use these medicines often, talk with your doctor.
• Stay at a weight that's healthy for you. Extra weight puts a lot of pressure on the valve between the stomach and esophagus. Losing even a few pounds can help. Talk to your doctor if you need help losing weight.
• Change your eating habits.
  • Try to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down. Snacking close to bedtime can make your symptoms worse.
  • 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.
• Try to quit smoking or chewing tobacco, or cut back as much as you can. If you need help quitting, talk to your doctor about quit-tobacco programs and medicines. These can increase your chances of quitting for good.
• If you have GERD symptoms while trying to sleep, raise the head of your bed 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.

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, regurgitation, or pain).
• Allow the esophagus to heal.
• Prevent problems caused by GERD.

You may take:

• Antacids. These include Mylanta 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 (Tagamet) 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 (Prilosec). 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 and other procedures can treat GERD. They're usually done when medicines haven't worked well enough. Most of the procedures work by strengthening the valve (lower esophageal sphincter) between the esophagus and the stomach. This helps keep acid from backing up into the esophagus.

Some examples are:

• Fundoplication. With this surgery, the stomach is wrapped around the esophagus to strengthen the valve. This is usually done using surgery, but sometimes it is done using endoscopy.
• Magnetic sphincter augmentation (MSA). A string of magnetic beads is wrapped around the valve.
• Stretta procedure. This uses radio waves to tighten the valve.
• Roux-en-Y gastric bypass. This might be used if you have obesity.

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