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How Do I Know If I Have It?

Your doctor may be able to diagnose GERD from your description of symptoms. The doctor may also suggest tests to rule out other possible causes of your symptoms, to monitor the degree of damage, or to determine the best treatment for you.

The two main tests used when GERD is suspected or known are esophageal pH monitoring and endoscopy. With pH monitoring, the doctor measures the amount of acid in the esophagus over a 24-hour period. This test is used mainly to rule out GERD if symptoms are vague.

Endoscopy uses a flexible tube with a light and video camera on the end. The tube is passed through the throat into the esophagus so the doctor can examine the esophagus for esophagitis (inflammation of the esophagus) and for Barrett's esophagus. Endoscopy usually is not done if symptoms are mild. If they are more severe, some doctors ask for an endoscopy right away. Others say it is only necessary after the patient has had GERD for a particular length of time. If you have Barrett's esophagus or severe esophagitis, your doctor may suggest regular endoscopy monitoring to screen for cancer.

What Are the Treatments?

GERD is a chronic disease, and the goal of treatment is to manage it as carefully as possible. Managing GERD means reducing the amount of acid in the stomach and the amount of reflux that occurs. For mild GERD, this can sometimes be accomplished by using over-the-counter antacids and making certain lifestyle changes. But while lifestyle changes can reduce the incidence of heartburn, they may not be sufficient to control even mild cases of GERD. For mild yet uncontrollable cases and for moderate to severe cases, GERD is treated first with drugs and, rarely, with surgery.

Conventional Medicine

Three types of drugs are generally used to treat GERD. They are:

• Antacids – such as Tums, Rolaids and Maalox
• Histamine H2-blockers (pronounced H-two) – such as Pepcid, Zantac, Tagamet and Axid
• Proton Pump Inhibitors – such as Prilosec, Prevacid, Aciphex, Nexium and Protonix

Taking antacids when needed may be appropriate for the initial treatment of minor symptoms. H2-blockers help cut the stomach's production of acid and work best for people with mild GERD. They are available in prescription strength and over the counter (half) strength. For moderate or severe GERD, doctors may start with these drugs or another type of drug known as the proton pump inhibitors, which are six to 10 times stronger than H2-blockers. These drugs turn off the acid pumps that stimulate the production of acid from the stomach. They are all available in prescription strength and now Prilosec OTC is available in a lesser over the counter strength. For complicated or chronic GERD these proton pump inhibitors are often taken indefinitely.

Proton pump inhibitors are effective in reducing symptoms and promoting healing of any inflammation. But when you stop taking the drugs, symptoms may rebound or return quickly. So if you use these drugs, you should work out a plan with your doctor for long-term GERD management. Occasionally, motility drugs such as Reglan or Propulsid can be used to strengthen the lower esophageal sphincter (LES) and speed the emptying of the stomach to reduce symptoms of GERD. Unfortunately these drugs have multiple side effects that limit their usefulness.

If drug therapy is ineffective, your doctor may suggest surgery to repair the damaged LES. Typically, because drugs usually are effective, surgery should not be considered until it's clear that drug therapy has not worked. However, if you are young to middle-aged, surgery may be considered a viable option to eliminate the need for lifelong treatment with medication. LES surgery can now be done with a laparoscope (a type of endoscope that leaves a mini scar) instead of opening the chest, so it's less invasive.

If you have GERD, be sure your doctor knows about other medicines — prescription and nonprescription — that you take. Drugs such as aspirin, nonsteroidal anti-inflammatory drugs such as Motrin or Naprosyn, and birth control pills can make the effects of GERD worse. Also, some medications may have side effects if combined with some GERD medications.

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