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Heartburn and GERD

What is acid reflux? What is heartburn?

Normally, after you swallow, the food goes down the esophagus into the stomach, where it mixes with acid, enzymes and gastric juice. A valve (sphincter) between the esophagus and the stomach prevents this caustic mixture from regurgitating back up into the esophagus.

When stomach acid, digestive juices or food particles surge back up into the esophagus from the stomach, we call it acid reflux. Heartburn, one of the main symptoms of acid reflux, is a painful burning sensation in the center of your rib cage.

Nearly everyone experiences acid reflux from time to time, especially after eating spicy or fatty foods or eating overly large meals. Occasional heartburn is not a major concern.

What is GERD?

When the valve (sphincter) between the stomach and the esophagus functions improperly, stomach acid and juices can travel up into the esophagus on a regular basis. This can result in damage to the lining of the esophagus, which (unlike the stomach lining) is quite vulnerable to acid related injury. We call this chronic condition GERD—short for gastroesophageal reflux disease.

What increases the risk of GERD?

Numerous factors, including:

    • Obesity
    • Pregnancy
    • Lying down after eating
    • Eating the wrong foods (fatty foods, chocolate, alcohol, peppermint, among others.)
    • Certain common prescription medications

How do we diagnose GERD?

We often make the diagnosis of GERD based on your clinical symptoms. To establish the diagnosis more firmly and to look for complications, we often perform testing, such as upper GI endoscopy, upper gastrointestinal tract X-rays, or a highly specialized test call ambulatory esophageal pH monitoring, that measures the exact amount of acid reflux over the course of a few days.

What are the potential complications of GERD?

Over time, the refluxed gastric acid can cause permanent precancerous changes in the lining of the esophagus, a condition known as Barrett’s esophagus. Unchecked, these changes can progress and transform into esophageal cancer, the most dreaded result of chronic GERD. Chronic injury can also lead to internal bleeding from ulcers in the esophagus, or difficulty swallowing, due to inflammatory narrowing or scarring in the lower esophagus.

Chronic GERD may also lead to airway issues, such as chronic cough, hoarseness, vocal cord polyps, or asthma.

How can we manage GERD?

Occasional acid reflux responds to diet and lifestyle modification, and simple over the counter antacids. If the symptoms are more chronic, then prescription-strength medications can provide relief. In some individuals with more advanced symptoms, minimally invasive endoscopic or surgical interventions may create a resolution of symptoms. If there is evidence of precancerous change in the lower esophagus, we will enroll you in a monitoring program, and recommend chronic acid reduction medication. We may also recommend endoscopic eradication of any precancerous tissues.

Heartburn and Acid Reflux: management strategies

Mild and occasional heartburn and acid reflux can usually be managed with over-the-counter products. Many people benefit from prescription products that reduce or neutralize the production of stomach acid.

More serious cases of GERD may require surgery to repair the esophageal sphincter.

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