How is GERD diagnosed?
GERD is diagnosed after your doctor conducts a physical examination and reviews your medical history. Tests that may be recommended to confirm the diagnosis of GERD include:
- Esophagoscopy
- Barium swallow test
- 24-hour pH monitoring
- Esophageal manometry
- Gastric emptying studies
How is GERD treated?
Many people experience relief from heartburn and pressure associated with GERD by following these recommendations:
- Elevate the head of your bed by 15 cm to allow gravity to keep the stomach contents down. You can use one or two pillows to lift your head when lying down. Do not use stacks of pillows as this may bend your body, worsening the condition by increasing abdominal pressure.
- Eat meals at least three to four hours before lying down, and avoid snacking before bedtime.
- Eat moderate portions of food and smaller meals.
- Maintain a healthy weight to eliminate excess intra-abdominal pressure caused by extra pounds.
- Limit the intake of fatty foods, chocolate, mint, coffee, tea, soda, and alcohol — which relax the lower esophageal sphincter or delay stomach emptying. Also, avoid tomatoes and citrus fruits or juices, which add extra acid that can irritate the esophagus.
- Stop smoking, as it relaxes the lower esophageal sphincter.
- Wear loose-fitting belts and clothing.
- Take antacid medications to relieve symptoms of gastroesophageal reflux.
If symptoms persist:
Patients with more severe symptoms or those who have used antacids for more than two weeks should contact their doctors, who may prescribe medications such as:
Prokinetics:
These medications help strengthen the lower esophageal sphincter (LES) and make the stomach empty faster.
Proton pump inhibitors (PPIs):
Medications that control or eliminate acid. Proton pump inhibitors include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole.
H2 receptor antagonists:
Medications that control or eliminate acid, but they may not be as effective as proton pump inhibitors. H2 receptor antagonists include cimetidine, famotidine, and ranitidine. Some of these medications are available over the counter but should not be used for more than a few weeks at a time.
Since these medications work differently, a combination of drugs may be prescribed to help control your symptoms.
If an esophagoscopy reveals that the inner lining of the esophagus is severely inflamed and irritated from stomach acid (reflux esophagitis), medications may be necessary to block acid production in the stomach or to increase LES strength. This condition, known as esophagitis, can lead to bleeding, ulcers, or difficulty swallowing if left untreated.
If medications do not successfully treat the symptoms, a small number of patients may require surgery to correct the disorder.