Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal reflux disease (GERD) is a common digestive disease that affects about 19 million people in the United Statest. The most common symptoms are frequent heartburn (also called acid indigestion or dyspepsia), acid regurgitation, and mucosal damage.

The name heartburn is misleading, as the burning sensation you feel in your chest or throat has nothing to do with your heart. It happens when the sphincter (a ring of muscle) in your esophagus (the tube that connects your mouth to your stomach) spontaneously opens for periods of time or does not close properly. Normally, the sphincter opens only to let food pass from the esophagus into the stomach. If it does not close properly, the contents of your stomach and sometimes digestive juices rise up into the esophagus. This is also referred to as acid reflux.

Most people experience heartburn occasionally. However, if you experience heartburn more than twice a week, you may have GERD. We can help you get relief with medicines and lifestyle changes.

In GERD, the valve at the top of the stomach (where the stomach and the esophagus connect) does not close tightly enough. This allows the contents of the stomach to move up into the esophagus.


Symptoms

The following symptoms suggest that you may have GERD:

Frequent heartburn. Heartburn may feel like a burning sensation, warmth, or heat under your breastbone. It can start in the chest or throat and spread up the neck in waves. This burning sensation may increase or decrease after eating and often gets worse when lying down or bending over.

Acid regurgitation or a sour or bitter taste in the mouth. This is a backflow of stomach acid and juices from the stomach into the esophagus. It often occurs along with heartburn, but in some cases it may be your only symptom.

Chest pain. This may feel like a dull, heavy discomfort that spreads across the chest. Chest pain may occur with heartburn, usually after you eat. Sometimes chest pain is confused with pain from a heart attack, which usually feels like pressure, heaviness, tightness, squeezing, discomfort, or a dull ache.

Other symptoms of GERD can include:

  • Trouble swallowing
  • Coughing
  • Extra saliva in your mouth (water brash)
  • Nausea

Diagnosis

Most of the time, we are able to diagnose GERD based on the symptoms you describe. Additional tests are necessary only if there is a concern about complications.

We may perform one of several diagnostic tests if:

  • Your symptoms do not respond to medications.
  • You have problems swallowing.
  • You have any bleeding.

These may be a sign of complications. 

Possible diagnostic tests include:

  • Upper gastrointestinal endoscopy. This allows us to look at the inner lining of your esophagus, stomach, and duodenum (upper small intestine) using a thin, flexible imaging instrument called an endoscope.
  • pH monitoring. This test shows how often acid from your stomach gets into the esophagus and how long it stays there. It involves inserting either a small tube or tiny clip into the esophagus. This procedure is usually used only before surgery for GERD or in patients who have unusual symptoms.
  • Manometry testing. This helps us determine how well your esophagus muscles move the food you eat into the stomach. It also shows how tightly the sphincter between the esophagus and stomach closes. We use it most often for people who have unexplained problems with their swallowing.

Causes and Risk Factors

We do not know the exact cause of GERD. However, we do know that there are many contributing factors such as:

Hiatal hernia. This is an anatomical abnormality that causes the top part of the stomach to rise above the diaphragm into the chest. It is common for people who have a hiatial hernia to also have GERD.

Hormonal changes during pregnancy. If a woman's hormones cause her digestive system to slow down during pregnancy, the esophagus sphincter may not close tightly and GERD may result. The growing baby may also increase pressure on the stomach, causing GERD.

A weak esophageal sphincter. If you have a weak sphincter, the valve may not close properly, which leads to acid reflux.

Slow digestion. If food stays in your stomach for a long time before going to the small intestine, this increases the chance that stomach contents will reflux up into the esophagus.

Eating a large meal. Having a large meal increases the likelihood that your sphincter will relax and allow stomach juices to back up (reflux) into your esophagus.

Certain foods. These foods may make symptoms worse in some people:

  • Fatty and fried foods
  • Caffeinated drinks (coffee or soda)
  • Alcohol
  • Citrus fruits (including tomatoes and tomato sauce)
  • Spicy foods
  • Chocolate
  • Onions
  • Garlic
  • Peppermint

Nicotine in tobacco products can make symptoms worse, and smoking can also damage the esophagus and weaken the sphincter.

Other factors that may contribute to GERD include obesity, since excess body fat compresses the stomach. Wearing tight clothing can also predispose to GERD by increasing pressure on the abdomen, forcing stomach contents upward.

Studies have shown that about 70 to 75 percent of people with asthma also have GERD. If you have asthma, the risk of getting GERD increases if you have:

  • Long-term asthma that is severe and does not respond well to treatment
  • Asthma that worsens after you eat, exercise, or lie down
  • Frequent coughing or hoarseness

Treatment

Most treatment for GERD tries to reduce the abnormal backflow, or reflux, of stomach acid and juices into the esophagus. Treatment also attempts to:

  • Prevent injury to the esophagus lining.
  • Encourage healing if injury has already occurred.
  • Prevent GERD from coming back.
  • Avoid long-term complications.

Depending on your symptoms, we may recommend a combination of different medicines (to reduce or block acid) in addition to lifestyle changes. If medicine and lifestyle changes are not working to ease your symptoms, we may suggest surgery as a long-term treatment option.

Medications

Many different medicines are available, and their use depends on the frequency and severity of your GERD symptoms. Because many GERD symptoms can be successfully treated with lifestyle changes, we strongly recommend that you change your diet and eating patterns prior to taking medications, as well as while you are taking them.

For symptoms that are mild and infrequent, we may recommend nonprescription medicines, such as antacids.

If your symptoms are severe or if nonprescription medicines do not control your symptoms for longer than 2 weeks, we may recommend prescription medicines. 

Medications include:

Antacids. These common medicines work by neutralizing stomach acid. Examples include Maalox, Mylanta, Tums, and Gelusil. Many brands use a combination of 3 basic salts (magnesium, calcium, and aluminum with hydroxide or bicarbonate ions). Antacids provide temporary relief but can have side effects such as constipation or diarrhea. 

H2 blockers. These reduce production of stomach acid. Examples include Pepcid AC, Tagamet HB, and Zantac. They generally provide short-term relief and are effective for about half of the people who have GERD symptoms. Many are available over-the-counter as well as by prescription.

Foaming agents. These cover your stomach with foam to prevent reflux.

Proton pump inhibitors. These medicines reduce the amount of acid in the stomach. Proton pump inhibitors are generally recommended when H2 blockers fail to control symptoms. They are also used to treat severe symptoms or inflammation of the esophagus (esophagitis). Side effects are uncommon but can include:

  • Headache
  • Stomach pain
  • Bloating
  • Diarrhea
  • Nausea

There are some concerns about long-term high-dose use of strong acid-suppressing medications. Possible side effects include bone fragility, digestive and pulmonary infections, and nutritional deficiencies.

Depending on your symptoms, you may need to take medicines only when GERD symptoms occur. In choosing a medication, we will try to treat your symptoms while minimizing side effects.

To learn more about GERD medications, please see the International Foundation for Functional Gastrointestinal Disorders' frequently asked questions about GERD treatment.

Surgery

Some people find that medicine and lifestyle changes don't relieve their symptoms. If this is the case, surgery may be an option. 

Fundoplication is the main surgical treatment for GERD. It involves wrapping the upper curve of the stomach (the fundus) around the esophagus and sewing it into place to strengthen the esophageal sphincter.

Endoscopic techniques are currently being investigated but are not regularly used in clinical practice at this time. These techniques involve using an endoscope (a thin, flexible imaging instrument) to perform the surgery.

Side effects of surgery

Some people who have surgery experience side effects or complications. The most common side effect is difficulty with swallowing or not being able to belch or vomit. These side effects are usually temporary but can sometimes last for long periods of time. If these side effects persist, we can help you manage them.

Your stomach is where the food you eat is broken down into smaller pieces. This action is called digestion. Stomach (gastric) juice is the term used to describe the chemicals that break down food in the stomach. These include hydrochloric acid and an enzyme called pepsin. Gastric juice is sometimes referred to as stomach acid, although not all of the substances in gastric juice are acidic.


Lifestyle Changes

GERD symptoms can be uncomfortable and sometimes even painful. The good news is that they can be managed with lifestyle and diet changes. We recommend that you try to:

Eat smaller meals. Large meals tend to empty more slowly from the stomach. This can cause pressure on the esophagus sphincter.

Avoid late-night snacks. Acid production is at its peak during the evening. It is best to eat an early dinner and avoid evening snacks.

Avoid lying down for at least 2 to 3 hours after you eat. Lying down after eating lets the acid flow back into the esophagus. When you do lie down, lie on your left side. This takes advantage of the curvature of your stomach and has been shown to reduce your chance of GERD.

Stop smoking. Quitting smoking will often improve GERD symptoms.

Lose a few pounds if you are overweight. Being overweight can make GERD symptoms worse. Losing even small amounts of weight has been proven to improve GERD.

Raise the head of your bed about 6 to 8 inches. Try putting sturdy blocks under the bed frame legs. If you are unable to raise your bed, raise your head (and upper body) by putting a foam wedge under your head and shoulders.

Avoid certain medicines. Anti-inflammatory drugs (such as aspirin, ibuprofen, and naproxen) can cause heartburn. Instead, try acetaminophen for pain relief. Let us know if you think medicines are causing heartburn.

Avoid or limit certain foods. Chocolate, fatty or fried foods, peppermint or spearmint-flavored foods, coffee, alcohol, and carbonated drinks can trigger GERD symptoms in some people and tend to make heartburn symptoms worse. Spicy foods can also make heartburn symptoms worse.

Wear loose clothing. Tight-fitting belts or waistbands can squeeze the stomach and force food up against the lower esophagus.

Reduce your stress. Stress can increase GERD symptoms.

Raise the head of your bed about 6 to 8 inches. Try putting sturdy blocks under the bed frame legs.


Long-Term Complications

If your GERD symptoms last for more than 2 weeks, please contact us. In some people, GERD can be accompanied by serious complications, but this can differ from patient to patient. If we think you may be at risk for complications, we will discuss it with you. Complications can include:  

  • Esophagitis. Excessive acid reflux (digestive juices that rise up from your stomach) can cause the lining of your esophagus to become inflamed.
  • Ulcers in the lining of the esophagus. Severe inflammation in the esophagus can result in crater-shaped sores (ulcers) in the lining of the esophagus.
  • Narrowing of the esophagus (esophageal stricture). This occurs from inflammation that causes scarring in the esophagus.
  • Bleeding from the esophagus. This can happen from prolonged irritation to the esophageal lining.
  • Barrett's esophagus. This is a change in the lining of the esophagus as a result of abnormal healing from an ulcer or erosion. Barrett's esophagus is not cancerous, but it has a small chance of turning into cancer. We do not know why some people with GERD have Barrett's esophagus, while others do not. For more information on Barrett's esophagus, see The National Digestive Diseases Information Clearinghouse.
  • Respiratory problems. Persistent cough, asthma, or pneumonia may occur.
  • Structural changes of the lungs or voice box (larynx). You may notice increased hoarseness or frequent laryngitis (inflammation of the larynx, causing your voice to become raspy or hoarse).
  • Pharyngitis. The passage that connects your nasal airway to the upper portion of the throat (pharynx) can become irritated.
  • Tooth decay. As stomach acid gets into the mouth, it can wear away at your tooth enamel and cause tooth decay.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.