Acid reflux and gerd

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What’s the Difference Between Acid Reflux and GERD?

Got a burning feeling in your upper chest? If you’re thinking heartburn, you’re probably right. “Heartburn is the manifestation — the symptom — of acid reflux, or stomach contents coming back up in your esophagus,” says Matilda Hagan, MD, a gastroenterologist at The Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore.

You can often pinpoint a reason for the burn (that five-alarm chili, perhaps?), but if heartburn happens often — defined as a couple of times a week — it could be a symptom of a more serious condition called gastroesophageal reflux disease (GERD).

While it may seem that GERD is just a fancy name for heartburn, they are more like close cousins than identical twins.

That Burning Feeling: What Is Heartburn?

After you swallow food, it makes its way down the esophagus and into the stomach, where a ring of muscle, called the lower esophageal sphincter (LES), closes to keep the food in. But sometimes the LES is weak or doesn’t properly close, allowing stomach acid to backup, which irritates the lining of the esophagus. That’s acid reflux, or heartburn.

The American College of Gastroenterology (ACG) estimates that more than 60 million Americans experience heartburn at least once a month. Symptoms include:

  • A burning sensation in the center of your chest that lasts from several minutes to an hour or two
  • A feeling of chest pressure or pain that is worse if you bend over or lie down
  • A sour, bitter, or acidic taste in the back of your throat
  • A feeling that food is “stuck” in your throat or the middle of your chest

You can generally avoid occasional bouts of heartburn with some lifestyle modifications. Your doctor will likely suggest you try to treat heartburn by making the following lifestyle changes before medication comes into play.

  • Avoid foods that trigger reflux for you. Spicy, acidic, and fried or fatty foods are more likely to trigger reflux. So can caffeine and alcohol.
  • Stay upright after eating a big meal to allow for optimal digestion. “It’s best to not eat in the hours leading up to bedtime,” says Dr. Hagan.
  • If you’re overweight or obese, losing some weight can help. (Obesity is a factor in the weakening of the lower esophageal sphincter.)
  • If you smoke, do your best to quit.

Related: Heartburn and Foods: Dos and Don’ts

Related: 7 Low Acid Foods to Add to Your Reflux Diet

When Acid Reflux Is Chronic: What Is GERD?

According to the ACG, GERD is acid reflux that occurs more than a couple of times per week. That said, it’s not the case that a person who has occasional heartburn will necessarily progress toward having GERD, says Louis Cohen, MD, gastroenterologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City. But the symptoms are the same as those of acid reflux, such as the burning feeling in your chest and the sensation that your stomach contents are in your throat. You may also have a dry cough or trouble swallowing.

Diagnosing the condition can usually be done by a primary care doctor (or gastroenterologist) by simply evaluating symptom frequency and severity.

“We may also put a probe into a patient’s esophagus for a day to measure how frequently reflux happens,” says Dr. Cohen. Knowing how often reflux occurs is another way (beyond symptoms) to confirm a diagnosis.

Treatment for GERD starts with lifestyle modifications, adds Hagan, “we’ll ask patients to try these steps before we offer medication, although we understand that it can be hard to do some things, such as quitting smoking.”

The medication most often prescribed for GERD is a proton pump inhibitor (PPI), such as:

  • Prevacid (lansoprazole)
  • Nexium (esomeprazole)
  • Prilosec (omeprazole)

PPIs work to decrease the amount of acid your stomach produces. The ACG notes that there’s strong evidence that an eight-week course of a PPI eases symptoms and can heal the lining of the esophagus that’s been damaged by stomach acid. Other drugs called H2 blockers, such as Zantac (ranitidine) or Pepcid (famotidine) may also be tried and are effective, says Hagan. H2 blockers also lower stomach acid production, and are available over the counter.

“If we determine that GERD symptoms are caused by hypersensitivity in the esophagus or excessive relaxation of the lower esophagus, we might prescribe tricyclic antidepressants or selective serotonin uptake inhibitors,” adds Cohen.

Delaying Treatment May Lead to Complications

If GERD goes untreated, it can lead to more serious complications. One such issue is esophagitis, which is inflammation in the esophagus. Hagan says if that’s not treated, you may develop strictures, which is a narrowing of the esophagus that can lead to esophageal pain and affect proper swallowing.

Another complication of GERD is a condition called Barrett’s Esophagus (BE). “Over time, the stomach acid causes cells in the lining of the esophagus to look more like the stomach lining,” says Hagan. These changes, which happen on a cellular level, may in rare cases lead to a form of esophageal cancer called esophageal adenocarcinoma. BE is more common in:

  • Caucasian males
  • People older than age 50
  • Smokers
  • People who are overweight

This form of cancer appears to be on the rise, according to research published in March 2013 in the journal Cancer.

Meanwhile more recent research, published in May 2016 in the Journal of the American Medical Association, suggests that the “chemical burn” of stomach acid may not be the sole cause of changes to the esophageal lining. Instead, the study suggests that damage may be caused by an inflammatory response to proteins called cyotokines that are secreted in the intestinal lining of people with GERD.

If you have BE, says Hagan, your doctor may recommend surveillance endoscopy, which means he or she will perform an endoscopy periodically to see how well your esophagus is healing, secondary to drug therapy.

The bottom line: If you’re experiencing heartburn at an increased frequency, talk to your doctor about testing to uncover the underlying issue. If you learn to treat GERD with lifestyle changes or medication, you can avoid more serious complications.

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Oesophageal cancer

The most common symptoms of oesophageal cancer include:

  • difficulty swallowing (dysphagia)
  • indigestion or heartburn that don’t go away
  • weight loss
  • pain in your throat or behind your breastbone
  • a cough that won’t go away

There are many other conditions that cause these symptoms. Most of them are much more common than oesophageal cancer.

You should see your doctor if you have difficulty swallowing, or you have symptoms that are unusual for you or that won’t go away. Your symptoms are unlikely to be cancer but it is important to get them checked by a doctor.

Difficulty swallowing (dysphagia)

You may feel pain or a burning sensation when you swallow, or your food may stick in your throat or chest.

This is the most common symptom of oesophageal cancer.

A harmless narrowing of the oesophagus called a stricture can also make it difficult for you to swallow. It is important to get this symptom checked by your doctor.

Indigestion or heartburn that don’t go away

You can get indigestion when acid from your stomach goes back up (refluxes) into the oesophagus. Or when the stomach is inflamed or irritated.

The valve between the stomach and oesophagus normally stops this from happening. The valve is called the cardiac sphincter. A tumour that develops here can stop the valve working, causing indigestion.

Remember that indigestion is common and it’s not usually caused by cancer. It can be very painful, even when there’s nothing seriously wrong.

See your doctor if you’ve had heartburn most days for 3 weeks or more, even if you’re taking medicine and it seems to help. Heartburn is burning chest pain or discomfort that happens after eating.

Weight loss

You may be put off eating if you find it hard to swallow or have pain when you swallow your food. This can make you lose weight.

Rarely, extreme weight loss can be a sign of an advanced cancer.

Pain in your throat or behind your breastbone

You may feel pain in the centre of your chest, or more rarely in your back or shoulder. This can get worse when you swallow or have indigestion.

A cough that won’t go away

A cough that won’t go away or that happens when you try to eat can be caused by oesophageal cancer.

Other symptoms

Other symptoms can include:

Food coming back up

You may regurgitate food – this is when food comes back up soon after you swallow it. It usually starts with food like meat and bread. You may start to bring up soft foods such as mashed potato, drinks and saliva if you don’t have treatment.

Hoarseness

Your voice can become raspy or croaky. It’s not a common symptom and can be caused by other harmless conditions.

Coughing up blood

You may cough up blood or have blood in your vomit (or food that you bring back up) if your oesophagus is bleeding. This isn’t common.

Dark poo

Your poo may be darker – almost black – if cancer is making your oesophagus bleed. This is uncommon. You can get darker poo if you’re taking iron tablets.

Occasional heartburn is among the commonest of symptoms. Ask any group of adults if they have had heartburn in the last year, and a third will put up their hands.

There are a number of things you can do to avoid simple heartburn that occurs now and then.

It is important to distinguish simple heartburn from long-standing heartburn that keeps recurring. This could be a sign of an underlying condition such as gastroesophageal reflux disease (GERD).

If the heartburn is frequent, or persistent it’s important to see a doctor so that you receive an accurate diagnosis and the right treatment.

Learn more about GERD

What is Heartburn?

Heartburn is a burning sensation in the chest behind the breastbone. This accounts for the “heart” in heartburn. Other than the name and the location, heartburn is not related to chest pain (angina) due to heart disease. Nevertheless, while chest pain or chest pressure may indicate acid reflux, it is right for anyone with this kind of pain or discomfort to seek urgent medical evaluation. Possible heart conditions must always be excluded first.

“Indigestion” is sometimes used to describe heartburn, but this term is imprecise and people use it to describe anything from diarrhea to belching.

“Dyspepsia” describes pain in the upper abdomen (below the chest) that resembles that of a peptic ulcer. It is important not to confuse dyspepsia with heartburn because the treatments are quite different.

Learn more about Dyspepsia

What Causes Heartburn?

In order to assist digestion, the stomach produces a very strong acid called hydrochloric acid. We are normally unaware of this since the stomach is designed to withstand this acid. However, the esophagus or swallowing tube is not so protected. If acid escapes back from the stomach into the esophagus (gastroesophageal reflux), it irritates or damages it.

We experience heartburn when reflux – the back-flow of stomach contents – occurs. To prevent this reflux, the lower esophageal sphincter (LES), a band of muscles at the lower end of the esophagus acts like a gate or valve. It permits food to pass down, and then closes to prevent gastric contents from coming back up (Figure One).

This works well most of the time, but many things such as overeating, obesity, aging, and some medicines may compromise this protective mechanism. Hiatus hernia (protrusion of part of the stomach from the abdomen into the chest) can also compromise LES function.

If your LES is not working well, there are a number of things that you may be doing that promote reflux and cause you to experience heartburn.

Tips for Preventing Reflux

Your posture – Gravity plays an important role in controlling reflux. Lying down after a large meal can overwhelm a less than perfect LES. Food comes back into the esophagus and heartburn occurs.

If you experience heartburn, think whether it occurs after meals, when you lie in bed at night, or if you take a nap after a meal. Maintaining an upright posture until the meal is digested may prevent the heartburn.

If heartburn occurs regularly at night, consider raising the head of the bed or inserting a triangular wedge to keep your esophagus above the stomach.

Avoid physical exertion after a meal. It contracts the abdominal muscles and forces food through a weakened sphincter. This is especially true of tasks that require bending such as lifting or cleaning the floor.

How you eat – How is perhaps more important than what you eat. A large meal will empty slowly from the stomach and exert pressure on the LES. A snack at bedtime is well positioned to reflux when you lie down.

It is best to eat early in the evening so that the meal is digested by bedtime. You might try having the main meal at noon and a lighter one at dinnertime.

All meals should be eaten in relaxed stress-free surroundings. If possible, stay seated during, and for a time after, eating.

Smaller meals and an upright, relaxed posture should help minimize reflux.

What you eat – Certain foods compromise the sphincter’s ability to prevent reflux, and are best avoided before bedtime or exertion.

These differ from person to person, but many recognize these foods as particularly troublesome:

  • Fats
  • Onions
  • Chocolate

Alcohol often provokes heartburn by compromising the LES, irritating the esophagus, and by stimulating stomach acid production.

Certain other foods may bother some people. When you notice a food provokes your heartburn, try avoiding or reducing it for a period of time.

Some oral medications will burn if allowed to rest in the esophagus. To be safe, always swallow medication in the upright position and wash it down with water.

Other factors – Being overweight can promote reflux. Excess abdominal fat puts pressure on the stomach and the loss of even a moderate amount of weight makes many people feel better.

Learn more about reducing heartburn by burning calories

Pregnant women are often troubled by heartburn, particularly in the first three months. Certain hormones appear to weaken the LES, and the increasingly crowded abdomen encourages reflux. Generally, if there has not been too much weight gain during the pregnancy, a woman’s heartburn improves after delivery.

Stress or strong emotion can also influence heartburn.

The most important measures are suggested by the information mentioned above. Avoidance of lying down or straining after meals, and elevation of the head of the bed are important.

Early dinners, smaller meals and the avoidance of fat, chocolate, and onions also seem particularly helpful. A review of diet, medications, and the stresses of life may help you manage the symptom.

When these measures fail an antacid preparation may temporarily relieve the symptom by neutralizing stomach acid. An antacid containing an alginate will float in the stomach and prevent reflux by blocking the lower esophagus. These are safe if used in moderation and as directed. There are now over-the-counter drugs that reduce acid production and may be safely taken for a few days until the heartburn subsides.

Complications

If the heartburn occurs on 2 or more days per week despite the measures discussed above, you should consult your family doctor.

If you are over 50 years old, your heartburn occurs with exercise, or you have a family history of heart disease, you should promptly see a physician to be sure that your heart is not the source of the pain.

See a doctor promptly if you experience difficulty swallowing, vomiting, passing blood, or significant weight loss.

If your heartburn is accompanied by breathing difficulties or hoarseness, you should seek medical advice.

Acid-Suppressing Drugs

There are powerful drugs that your doctor may prescribe for persistent symptoms, and tests may be done to exclude other diseases. The acid-suppressing action of these drugs controls the symptom of heartburn, but the conditions that cause reflux remain. Therefore, the heartburn is likely to return once the drugs are stopped.

Many people learn to control heartburn without using acid-suppressing drugs. The posture and eating modifications mentioned above remain an important part of treatment.

Nevertheless, persistent heartburn, or complicated GERD may require medication therapy to permit healing and prevent recurrence. This therapy should be done under the guidance of a physician.

Adapted from IFFGD Publication: Heartburn: Nothing to do with the Heart by W. Grant Thompson, MD, FRCPC, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada.

Occasional heartburn is often treatable with over-the-counter medication and/or lifestyle modification.

Ask yourself these questions to see if your heartburn may be caused by a more serious condition, such as gastroesophageal reflux disease, also called GERD:

  • Have you been having symptoms of GERD and treating with over-the-counter medicines for more than 2 weeks?
  • Has the pattern of your heartburn changed? Is it worse than it used to be?
  • Do your symptoms include regurgitation — bringing up gas and small amounts of food from your stomach to your mouth?
  • Do you wake up at night with heartburn?
  • Have you been having any difficulty swallowing?
  • Do you continue to have heartburn symptoms even after taking non-prescription medication?
  • Do you experience hoarseness or worsening of asthma after meals, lying down, or exercise, or asthma that occurs mainly at night?
  • Are you experiencing unexplained weight loss or loss of appetite?
  • Do your heartburn symptoms interfere with your lifestyle or daily activity?
  • Are you in need of increasing doses of nonprescription medicine to control heartburn?

If you answered yes to any of these questions, your heartburn warrants attention from a medical professional. People with long-standing chronic heartburn are at greater risk for serious complications including stricture (narrowing) of the esophagus or a potentially precancerous condition called Barrett’s esophagus.

Understanding the Difference Between GERD and Heartburn

After a large meal, do you ever get a burning sensation in your stomach or chest, or taste acid in your mouth? Many of us would chalk this unpleasant feeling up to acid reflux or heartburn.

But if it happens often, heartburn could be a symptom of gastroesophageal reflux disease (GERD), a digestive tract disorder which affects the muscle separating the lower esophagus from the stomach.

What’s the Difference Between GERD and Heartburn?

Dr. Gurtej Malhi, a gastroenterologist with Dignity Health Medical Group, explains that, “GERD is reflux of the stomach contents into the esophagus. Heartburn, or a burning sensation in the chest, can be one of the symptoms of GERD.”

Frequent and persistent heartburn is the most common symptom of GERD, but GERD is also associated with other symptoms, such as:

  • regurgitation
  • chronic cough
  • difficulty swallowing
  • chest pain, especially while lying down

What Causes GERD?

Factors that can contribute to GERD include:

  • smoking
  • excessive caffeine intake
  • being overweight
  • eating late in the evening

One possible cause of GERD is a hiatal hernia, or stomach hernia. “A hiatal hernia happens when part of your stomach moves up through the diaphragm and into the chest” Dr. Malhi explains. “Because the diaphragm normally acts as an additional barrier to acid reflux, the presence of a hiatal hernia can aggravate GERD symptoms.”

Not everyone with a hiatal hernia experiences GERD, but a hernia can make it easier for the stomach’s contents to flow into the esophagus, making GERD more likely.

Is It Heartburn or Is It GERD?

Occasional heartburn on its own is fairly common. To determine whether your heartburn might actually be a symptom of GERD, ask yourself the following questions:

  • Have the symptoms persisted for more than two weeks, even after taking over-the-counter (OTC) medications?
  • Do you find you need to increase your dosage of OTC medications to find relief?
  • Are you constantly bringing up bits of food?
  • Has your heartburn increased in severity?
  • Have you lost your appetite or lost an inexplicable amount of weight?
  • Do you have trouble swallowing?
  • Does your heartburn wake you in the middle of the night?

If you answered yes to any of the above questions, you should consider scheduling an appointment with your doctor to ensure your heartburn isn’t a sign of GERD or another serious condition.

For example, Dr. Malhi explains, “Heartburn can occasionally present as symptoms of heart disease, especially in women. There are usually associated symptoms of a pressure-like sensation in the chest, pain in arm, jaw or neck, shortness of breath, or nausea or vomiting. If you are not sure, please seek immediate medical attention.”

Managing GERD Symptoms

Lifestyle choices can help GERD symptoms. For example, regular exercise can help alleviate acid reflux, andresearch studies have shown that losing weight significantly improves GERD symptoms for many people.

If yousmoke, quitting could also have a substantial impact on your GERD symptoms. Smoking can lead to affect the lower esophageal sphincter and cause more acid reflux.

According to Dr. Malhi, some people find that certain foods, including chocolate, peppermint, alcohol, spicy foods, and citrus fruits and juices, can trigger GERD. If you experience GERD, avoiding these foods can help prevent or lessen your symptoms.

Changing what time of day you eat – or more specifically, avoiding eating late at night – can also help reduce your symptoms. Dr. Malhi also offers the following advice: “Avoid lying down two-to-three hours after eating and when you get in bed, prop your head up.”

CertainOTC and prescription medications can help you manage GERD. In some cases, when medication does little to control symptoms or when lifestyle changes still do not prevent GERD symptoms from occurring, surgery might be necessary to correct the condition.

If you think you might have GERD, scheduling an appointment with your doctor can help you determine whether your heartburn might indicate something more serious, and help you manage or reduce your symptoms.

What’s the Difference Between Heartburn, Acid Reflux, and GERD?

January 14, 2020

Acid reflux, heartburn, GERD. Do you sometimes hear those terms used interchangeably, or think you know what they mean but not sure how they’re different? You’re not alone. They are commonly confused because they’re related, but they are not the same.

What’s the difference?

Heartburn

Heartburn might be the first thing you think of when you hear acid reflux or GERD. That’s because it is a primary symptom of both. However, getting heartburn doesn’t automatically mean you have acid reflux or GERD.

Heartburn is a symptom, not a disease. It describes the burning feeling under your breastbone that anyone can get occasionally, especially after large, fatty, or spicy meals. It can come with a sour taste in your mouth and the feeling of food coming up from your stomach. It is caused by stomach acid leaking up into your esophagus.

On its own, occasional heartburn is nothing to be worried about, although it’s uncomfortable at the time. Lots of people get heartburn sometimes.

Acid Reflux

Acid reflux is what causes heartburn. It’s when stomach contents, including stomach acid, leak up into your esophagus. It’s also called gastroesophageal reflux (GER). Stomach contents can leak up into the esophagus when the valve that normally keeps the contents in the stomach doesn’t stay closed.

The lower esophageal sphincter (LES) normally keeps contents safely in your stomach. But it can allow leaks to occur if your stomach is overly full or if you’ve eaten certain foods that relax the LES, causing it to open.

GERD

Gastroesophageal reflux disease (GERD) is an acid reflux disease that must be diagnosed by a doctor. When mild acid reflux happens more than two times per week or severe reflux happens weekly, you might have (GERD). This is a chronic condition that can cause serious symptoms.

The acid from this frequent reflux can lead to difficulty swallowing, a chronic cough, tooth damage from acid, and other symptoms. If it’s not controlled, the damage to the esophagus can lead to ulcers, scarring, and even esophageal cancer.

GERD can often be successfully treated with medication or lifestyle changes, but surgery is sometimes necessary.

What can you do if you have heartburn?

If you experience occasional heartburn from acid reflux, try these:

  • Don’t lay down after eating for two to three hours
  • Raise the head of your bed so gravity helps keep your stomach contents in your stomach
  • Eat smaller, more frequent meals instead of two to three large meals
  • Don’t smoke
  • Avoid tight clothing that can put pressure on your stomach
  • Keep a food diary to pinpoint trigger foods to avoid
  • Lose extra weight
  • Use over the counter antacids if needed*

If you’re taking antacids more than two times per week, or your symptoms are getting worse, you may have GERD. Your doctor can talk to you about your history and symptoms, rule out other conditions, and determine if you have acid reflux or GERD.

Together you can come up with a plan to treat your symptoms and avoid the complications that can come from untreated GERD.

Reflux in Children

What are reflux (GER) and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

What causes reflux and GERD in children?

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don’t flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn’t, and the stomach contents flow back into the esophagus. This can happen because of

  • A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
  • Increased pressure on the abdomen from being overweight or having obesity
  • Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
  • Smoking or exposure to secondhand smoke
  • A previous surgery on the esophagus or upper abdomen
  • A severe developmental delay
  • Certain neurological conditions, such as cerebral palsy

How common are reflux and GERD in children?

Many children have occasional reflux. GERD is not as common; up to 25 percent of children have symptoms of GERD.

What are the symptoms of reflux and GERD in children?

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause

  • Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
  • Bad breath
  • Nausea and vomiting
  • Problems swallowing or painful swallowing
  • Breathing problems
  • The wearing away of teeth

How do doctors diagnose reflux and GERD in children?

In most cases, a doctor diagnoses reflux by reviewing your child’s symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include

  • Upper GI series, which looks at the shape of your child’s upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
  • Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child’s esophagus. A doctor or nurse places a thin flexible tube through your child’s nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
  • Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child’s esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

What lifestyle changes can help treat my child’s reflux or GERD?

Sometimes reflux and GERD in children can be treated with lifestyle changes:

  • Losing weight, if needed
  • Eating smaller meals
  • Avoiding high-fat foods
  • Wearing loose-fitting clothing around the abdomen
  • Staying upright for 3 hours after meals and not reclining and slouching when sitting
  • Sleeping at a slight angle. Raise the head of your child’s bed 6 to 8 inches by safely putting blocks under the bedposts.

What treatments might the doctor give for my child’s GERD?

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child’s stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include

  • Over-the-counter antacids
  • H2 blockers, which decrease acid production
  • Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
  • Prokinetics, which help the stomach empty faster

If these don’t help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Current Advances in the Diagnosis and Treatment of Nonerosive Reflux Disease

Abstract

Nonerosive reflux disease (NERD) is a distinct pattern of gastroesophageal reflux disease (GERD). It is defined as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal mucosal erosions/breaks at conventional endoscopy. In clinical practice, patients with reflux symptoms and negative endoscopic findings are markedly heterogeneous. The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep), and sustained esophageal contractions. The use of 24-hour esophageal impedance and pH monitoring gives further insight into reflux characteristics and symptom association relevant to NERD. The treatment choice of NERD still relies on acid-suppression therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily) for 2–4 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily) is recommended. In patients with poor response to appropriate PPI treatment, 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid-reflux-related NERD (hypersensitive esophagus), nonacid-reflux-related NERD, and functional heartburn. The response is less effective in NERD as compared with erosive esophagitis.

1. Definitions of Gastroesophageal Reflux Disease and Nonerosive Reflux Disease

Gastroesophageal reflux disease (GERD) has been defined in the Montreal Consensus Report as a chronic condition that develops when the reflux of gastric contents into the esophagus in significant quantities causes troublesome symptoms with or without mucosal erosions and/or relevant complications . The typical symptoms of GERD are recognized as heartburn and/or acid regurgitation. GERD is a common disorder with its prevalence, as defined by at least weekly heartburn and/or acid regurgitation, estimated to range from 10 to 20% in western countries and is less than 5% in Asian countries . However, it has been demonstrated that GERD is emerging as a leading digestive disorder in Asian countries and has an adverse impact on health-related quality of life .

It is noteworthy that symptoms and esophageal lesions do not necessarily exist together. A proportion of patients with erosive esophagitis have no symptoms, whereas 50–85% of patients with typical reflux symptoms have no endoscopic evidence of erosive esophagitis . The latter group of GERD patients is considered to have nonerosive reflux disease (NERD) .

The Vevey Consensus Group defined NERD as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal erosions/breaks at conventional endoscopy and without recent acid-suppressive therapy . There are some important developments that have emerged in the field of GERD with emphasizing the importance in managing those patients with NERD. It has been observed that most of the community-based GERD patients appear to have NERD . In addition, previous studies have shown that NERD patients appear to be less responsive to proton pump inhibitors (PPIs) as compared with patients with erosive esophagitis .

The axiom “no acid, no heartburn” is not theoretically proper . Heartburn has been demonstrated as a cortical perception of a variety of intraesophageal events . Subjects with heartburn without erosive esophagitis represent a heterogeneous group of patients of whom some may not have gastroesophageal-reflux- (GER-) related disorder . In clinical practice, patients with reflux symptoms and negative endoscopic findings can be classified as (1) acid-reflux-related NERD (increased acid reflux), (2) weakly acid-reflux-related NERD (weakly acid reflux with positive symptom association; hypersensitive esophagus), (3) nonacid-reflux-related NERD (nonacid reflux with positive symptom association), and (4) functional heartburn (no associations between symptoms and reflux) (Table 1) . The Rome II committee for functional esophageal disorders defined functional heartburn as an episodic retrosternal burning in the absence of pathologic GERD, pathology-based motility disorders, or structural explanations . Patients with functional heartburn should be excluded from NERD because their symptoms are not related to GER.

Classification Distal esophageal acid exposure Symptom correlation Symptom response to PPI
Erosive esophagitis Increased (+) Good
Barrett’s esophagus Increased (+) Good
NERD
 Acid reflux related Increased (+) Good
 Weakly acid related Not increased (+) Moderate*
 Nonacid related Not increased (+) Poor*
Functional heartburn Not increased (−) Poor
Not well investigated.

Table 1 Classification of patients with reflux symptoms.

2. Natural History of NERD

Recent studies regarding natural history of NERD are limited with some shortcomings including retrospective design, irregularity in follow-up, and confounding with use of medication. Very low proportion of NERD patients (3–5%) develops erosive esophagitis with the duration up to 20 years with intermittent use of antireflux therapy .

In a recent retrospective study on 2306 GERD patients with at least two separate upper endoscopies during a mean follow-up of 7 years, it was shown that most of the patients remained unchanged, while only 11% of patients worsened . Similarly, the other study on patients with mild erosive esophagitis for a mean duration of 5.5 years suggests that, even within the different gradings of erosive esophagitis, the progression to severe disease is uncommon over time . Therefore, the current notion regarding natural course of NERD indicates that the progression of NERD to severe form of GERD is uncommon, and there is no evidence to develop Barrett’s esophagus over time .

3. Prevalence of NERD

It is difficult to estimate the true prevalence of NERD, since it is hard to identify community subjects with symptoms without seeking medical attention. There are several community-based studies in Europe that found that about 70% of the patients met the diagnosis for NERD . Other international studies on subjects in primary care centers showed that about 50% of their enrolled patients had normal upper endoscopy . A US study on subjects who had their reflux symptoms controlled by antacids alone has shown that 53% of those subjects had no erosive esophagitis on upper endoscopy . From the previous studies, the prevalence of NERD is therefore estimated to be between 50% and 70% of the GERD population in western countries. In Asia, NERD is reported to affect different ethnic GERD populations such as 60% to 90% of the Chinese, 65% of the Indians, and 72% of the Malay .

4. Pathogenesis of NERD

Recent studies have provided greater insight into the pathophysiology and symptom generation in NERD. The major concepts in the pathophysiology we review include the pattern of mucosal response to gastric contents during reflux and on mucosal factors that may affect symptom perception.

Both esophageal dysmotility and hiatal hernia are less common in NERD than in erosive esophagitis . The pathophysiology as reduced ability to clear acid from the esophagus following reflux events in patients with erosive disease is thus uncommon in NERD patients; however, the latter group is characterized by greater esophageal sensitivity in the proximal esophagus . Despite no difference in gastric acid output between NERD and esophagitis , NERD patients have lower acid reflux when compared with patients with erosive esophagitis and Barrett’s esophagus . In addition, there is considerable overlap in acid exposure times between three groups of GERD patients . Proximal migration of acid and nonacidic reflux seems to play a role in the symptom generation in NERD . Total acid and weakly acidic reflux are greater in erosive esophagitis and Barrett’s esophagus than in NERD , but NERD patients are shown to be of more homogenous distribution of acid exposure throughout the esophagus with greater proximal reflux . With the advantage of impedance studies, NERD patients are shown to have greater proximal extent of reflux episodes (with and without prolonged esophageal acid exposure) than in healthy controls . Further studies have shown greater proximal extent of reflux events which appears to be associated with symptom perception in GERD patients refractory to acid-suppression therapy . Furthermore, some of the NERD patients are more sensitive to weakly acid reflux than those with erosive esophagitis , supporting the explanation for poor PPI response in NERD patients.

The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep), and sustained esophageal contractions . It has been observed that acid exposure disrupts intercellular connections in the esophageal mucosa, producing dilated intercellular spaces (DIS) and increasing esophageal permeability, allowing refluxed acid to penetrate the submucosa and reach chemosensitive nociceptors . DIS has been observed in both NERD and erosive disease without a significant specificity as is also found in 30% of asymptomatic individuals . DIS has been found to regress with acid suppression . The development of DIS may also be potentiated by bile acids and by stress . Stress alone may increase esophageal permeability, provoking DIS that can be enhanced by acid exposure . These observations suggest a complex relationship between stress and acid exposure in the generation of reflux symptoms.

Peripheral receptors are shown to be mediating esophageal hypersensitivity due to acid reflux including upregulation of acid sensing ion channels, increased expression of TRPV1 receptors (transient receptor potential vanilloid type 1) , and prostaglandin E-2 receptor (EP-1) . Peripheral and central mechanisms have also been shown to influence processing of visceral sensitivity . It has been demonstrated that acute laboratory stress increased sensitivity to intraesophageal acid perception in patients with GERD , suggesting that the increase in perceptual responses to acid was associated with greater emotional response to the stressor. Sleep deprivation has also been shown to induce acid-related esophageal hypersensitivity , although there is no difference in sleep disturbance between patients with erosive esophagitis and NERD .

5. Risk Factors

GERD has been demonstrated to be influenced by genetic factors in some of the patients. In a genetic study on monozygotic twins with GERD, a significant association was found between reflux symptoms and several lifestyle factors by controlling for genetic influences . Obesity was independently associated with reflux symptoms in women, but was not evident in men . Smoking and physical activity at work appear to be risk factors, whereas recreational physical activity is protective . Independent associations have also been reported between reflux symptoms and anxiety, depression , and low socioeconomic status . However, it is yet unclear whether there is a specific correlation between psychological comorbidity and esophageal mucosa injury . There is a higher than expected prevalence of irritable bowel syndrome (IBS) in patients with GERD symptoms . A recent population-based study confirmed a significant overlap between reflux symptoms and IBS, with both occurring together more frequently than expected .

It appears that it is the NERD group that contributes most to the phenomenon as it is the predominant phenotype of patients with GERD symptoms, whereas some patients with erosive esophagitis may have no symptoms. Although an earlier work has attempted to compare clinical characteristics of NERD patients with those of erosive diseases patients in the same population, the potentially confounding contribution from functional heartburn has not been fully controlled . Previous studies have shown that NERD patients are more likely to be female and leaner as compared with those with erosive esophagitis . NERD patients are also less likely to have a hiatus hernia and more likely to have Helicobacter pylori . Further studies in patients with NERD and erosive esophagitis indicate that both groups of the patients appear to have distinct differences regarding clinical and physiological characteristics (Table 2) .

Characteristics NERD Erosive esophagitis
Gender Female No difference
Age (yr) 40–50 50–60
Smoking (%) 15–23 10–23
Alcohol (%) 8–59 6–64
Symptom duration (yr) 1–5 1–5
Hiatal hernia (%) 20–29 39–56
Helicobacter pylori (+) (%) 34–41 20–26
Resting LES pressure Normal Normal to low
Abnormal esophageal motility Mild Moderate to severe
Esophageal acid clearance Normal Abnormal
Distal esophageal pH (<4) (% of time) Slightly increased Moderately increased
NERD: nonerosive reflux disease; mild: ineffective esophageal motility alone; moderate to severe: ineffective esophageal motility and impaired bolus clearance.

Table 2 Clinical and physiological characteristics between patients with NERD and erosive esophagitis.

Recent data from Taiwan showed higher neuroticism scores in patients with reflux symptoms (with and without esophagitis) than in patients with asymptomatic esophagitis . In a further study from Hong Kong, which excluded functional heartburn, IBS was independently associated with NERD instead of erosive esophagitis . In addition, NERD patients were found to have increased tendency to have functional dyspepsia, psychological disorders, and positive acid perfusion test . However, clinical studies show equal influence between NERD and erosive esophagitis regarding heartburn intensity , quality of life , and sleep dysfunction .

6. Diagnosis of True NERD and Functional Heartburn

6.1. Endoscopic Image

Currently, NERD is differentiated from erosive esophagitis by white light endoscopy, and NERD is further differentiated from functional heartburn by using pH monitoring (±impedance) with symptom reflux association. Recent technological advances may improve diagnostic sensitivity regarding upper endoscopy. Due to a significant overlap in the amount of reflux episodes between patients with NERD and erosive esophagitis , it is suggested that mucosal changes in NERD patients may be too subtle to be detected by conventional endoscopy. A recent study has confirmed the clinical utility of magnification endoscopy with narrow band imaging (NBI) which provides detailed findings in reflux diseases which are not visible by conventional endoscopy . This study has shown several subtle changes in the esophageal mucosa which were identified to be highly associated with reflux disease. NERD patients appear to have intrapapillary capillary loops and microerosions identified on NBI than controls. The notation is also evident in subgroup analysis when NERD patients and esophagitis patients were compared with controls. However, despite excellent interobserver agreement for NBI findings, the drawback of NBI alone is present as modest intraobserver agreement has been demonstrated . Further studies of NBI suggest that combined NBI with conventional findings gives the resolution for improving diagnostic accuracy for NERD by upper endoscopy .

6.2. 24-Hour Impedance pH Monitoring

24-hour esophageal pH monitoring has been criticized for having limited sensitivity in diagnosing GERD; however, this technique is still essential for the diagnosis of NERD. The limitation of conventional pH monitoring has been overcome by combining pH with impedance monitoring . 24-hour impedance pH monitoring enables detection of acidic, weakly acidic, and nonacidic reflux and correlation with symptoms. This technique is able to identify three subsets of NERD (i.e., patients with an excess of acid, with a hypersensitive esophagus , or with nonacid-reflux-related symptom) and patients with functional heartburn. Savarino et al. investigated the data of combined impedance pH monitoring in 150 patients with reflux symptoms and negative endoscopy under off-PPI condition (Figure 1). It was concluded that adding impedance to pH monitoring improved the diagnostic sensitivity mainly by identifying a positive symptom association probability with weakly acid or nonacid reflux in patients off PPI therapy . By using this advanced technique in a group of patients with reflux symptoms not taking PPI, it was observed that the value of adding impedance measurement to standard pH monitoring could increase the observed positive symptom-reflux event association that might improve the diagnostic sensitivity of NERD . From the findings previous, although combined impedance and pH measurement is necessary to reliably distinguish NERD patients from patients with functional heartburn, the test is not commonly used in general practice, and the response to PPI is more realizable than to identify those with functional heartburn . Furthermore, NERD with weakly acid reflux is relatively uncommon without the condition during acid-suppression treatment.


Figure 1
Classification of patients with reflux symptoms and normal endoscopy (SAP: symptom association probability).

7. Treatment of NERD

7.1. PPIs

PPIs are the most recommended and effective agents employed in the treatment of GERD. The advantage of PPIs relieving reflux symptoms is also found in NERD patients. PPIs are more effective than other acid-suppressing agents such as histamine-2 receptor antagonists (H2RAs). It has been demonstrated in NERD patients that the relative risk for PPIs versus H2RAs was 0.74 (95% CI: 0.53–1.03) for controlling heartburn .

Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily) for 2–4 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily) is recommended. In patients with poor response to appropriate PPI treatment, esophageal pH (±impedance) monitoring is indicated to differentiate pathological acid reflux, acid-sensitive (hypersensitive) esophagus, and functional heartburn. The beneficial effects of PPIs in achieving symptom relief in NERD have been well documented in several studies. The rates of the relief of symptoms are shown to be 40–60% for omeprazole and rabeprazole 20 mg/day and about 30% for omeprazole 10 mg/day for 4 weeks . By using the wireless Bravo pH monitoring, normalization of esophageal acid exposure is found in NERD patients within 48 hours after starting PPIs .

NERD patients have been shown to be less responsive to PPIs as compared with patients with erosive esophagitis by approximately 20–30% after 4 weeks of the treatment . The overall PPI symptomatic response rate was 36.7% (95% CI: 34.1–39.3) in NERD and 55.5% (95% CI: 51.5–59.5) in erosive esophagitis, whereas the rate of therapeutic gain was 27.5% in NERD and 48.9% in erosive esophagitis . In NERD patients, the response rate appears to positively correlate with the extent of distal esophageal acid exposure with the higher symptom resolution in patients with greater acid exposure . Furthermore, patients with NERD demonstrate similar symptomatic response to half and full standard dose of PPI as a prior study has shown a similar median time to first symptom relief (2 days) and to sustained symptom relief (10–13 days) for pantoprazole (20 mg/day) and esomeprazole (20 mg/day) . In a subsequent study, administration of a lower dose of rabeprazole (5 mg/day) is not superior to half dose rabeprazole (10 mg/day) for heartburn relief .

Studies have demonstrated that on-demand or intermittent PPI therapy is also an effective strategy in NERD treatment . Due to the fact that most of the NERD is less likely to be progressive , treatment for those patients can be tailored by the presence of their symptoms. Therefore, on-demand or intermittent therapy is widely used as alternative PPI treatment for NERD patients , which also has the advantage of convenience, stable acid control, cost effectiveness, and reducing the chance of acid rebound.

Dexlansoprazole MR is an R-enantiomer of lansoprazole with dual delayed-release benefit in prolonging plasma concentration and pharmacodynamic effects better than those of single-release PPIs with its administration allowed at any time of the day without regard to meals. In patients with NERD, dexlansoprazole MR 30 mg daily has been shown to be more efficacious than placebo in controlling heartburn .

7.2. Novel Therapeutic Modalities

There are novel therapeutic modalities developed specifically for NERD patients. The targets for novel therapy are thought to be improving the competence of LES function such as new GABA-B agonists, better acid-suppression therapy, normalizing esophageal sensitivity, and augmenting esophageal motility. In patients with failure to respond to PPI treatment, it has been suggested that pain modulators like tricyclics and selective serotonin reuptake inhibitors are an alternative treatment option for controlling refractory symptoms such as heartburn and chest pain . However, there is no sufficient evidence to support their efficacy in PPI-failure patients. In patients with PPI failure, the use of pain modulators alone or combined with PPIs can be a treatment strategy, but further studies need to confirm such approach in PPI-failure patients.

The role of antireflux surgery NERD has not beenwell established. In general, NERD patients are less responsive to antireflux surgery . In one earlier study comparing the clinical outcome of antireflux surgery between patients with erosive esophagitis and NERD, it was demonstrated that 91% versus 56% reported heartburn resolution, 24% versus 50% reported dysphagia after surgery, and 94% versus 79% were satisfied with surgery, respectively .

8. Conclusions

The definition of GERD is well established and simply understood, whereas the NERD has been intangibly defined with more conditions needed, largely because of the increased recognition of functional heartburn due to the evolution of the Rome criteria for functional gastrointestinal disorders. NERD is generally accepted as an entity within the broader definition of GERD by excluding functional heartburn. NERD has been increasingly recognized as the most common cause of reflux symptoms in community population with impact on quality of life. Mechanisms of the symptom generation in NERD remain complex, and stress may play a role in the symptom generation. Treatment with PPIs remains the choice of the therapy in NERD patients, but may be less effective when compared with those with erosive esophagitis. The role of anti-reflux surgery in NERD remains to be further investigated and defined. PPIs therapy with intermittent or on-demand fashion can be an alternative treatment strategy in most of the NERD patients due to the relatively low risk for the progression to erosive esophagitis or Barrett’s esophagus.

† Based on 192 patients who underwent MSA with LINX as well as a matched pair analysis in which 47 patients underwent MSA2. 98.1% (p=0.118) and 97.8% of patients, respectively, reported symptom improvement or resolution. In a study of 100 patients implanted with LINX, bothersome heartburn decreased to 11.9% (p<0.001) and bothersome regurgitation decreased to 1.2% (p<0.001).

‡ Based on a 5 year prospective, multi-center, single-arm study observing 100 patients who were implanted with LINX, bothersome heartburn was 89% at baseline and decreased to 11.9% at 5 years. (p<0.001)

§ Ganz R. Edmundowicz S, Taiganides P, et al. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016. 14(5):671-7. Based on a study observing 100 patients who were implanted with LINX, daily use of PPIs decreased to 15.3% at 5 years. (p<0.001)

¶ Ganz R. Edmundowicz S, Taiganides P, et al. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016. 14(5):671-7. Based on a 5 year prospective, multi-center, single-arm study observing 100 patients who were implanted with LINX, regurgitation was 57% at baseline and decreased to 1.2% at 5 years. (p<0.001)

** Ganz R. Edmundowicz S, Taiganides P, et al. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016. 14(5):671-7. Based on a 5 year prospective, multi-center, single-arm study observing 100 patients who were implanted with LINX, there was a significant improvement in the median GERD-HRQL score at 5 years, as compared with baseline, both with and without PPI use, 4 vs 11 and 27 respectively (p<0.001).

†† Based on a 5 year prospective, multi-center, single-arm study observing 100 patients who were implanted with LINX, the success criteria for quality of life (50% reduction in total GERD-HRQL score, and PPI use 50% reduction) were met.

€ Ganz R. Edmundowicz S, Taiganides P, et al. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016. 14(5):671-7. 84 subjects were followed up for 5 years, baseline dissatisfaction was 95% and decreased to 7.1% in year 5 (p < .001). Based on the GERD-HRQL.

‡‡ Reynolds J, Zehetner J, Wu P, et al. Laparoscopic Magnetic Sphincter Augmentation vs Laparoscopic Nissen Fundoplication: A Matched-Pair Analysis of 100 Patients. J American College of Surgeons. 2015. 221(1):123-128. Based on a retrospective analysis of 1-year outcomes of patients undergoing MSA and LNF from June 2010 to June 2013. Matched-pair analysis of 100 patients. More LNF patients were unable to belch (8.5% of MSA and 25.5% of LNF; p= 0.028) or vomit (4.3% of MSA and 21.3% of LNF; p=0.004).

§§ Reynolds J, Zehetner J, Wu P, et al. Laparoscopic Magnetic Sphincter Augmentation vs Laparoscopic Nissen Fundoplication: A Matched-Pair Analysis of 100 Patients. J American College of Surgeons. 2015. 221(1):123-128. Based on a retrospective analysis of 1-year outcomes of patients undergoing MSA and LNF from June 2010 to June 2013. Matched-pair analysis of 100 patients. There were no patients with severe gas and bloating in the MSA group compared with 10.6% in the LNF group (p=0.022). 8.5% of MSA patients were unable to belch, compared to 25.5% of LNF patients (p = 0.028). 4.3% of MSA patients were unable to vomit when necessary compared to 21.3% of LNF patients (p = 0.004).

LINX® Reflux Management System Important Safety Information

The LINX® Reflux Management System is a laparoscopic, fundic-sparing anti-reflux procedure indicated for patients diagnosed with Gastroesophageal Reflux Disease (GERD) as defined by abnormal pH testing, and who are seeking an alternative to continuous acid suppression therapy (i.e. proton pump inhibitors or equivalent) in the management of their GERD.

Rx Only

Contraindications: Do not implant the LINX Reflux Management System in patients with suspected or known allergies to titanium, stainless steel, nickel, or ferrous materials.

Warnings: The LINX device is considered MR Conditional in a magnetic resonance imaging (MRI) system up to either 0.7 Tesla (0.7T) or 1.5 Tesla (1.5T), depending on the LINX model implanted. Scanning under different conditions may result in serious injury to you and/or interfere with the magnetic strength and the function of the device. In the event alternative diagnostic procedures cannot be used and MRI is required, the LINX device can be safely removed utilizing a laparoscopic technique that does not compromise the option for traditional anti-reflux procedures. It is recommended that patients receiving the LINX device register their implant with the MedicAlert Foundation (www.medicalert.org) or equivalent organization.

Failure to secure the LINX device properly may result in its subsequent displacement and necessitate a second operation.

Laparoscopic placement of the LINX device is major surgery and death can occur.

General Precautions: The LINX device is a long-term implant. Explant (removal) and replacement surgery may be indicated at any time. Management of adverse reactions may include explantation and/or replacement.

The use of the LINX device in patients with a hiatal hernia larger than 3cm should include hiatal hernia repair to reduce the hernia to less than 3cm. The LINX device has not been evaluated in patients with an unrepaired hiatal hernia greater than 3cm.

The safety and effectiveness of the LINX device has not been evaluated in patients with Barrett’s esophagus or Grade C or D (LA classification) esophagitis.

The safety and effectiveness of the LINX device has not been evaluated in patients with electrical implants such as pacemakers and defibrillators, or other metallic, abdominal implants.

The safety and effectiveness of the LINX Reflux Management System has not been established for the following conditions:

Scleroderma
Suspected or confirmed esophageal or gastric cancer.
Prior esophageal or gastric surgery or endoscopic intervention.
Distal esophageal motility less than 35mmHg peristaltic amplitude on wet swallows or <70% (propulsive) peristaltic sequences or High Resolution Manometry equivalent, and/or a known motility disorder such as Achalasia, Nutcracker Esophagus, and Diffuse Esophageal Spasm or Hypertensive LES.
Symptoms of dysphagia more than once per week within the last 3 months.
Esophageal stricture or gross esophageal anatomic abnormalities. (Schatzki’s ring, obstructive lesions, etc.)
Esophageal or gastric varices.
Lactating, pregnant or plan to become pregnant.
Morbid obesity. (BMI >35)
Age < 21
Potential Side Effects: Potential adverse events associated with laparoscopic surgery and anesthesia include adverse reaction to anesthesia (headache, muscle pain, nausea), anaphylaxis (severe allergic reaction), cardiac arrest, death, diarrhea, fever, hypotension (low blood pressure), hypoxemia (low oxygen levels in the blood), infection, myocardial infarction, perforation, pneumonia, pulmonary embolism (blood clot in the lung), respiratory distress, and thrombophlebitis (blood clot). Other risks reported after anti-reflux surgery procedures include bloating, nausea, dysphagia (difficulty swallowing), odynophagia (painful swallowing), retching, and vomiting.

Potential risks associated specifically with the LINX Reflux Management System include achalasia (lower part of esophagus does not relax), bleeding, cough, death, decreased appetite, device erosion, device explant/re-operation, device failure, device migration (device does not appear to be at implant site), diarrhea, dyspepsia (indigestion), dysphagia (difficulty swallowing), early satiety (feeling full after eating a small amount of food), esophageal spasms, esophageal stricture, flatulence, food impaction, globus sensation (sensation of a lump in the throat), hiccups, inability to belch or vomit, increased belching, infection, impaired gastric motility, injury to the esophagus, spleen, or stomach, nausea, odynophagia (painful swallowing), organ damage caused by device migration, pain, peritonitis (inflammation of the peritoneum), pneumothorax (collapsed lung), regurgitation, saliva/mucus build-up, stomach bloating, ulcer, vomiting, weight loss, and worsening of preoperative symptoms (including but not limited to dysphagia or heartburn).

For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.

Manufactured by:
Torax® Medical, Inc.
4188 Lexington Avenue North
Shoreview, Minnesota 55126, USA

Q: Are heartburn and acid reflux the same thing? What about GERD?

A: They are different but related. It starts with the esophagus. The esophagus is made up of predominantly smooth muscle. It extends from the throat down through the chest cavity and, when it gets past the abdomen, joins up with the stomach. When you swallow, the esophagus opens and then squeezes food down.

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At the very bottom of the esophagus, there is a valve that separates it from the stomach. That valve should normally be closed. When you swallow, it opens so that food can pass through, and then it closes again. Acid reflux is a disorder that occurs when that valve opens when it’s not supposed to, so stomach contents (acid, digestive juices, enzymes and/or food) can flow backward from the stomach into the esophagus and cause symptoms.

Now, normal individuals can have up to an hour of reflux per day and not feel it. But if people have problematic reflux, it can cause heartburn, which is a burning that’s felt mid-chest, below the sternum, especially after meals or at night when you lay down. So heartburn is a symptom of acid reflux. Acid reflux can also cause regurgitation.

GERD stands for gastroesophageal reflux disease. It’s a more severe form of acid reflux where the stomach contents flowing back up into the esophagus becomes problematic. It can also cause a cough or the feeling that there’s a lump in the back of your throat.

GERD should be treated to avoid long-term problems.

— Gastroenterologist Scott Gabbard, MD

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