• Heartburn (a burning sensation in the chest)
• Chest pain or stomach pain
• Burning/acid taste in the throat
• Difficulty swallowing
• Regurgitation
• Feeling like you have a lump in your throat/sore throat

• Coughing (with no other explanation, like a cold or allergies)

• Obesity
• Older age
• Having a hiatal hernia
• Having a weak lower esophageal sphincter (LES)
• Smoking
• Drinking alcohol
• Eating certain foods (citrus, chocolate, fatty foods, very spicy foods)
• Use of certain medications (aspirin, NSAIDs like ibuprofen or naproxen)

You and your doctor will work together to determine if you need to be tested for GERD. If you do, there are several approaches that your doctor may take to evaluate your symptoms and make a diagnosis.

pHz Monitoring

pH monitoring allows your provider to determine if acid and/or alkaline contents flows from your stomach to your esophagus (reflux).

• 24-hour pH monitoring
  pH monitoring allows your provider to determine if—and how much acid flows from your stomach to your esophagus over a 24 hours. This is an outpatient test.
• Bravo Esophageal pH Test
  During an outpatient procedure called an upper endoscopy, your doctor will place a small capsule in your esophagus. This will measure pH levels and transmit them to a receiver. In addition, you will be asked to record certain behaviors (eating, lying down) while the capsule is active.

Muscle Function

• Test - esophageal manometry (pronounced "muh-NOM-uh-tree")
  This test provides information about how the muscles in your esophagus and at the top of your stomach are working. Improper function of these muscles can contribute to GERD. You doctor may also refer to this as "motility testing."
• The lower esophageal sphincter (LES) is a group of muscles that open to let food into the stomach and then quickly close to keep stomach acid and food from backing up into the esophagus. Your doctor can use manometry to ensure the LES is opening and closing properly.
• The muscles in your esophagus move food from your mouth to your stomach. If these muscles aren't working well, you may experience chest pain or trouble swallowing.

If your doctor determines that one of these tests will be an important part of your care, your care team will explain the test in more detail and give you all the information you need to prepare.

Upper Endoscopy

Upper endoscopy is an outpatient procedure. Your doctor will use this test to examine the upper part of your digestive tract using a tube with a very small camera on the end. This is a more general test than pH testing and manometry, and your doctor may use it to rule out conditions such as Barrett's esophagus and other erosive conditions, which have similar symptoms to GERD.

Lifestyle Changes 

• Losing weight (if appropriate)
• Avoiding aggravating foods
• Limiting/stopping smoking or drinking alcohol
• Not lying down for ~three hours after you eat
• Raising the head of your bed

Medications for GERD

Several medications can help with GERD. Although they work in different ways, they all have one purpose: reducing or blocking stomach acid.

The most common types of medications include:

• Antacids: short-term relief, available over-the-counter
• Histamine blockers: short term relief, available over-the-counter
• Proton pump inhibitors (PPIs): longer-term relief, available over-the-counter or by prescription

You should always talk to your doctor before taking medication, especially if you have GERD symptoms regularly.

It is also important to note that using medications for GERD for a long time does have risks. If you use antacids, histamine blockers, or PPIs consistently for more than six weeks, you should discuss your symptoms with a doctor.

Surgical Treatments for GERD

If lifestyle changes and medications don't improve your GERD symptoms, your doctor may want to discuss surgical options. At Middlesex Health, we offer several of the most advanced and innovative symptom management and relief procedures. Learn more below.

Primary Care Provider

If you are experiencing symptoms of GERD, the best first step is to talk to your primary care provider (PCP). PCP's are most helpful if you have intermittent symptoms, or symptoms on an irregular basis.

Middlesex Health Primary Care

Gastroenterologist

Gastroenterologists are most helpful if you require daily medication or need to change the dose of your medication. You should also see a gastroenterologist if you have a family history of stomach or esophageal cancer.

Middlesex Health Gastroenterology

Surgeon

The gastroenterologist may refer you to a specialized surgeon who can perform multiple procedures to manage or cure GERD. Many of these are minimally invasive surgeries. You may wish to meet with a surgeon if:

• You have a family or personal history of Barrett's esophagus or esophageal adenocarcinoma (cancer)
• Proton pump inhibitors (PPIs) become less effective over time
• You are unable to tolerate the side effects of PPIs or other medications
• You do not want to rely on medications to control your symptoms
• You have a hiatal hernia, as well as GERD symptoms

Middlesex Health Center for Advanced Surgery