GERD (gastroesophageal reflux disease) is the flow of stomach juices back up into the esophagus. This backup, called reflux, happens if the valve between the lower end of the esophagus and the stomach doesn't close tightly enough.

The most common symptom is heartburn, an uncomfortable feeling of burning or pain just behind the breastbone. Another common symptom is a sour taste in the mouth.

People with very bad, untreated GERD symptoms may get esophagitis (say "ee-saw-fuh-JY-tus"). This means that the esophagus is inflamed and irritated from the constant contact with stomach acids and digestive juices. GERD also can cause Barrett's esophagus, which is a change in the cells lining the esophagus. In rare cases, it may lead to cancer.

Treatment usually starts with lifestyle changes—such as quitting smoking and losing weight—and with medicines that you can buy without a prescription. These medicines reduce or block stomach acid. They include H2 blockers (such as Pepcid) and proton pump inhibitors (such as Prevacid and Losec).

Talk to your doctor if over-the-counter medicines aren't controlling your symptoms. In most cases, he or she can prescribe other medicine to help control your symptoms.

The most common surgery for GERD is called fundoplication surgery. It involves wrapping part of the stomach around the esophagus to strengthen it. If you have a hiatal hernia, it also will be fixed.

This surgery is often done laparoscopically. Instead of making a large cut (incision) in the belly, the doctor puts a lighted tube, or scope, and surgical tools into small cuts in your belly. This allows the doctor to see into your belly to do the surgery.

You may decide to have surgery if:

• Medicines don't relieve your symptoms enough.
• Medicine works to stop your symptoms, but for other reasons you can't or don't want to take the medicine.
• You have other problems that don't get better with medicine, such as asthma, hoarseness, or a cough caused when the acid backs up in your throat.

Treating GERD in pregnant women

Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Most non-prescription antacids are safe to use during pregnancy to treat symptoms. Antacids that contain sodium bicarbonate can cause fluid to build up, so they should not be taken by pregnant women. It is okay to use antacids that contain calcium carbonate (such as Tums).

Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. While you are pregnant, do not take aspirin or medicines that contain aspirin unless your doctor says it is okay.

If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines.

Medicines relieve GERD symptoms for most people.

Depending on your symptoms, proton pump inhibitors may work better than H2 blockers. But you may need to try more than one medicine to find one that works well for you. And you may still sometimes need to take an antacid (such as Tums) to stop heartburn.

The medicines

• Antacids, such as Gaviscon or Rolaids. Antacids work very well for people who get mild to moderate heartburn now and then. They relieve symptoms quickly. You can buy these without a prescription in grocery stores and drugstores. Antacids probably won't help people who have bad symptoms.
• H2 blockers, such as Pepcid or cimetidine. H2 blockers help most people with mild to moderate heartburn. You can get them with or without a prescription.
• Proton pump inhibitors, such as Prevacid or Losec. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis).

No matter which medicines you try, making lifestyle changes is still an important part of your treatment.

If your GERD symptoms are very bad, you will probably need to take medicines every day. That's because symptoms tend to return if you stop taking medicine.

The medicines for GERD are generally safe, but each has different side effects.

• Antacids can contain aluminum, magnesium, or aspirin. Those that contain aluminum may cause constipation. Those that contain magnesium may cause diarrhea. You should not use antacids that contain either aluminum or magnesium if you have serious kidney problems. Also, if you are on a low-salt diet or are pregnant, talk with your doctor or pharmacist before you choose an antacid. Some are high in sodium (salt). And some antacids have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
• H2 blockers. They sometimes cause headaches, dizziness, diarrhea or constipation, or nausea and vomiting.
• Proton pump inhibitors. Headaches and diarrhea are the most common side effects.

Surgery relieves symptoms for most people, but not for everyone. Laparoscopic surgery improves GERD symptoms in 8 out of 10 people. And surgery heals the damage done by GERD to the esophagus (esophagitis) in about 9 out of 10 people.^{footnote 1}

All major surgery has risks, including a risk of breathing problems caused by the anesthesia. There also is a risk of bleeding, infection, and pain.

Surgery for GERD can involve other problems:

• Surgery might not make symptoms go away completely.
• Some people still need to take medicine for GERD symptoms after surgery.
• Some people have increased flatulence and bloating after surgery.
• It is also possible for the stomach wrap to slide down around the stomach instead of staying around the esophagus. If this rare problem happens, you may need surgery to fix it.
• The stomach wrap could loosen, causing symptoms to return. You might need a second surgery to fix it.

Your doctor might recommend surgery if:

• Medicine doesn't completely relieve your symptoms.
• Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.
• You have other symptoms, including asthma or hoarseness, that don't get much better with medicines.