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5 Myths of GERD

Heartburn, or Something Else?

True or false: You have heartburn, so you have gastroesophageal reflux disease (GERD).

False. While heartburn is one symptom of GERD, it is not the only symptom, nor is it a necessary one to receive a diagnosis. John E. Pandolfino, MD, chief of Gastroenterology and Hepatology at Northwestern Medicine, discusses some of the myths surrounding GERD and why it’s important to get to the bottom of this condition.

Myth 1: GERD is equal to heartburn.

Acid reflux occurs when the acid in your stomach comes up through the valve that is between your stomach and your esophagus. This is commonly called heartburn. Sometimes, contents of the stomach, including partially digested food or acid, can travel all the way up into the mouth or upper portion of the esophagus. This is known as regurgitation. If you experience heartburn or regurgitation more than twice a week, you may have GERD.

“Most people think if they have heartburn, they have GERD. Most of the time they’re probably right, but it may represent other medical problems too,” says Dr. Pandolfino. Similarly, if you don’t have heartburn, but experience other symptoms, you can also have GERD.

Symptoms of GERD include:

  • Heartburn
  • Regurgitation
  • Chest pain
  • Chronic or recurring cough
  • Recurrent respiratory infections
  • Pneumonia
  • Asthma
  • Nausea
  • Hoarseness
  • Dental decay

See a full list of symptoms you should not ignore.

Myth 2: You can take over-the-counter medications unmonitored.

Several medications are readily available over the counter for temporary heartburn relief:

  • Proton pump inhibitors (PPI)
  • H2 blockers
  • Antacids

These medications all work to reduce acid exposure in the stomach. Antacids dilute the acid produced by the stomach, while PPIs and H2 blockers reduce the stomach’s production of acid. Although these can help manage symptoms, consult your physician if you find yourself needing these medications more frequently or more than two times a week.

Your physician will use a series of tests to determine if your symptoms are related to the body’s release of acid. It is important to undergo testing to identify what is really going on, and if you have GERD or some other condition. Only then can your care team identify a treatment plan. It is not a good idea to be on medication unmonitored.

Additionally, your physician may be able to recommend a specific approach to alleviate symptoms. For example, taking an antacid and an H2 blocker may help you by first neutralizing the acid in your stomach and then limiting additional acid production.

Myth 3: Medications ‘fix’ GERD.

Non-surgical options can help manage symptoms by reducing or stopping acid production in your stomach. However, for those with GERD, the actual root issue lies in the anatomy and mechanics of your body. “Reflux is still occurring, but now it is less noxious and irritating,” says Dr. Pandolfino.

If left untreated, GERD could put you at risk for other, more serious health issues. Persistent reflux can cause inflammation in your esophagus and this can be associated with Barrett’s esophagus, which has a small risk for esophageal cancer. 

Additionally, scarring related to inflammation and ulceration can narrow your esophagus, which can lead to difficulty eating. Medication helps, but some people do not respond to medication and may need a surgical or endoscopic fix. In those cases, Dr. Pandolfino recommends getting specialized testing to determine if GERD is the cause and why it is not responding to medications.

Myth 4: There aren’t many surgical options.

For many years, there was one mainstay of surgical treatment: laparoscopic antireflux surgery, also known as fundoplication. This procedure uses part of your stomach to reinforce the valve at the bottom of your esophagus. It is often very effective and can be done using different approaches focused on how tight the wrap/valve is made. The main issues with fundoplication tend to be some minor trouble swallowing and bloating. Most people can eat normally after fundoplication without heartburn or regurgitation.

In March 2012, the FDA approved the LINX procedure. This minimally invasive procedure uses a string of magnetic beads to encircle the lower esophagus. The magnets reinforce the valve, preventing acid from going up into the esophagus. LINX also has a shorter recovery time than fundoplication.

Endoscopic procedures that allow for the creation of an endoscopic fundoplication, called transoral incisionless fundoplication, are also a less invasive approach compared to classic fundoplication.

No matter which approach to GERD management you are considering, talk to your care team.

“Remember, treatment decisions are made based on each person’s needs,” says Dr. Pandolfino. He stresses the importance of seeing a specialist who is well versed on all of the options available to determine what is best for your unique needs.

Myth 5: Stress causes reflux

Stress does not cause reflux to occur, but it can induce symptoms like reflux, such as heartburn and chest pain. These symptoms may happen without actual reflux of stomach acid into the esophagus or throat.

Treatments that can help address these non-reflux causes include:

  • Breathing exercises
  • Behavioral techniques like cognitive behavioral therapy
  • Hypnosis

Stress can also make acid reflux symptoms worse; therefore stress reduction can help many patients with heartburn and chest pain, regardless of their connection to GERD.