GERD: Esophageal Erosion and Ulcers

Topic Overview

The backup, or reflux, of stomach acids and juices into the esophagus that occurs with gastroesophageal reflux disease (GERD) can wear away (erode) the lining of the esophagus and cause sores, called ulcers.

GERD is caused when stomach acid and juices reflux into the esophagus. This happens when the valve between the lower end of the esophagus and the stomach (the lower esophageal sphincter) does not close tightly. This reflux can cause irritation, inflammation, or wearing away of the lining of the esophagus, which is called esophagitis.

In severe cases, patches of the lining of the esophagus wear away completely, and ulcers may develop. Ulcers can be shallow or deep and can destroy the lining of the esophagus where they develop.

Treatment for ulcers in the esophagus usually means treating the GERD that caused the ulcer in the first place. Treatment for GERD involves lifestyle changes and medicine. Treatment sometimes involves surgery.

Lifestyle changes include the following:

• Change your eating habits.
  • It's best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down.
  • Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
  • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
• Do not smoke or chew tobacco. Smoking can make GERD worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• If you have GERD symptoms at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Do not wear tight clothing around your middle.
• Lose weight if you need to. Losing just 5 lb (2 kg) to 10 lb (5 kg) can help.

Medicines used to treat GERD include:

• Proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec).
• H2 blockers, such as cimetidine (Tagamet) and famotidine (Pepcid).

The most common surgery to treat GERD is fundoplication surgery. During surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the lower esophageal sphincter, which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.