GERD (Heartburn and Reflux)

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GERD (gastroesophageal reflux disease) is a digestive disorder that frequently overlaps with asthma. Having GERD on top of asthma can lead to more respiratory symptoms and worse quality of life.1

A tube called the esophagus connects your mouth to your stomach.2 There is a group of muscles at the bottom of the tube called the LES or lower esophageal sphincter. The LES opens to let food through, and then tightens to keep food in the stomach. Sometimes, these muscles are weak or too relaxed. When this happens, stomach contents (food, fluid, and digestive juices) back up into the esophagus, which is called GERD. GERD may also be described as “acid reflux” or “acid indigestion.”

What are the symptoms of GERD?

Common symptoms of GERD are heartburn, regurgitation, chest pain, and dry cough.1 Both GERD and asthma can cause chronic cough, which can make diagnosis complicated. Other symptoms of GERD are:3

  • Pain while swallowing
  • Excessive saliva
  • Ongoing sore throat
  • Horse voice
  • Cavities and inflamed gums
  • Bad breath

Forty percent to 60% of people with asthma and GERD do not experience classic GERD symptoms, such as reflux.4

How does GERD affect asthma?

People with GERD tend to have frequent nighttime asthma symptoms. One large study showed that people with GERD symptoms at bedtime were 2.5-times more likely to wheeze and almost 3-times more likely to feel short of breath during the night.5 The people with GERD were also more likely to have nighttime cough and morning phlegm. Their lung function fluctuated more between night and day than people without GERD.

The National Heart, Lung, and Blood Institute recommends that health care providers evaluate for GERD in (1) people who have heartburn and (2) in people with poorly controlled asthma and nighttime symptoms.6 GERD is diagnosed using tests such as endoscopy, x-ray, or acid tests (also known as the esophageal pH monitoring test).3 Sometimes a trial of medication is given to see if symptoms improve.1

How common is comorbid asthma and GERD?

GERD may be more common in people with asthma than the general population.1 About 44% of US adults have heartburn and regurgitation at least once per month.4 In contrast, 50% to 80% of adults with asthma have GERD.4

Asthma may cause GERD by lowering the pressure in the chest cavity and LES, causing stomach contents to rise. Additionally, some asthma medications make reflux worse.1 In about 30% of people, GERD causes asthma.4 The reasons are unclear. Regurgitated acid could injure the throat, airways, and lungs, or trigger a reflex that causes the airways to narrow.7

How is GERD treated?

You can take many steps on your own to reduce GERD symptoms:4,6

  • Eat small meals.
  • Avoid heavy meals and high-fat foods.
  • Avoid caffeine (coffee, tea, colas) and alcohol.
  • Avoid chocolate, peppermint, onions, garlic, tomatoes, and citrus fruits/juices.
  • Stay upright after eating for at least 3 hours.
  • Use blocks to lift the head of your bed 6 to 8 inches.
  • Wear loose clothing and belts.
  • Lose weight, if you are overweight.
  • Quit smoking.

Over-the-counter and prescription medications are available to treat GERD.

What effect does treating GERD have on asthma?

In some studies, people who took medications for GERD have fewer nighttime asthma symptoms, fewer asthma attacks, and better quality of life.6 People who have surgery for GERD have fewer asthma symptoms and need less asthma medication.6

view references
  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Accessed 11/12/14 at: www.ginasthma.org.
  2. Marieb E. Anatomy and physiology. 2nd ed. New York, NY: Pearson, Benjamin Cummings; 2005.
  3. American Academy of Allergy, Asthma, and Immunology. Gastroesophageal reflux disease (GERD). Accessed 1/12/14 at: http://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease.aspx.
  4. Heidelbaugh JJ, Gill AS, Van Harrison R, Nostrant TT. Atypical presentations of gastroesophageal reflux disease. Am Fam Physician. 2008;78:483-488. http://www.aafp.org/afp/2003/1001/p1311.htmlhttp://www.aafp.org/afp/2003/1001/p1311.html
  5. Gislason T, Janson C, Vermeire P, et al. Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries. Chest. 2002;121:158-163. http://journal.publications.chestnet.org/data/Journals/CHEST/21972/158.pdf
  6. National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
  7. Cleveland Clinic. GERD and asthma. Accessed 1/12/15 at: http://my.clevelandclinic.org/health/diseases_conditions/hic_gastroesophogeal_reflux_disease_GERD/hic_GERD_and_Asthma
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