Acid Reflux and GERD: Online Diagnosis and Treatment

Occasional gastroesophageal reflux (GER) can be normal, especially after eating a big, greasy hamburger. Stomach acid backflows up the esophagus and into the mouth, causing burning, difficulty swallowing, bad breath, chest pain, and the feeling that food is stuck. Persistent acid reflux can cause gastroesophageal reflux disease (GERD), which can be serious, as repeatedly burning the esophagus can cause esophageal damage and increased cancer risk. GERD can also feel very similar to a heart attack, adding to your stress.

Gastroesophageal reflux is also known as:

• Acid reflux
• Acid indigestion
• Heartburn

Heartburn is a symptom that describes the sensation of acid refluxing into your esophagus. When acid reflux occurs repeatedly, it can lead to GERD.

GERD is a common disorder that affects between 18% and 28% of people in North America.¹  About half of all adults experience acid reflux symptoms at some time.² An array of diagnostic and treatment options for GERD make it possible to diagnose your condition and relieve your symptoms quickly.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for GERD diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat GERD. Telehealth for GERD treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your GERD quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you might have GERD and receive a personalized treatment plan.

What Is GERD?

GERD is defined as a constellation of troublesome symptoms and complications that result from the reflux of stomach contents into the esophagus.^3,4

Food and drink leave the mouth, pass through the throat and esophagus and enter the stomach. Hydrochloric acid and digestive enzymes begin to digest food in the stomach. Hydrochloric acid is a very strong acid that can dissolve nails. Although your stomach is protected from its effects, your esophagus is not.

At the bottom of the esophagus, a band of muscle, the lower esophageal sphincter (LES), contracts to prevent stomach contents from backflowing into the esophagus. The LES relaxes to allow food and drink to pass from the esophagus into the stomach and contracts to keep it there.

Certain foods, drinks, and medications can impair the LES’s ability to stay contracted. Reduced lower esophageal sphincter pressure, hiatal hernias, delayed stomach emptying, and transient sphincter muscle relaxation are just some of the physiologic factors that contribute to GERD.²

Functional abnormalities of the esophagus, LES, or stomach can contribute to GERD. If the esophagus is unable to clear acidic material that has refluxed past the LES, it can cause esophageal damage, scarring, and increased cancer risk. If the LES is dysfunctional, more acidic material from the stomach can reflux into the esophagus. If pressure in the stomach is abnormally increased or there is delayed stomach emptying, pressure on the LES increases, increasing the risk of GERD.

What Are The Common Symptoms Of GERD?

Common symptoms from acid reflux or GERD include:

• Heartburn
• Sour taste in the mouth
• Difficulty swallowing
• Dry cough
• Throat clearing
• Hoarseness
• Sore throat
• Nausea
• Vomiting
• Bad breath
• Wheezing
• Waking at night
• Chest pain unrelated to the heart
• Enamel erosion

Can GERD Be Treated Through Telehealth?

Consulting a medical professional via telehealth is a convenient way to diagnose and treat GERD. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your symptoms and call your online prescription to a local pharmacy. Online doctors who prescribe psoriasis treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Are Some People at Increased Risk for GERD?

Risk factors for GERD include:²

• Overweight or obesity
• Smoking
• Anxiety
• Depression
• Decreased physical activity throughout the day
• Pregnancy

Some foods and drinks are associated with increased risk of heartburn and GERD, including:

• Alcohol
• Caffeinated beverages
• Carbonated drinks
• Chocolate
• Fried, greasy or fatty foods
• Onions
• Peppermint
• Spicy foods

Medications that may increase your risk for GERD include:⁵

• Antibiotics like tetracycline and doxycycline
• Aspirin
• Asthma medications
• Corticosteroids
• Iron supplements
• Non-steroidal anti-inflammatory medications
• Hormones
• Bisphosphonates
• Vitamin C
• Benzodiazepines
• Anticholinergics
• Beta-adrenergic agonists

How Do You Diagnose GERD?

Typically, GERD is a clinical diagnosis based on your medical history and history of response to acid-suppressing medications. A trial of H2 receptor blockers or proton pump inhibitors (two medications used to treat GERD) and cessation of symptoms is diagnostic for GERD.^2,4

If the diagnosis is unclear or your doctor suspects you may have developed complications from GERD, they may request an upper gastrointestinal endoscopy or esophagogastroduodenoscopy (EGD). For this test, a specialist will use a long, flexible tube with a camera and a light to examine your esophagus and lower esophageal sphincter.

Alarm symptoms that may prompt your doctor to request an endoscopy include:

• Difficulty swallowing
• Painful swallowing
• Anemia
• Bleeding
• Weight loss

How Do You Treat GERD?

Medications can neutralize acidity or block acid production. They can also increase motility in the gastrointestinal tract to help move acidic substances from the stomach into the intestines and reduce the risk of GERD.

• H2 blockers are a first-line treatment for GERD and are recommended for people with mild-to-moderate acid reflux. Examples of H2 blockers include:
  • Cimetidine
  • Famotidine
  • Nizatidine
• Proton pump inhibitors inhibit acid production in the stomach. These medications are considered second-line treatment. Examples of proton pump inhibitors include:
  • Omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
  • Rabeprazole (Aciphex)
  • Esomeprazole (Nexium)
• Prokinetics such as metoclopramide increase motility in the stomach and esophagus and increase LES pressure.
• Baclofen, a GABA agonist, helps prevent LES relaxation, which can prevent reflux into the esophagus. The medication’s side effects limit its use.

If medication is unable to control your GERD symptoms, anti-reflux surgical options are available. These surgical procedures provide structural support to the lower esophageal sphincter to prevent acidic stomach contents from refluxing into the esophagus.

How Can You Prevent GERD?

Several lifestyle modifications have been shown to reduce GERD symptoms, including the following:⁴

• Managing your weight: increased abdominal fat is associated with increased abdominal pressure, which puts more pressure on the lower esophageal sphincter (LES).
• Eating smaller, more frequent meals: smaller meals keep the stomach from being distended and reduce the pressure of the LES.
• Avoid wearing constrictive clothing: Tight clothing increases abdominal pressure.
• Watch your diet: Avoid foods and drinks known to trigger heartburn or lower esophageal sphincter tone, such as alcohol, chocolate, citrus juice, tomato-based products, peppermint, and coffee.
• Elevate the head of your bed: This raises the esophagus above the stomach and reduces heartburn. Likewise, wait about three hours after meals to lie down.
• Quitting smoking: Nicotine relaxes LES tone and increases the likelihood that acid will reflux into the esophagus.
• Drink water throughout the day: Consuming small amounts of water throughout the day helps wash acid from the esophagus.

When Should You See a Doctor for GERD?

If you have heartburn more than twice per week, or your heartburn is not responding to your current treatment, see your doctor. GERD can cause serious complications that are more likely to develop the longer GERD is untreated.

Complications associated with GERD include:

• Barrett’s esophagus: Chronic acid exposure can cause a change in the cells lining the esophagus, which increases the risk of developing esophageal cancer. Reducing acid reflux and monitoring for any changes in the esophageal lining are necessary to reduce cancer risk.⁶
• Esophageal cancer: GERD is a risk factor for adenocarcinoma, an esophageal cancer. While Barrett’s esophagus increases the risk for esophageal cancer, less than 5% of people diagnosed with esophageal cancer have a diagnosis of Barrett’s esophagus.⁷ See your doctor if you have difficulty swallowing, chest pain, weight loss, anemia, or persistent vomiting or reflux symptoms.
• Esophageal strictures: Prolonged acid reflux can cause esophageal inflammation and scarring. Scar tissue can cause the esophageal lumen to narrow, which makes it difficult for food to pass. If you experience a feeling that food is getting stuck in your chest, call your doctor.⁸
• Respiratory disease: If acidic stomach contents are refluxed, and you breathe them into your lungs, it can irritate the lining of the tubes that carry air into your lungs. This can cause shortness of breath, wheezing, coughing, and pneumonia.

Telehealth for GERD is the perfect diagnosis and treatment option. You can schedule an online appointment with a virtual doctor using the TelegraMD platform and receive a diagnosis based on your reflux and heartburn symptoms. Your virtual doctor can give tips on reducing your symptoms and call in a prescription to a local pharmacy. Online doctors who treat GERD provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a GERD treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for GERD treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your GERD treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for GERD, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

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2. Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167.

3. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920.

4. DeVault KR, Castell DO; American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005 Jan;100(1):190-200. doi: 10.1111/j.1572-0241.2005.41217.x. PMID: 15654800.

5. Tutuian R; Clinical Lead Outpatient Services and Gastrointestinal Function Laboratory. Adverse effects of drugs on the esophagus. Best Pract Res Clin Gastroenterol. 2010 Apr;24(2):91-7. doi: 10.1016/j.bpg.2010.02.005. PMID: 20227023.

6. Modiano N, Gerson LB. Barrett’s esophagus: Incidence, etiology, pathophysiology, prevention and treatment. Ther Clin Risk Manag. 2007 Dec;3(6):1035-145. PMID: 18516262; PMCID: PMC2387291.

7. Napier KJ, Scheerer M, Misra S. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 2014 May 15;6(5):112-20. doi: 10.4251/wjgo.v6.i5.112. PMID: 24834141; PMCID: PMC4021327. 8. Desai JP, Moustarah F. Esophageal Stricture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK5