Gastroesophageal refers to the stomach and esophagus (or "food pipe"). Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents back up into the esophagus.

In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus.

The severity of GERD depends on LES dysfunction, as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.

Heartburn, also called acid indigestion, is the most common symptom of GERD and usually feels like a burning chest pain beginning behind the breastbone and moving upward to the neck and throat. Many people say it feels like food is coming back into the mouth, leaving an acid or bitter taste.

The burning, pressure, or pain of heartburn can last as long as two hours and is often worse after eating. Lying down or bending over also can result in heartburn. Many people obtain relief by standing upright or by taking an antacid that clears acid out of the esophagus.

Heartburn pain can be mistaken for the pain associated with heart disease or a heart attack, but there are differences. Exercise may aggravate pain resulting from heart disease, and rest may relieve the pain. In a small percentage of heartburn sufferers, heartburn pain is associated with physical activity.

More than 60 million American adults experience GERD and heartburn at least once a month, and about 25 million adults suffer daily from heartburn. Twenty-five percent of pregnant women experience daily heartburn, and more than 50 percent have occasional distress. Recent studies show that GERD in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing, and other respiratory problems, or failure to thrive.

Some doctors believe a hiatal hernia may weaken the lower esophageal sphincter (LES) and cause reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the stomach from the chest. Recent studies show that the opening in the diaphragm acts as an additional sphincter around the lower end of the esophagus. Studies also show that hiatal hernia results in retention of acid and other contents above this opening. These substances can reflux easily into the esophagus.

Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and older have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, i.e., paraesophageal hernia) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

Dietary and lifestyle choices may contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may cause relaxation of the LES, resulting in reflux and heartburn. Studies show that cigarette smoking relaxes the LES. Obesity and pregnancy also can cause GERD.

Heartburn medications control acid production in the stomach so that symptoms related to acid reflux don't occur, but these medications don't fix the anatomic cause of GERD. For example, if the lower esophageal sphincter (LES) that normally stops stomach acid from flowing back into the esophagus is weak and stays open, acid from the stomach can push back into the esophagus, causing heartburn. The LES is strengthened after the minimally invasive surgery corrects the anatomical cause of GERD.

Exercise can induce reflux. This occurs in about 10 to 15 percent of patients. Patients in whom this occurs are typically advised to avoid excessive stooping, bending, or heavy exertion for one hour after eating.

They may be. Although other reflux symptoms are more common, unexplained persistent sore throat, hoarseness, and/or cough may be secondary symptoms of GERD.

Each individual is sensitive to different foods. However, there are some foods and beverages to avoid, such as chocolate, alcohol, peppermint, coffee, garlic, onion, cinnamon, citrus fruits and juices, and tomato products. These can increase symptoms of heartburn. Many physicians recommend keeping a diary of foods and beverages that increase heartburn symptoms in order to identify the triggers to avoid in the future.

Yes. There are antacids and acid blockers (also called H2 blockers) available over the counter. The acid blockers inhibit the release of acid and take about an hour to work. They will last about nine to 12 hours. Ask your doctor about acid blocker medications, since they can cause side effects or drug interactions. If there is a certain food that usually gives you indigestion, you may want to take an acid blocker before you eat.

If you already are experiencing indigestion, an antacid, such as Mylanta®, is the best way to get fast, short-term relief. Antacids neutralize acid in the stomach and esophagus, are fast-acting, and will last about one to two hours.

If you are experiencing long-term or frequent heartburn, you should see your doctor. The use of over-the-counter medications may mask a more serious condition.

The most common prescription drugs are proton pump inhibitors (PPIs).

Proton pump inhibitors, such as Prilosec OTC® and Aciphex® , are another type of acid reducer. They suppress stomach acid. By drastically reducing the acid, these drugs can help stop the irritation and allow the damaged tissue in the esophagus to heal.

The long-term effects of preventing acid secretion with proton pump inhibitors (PPIs) are not known, as PPIs have only been available for the last decade. However, most doctors believe them to be safe. H2 inhibitors (or blockers), such as Pepcid® AC , have been around for nearly 30 years.

Barrett's esophagus occurs in approximately 10 to 20 percent of patients with GERD. It is believed that prolonged exposure of the esophagus to acid reflux causes dramatic structural damage to the inner esophageal lining, or epithelium. It also can lead to the development of ulcers, or, potentially, cancer.

New research indicates that esophageal cancer (adenocarcinoma) associated with Barrett's esophagus is on the rise. A test called an endoscopy is a valuable tool in early detection. Click here to learn more about endoscopy tests.

Medical and surgical antireflux treatments may be used to relieve symptoms, particularly if the esophagus has been ulcerated. Surgery is usually the primary treatment for patients with major cellular alterations or cancer.