GERD: Esophageal Erosion and Ulcers

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.

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  • What are the symptoms of gastro-esophageal reflux oesophagitis?

    A painful or burning sensation in the upper abdomen or chest, sometimes radiating to the back (heartburn).

    The acid reflux may reach the pharynx (throat) and mouth. It is sour and may burn.

    A small number of patients have difficulties breathing and suffer from hoarseness because the refluxed fluid irritates the larynx and respiratory tract.

    Excess belching is common.

  • Hi Hun very informative always wondered what it was now I know.

  • I just thought I'd document my findings, it'll be a good reference point for myself and I thought since it was fairly common with Endo girls it may benefit somebody else xx

  • How does gastro-oesophageal reflux affect your health?

    It is an unpleasant condition that can have a big influence on your lifestyle.

    Many people feel that their quality of life is lowered by the symptoms.

    Prolonged exposure to refluxed acid leads to oesophagitis (inflammation of the oesophagus).

    Long-standing oesophagitis may be complicated by the formation of scar tissue that contracts and results in a narrowing (stricture) in the affected part of the oesophagus. This can make it difficult or even impossible to swallow.

    It is a serious condition that requires urgent assessment and treatment, but, fortunately, this complication is relatively rare.

    It can cause ulceration leading to bleeding and an iron deficiency that could develop into anaemia due to a chronic blood loss.

  • Which conditions can cause gastro-oesophageal reflux?

    In many cases, the disorder cannot be attributed to any specific cause but the following conditions can contribute to the problem.

    Hiatus hernia

    The stomach pokes through the diaphragm, preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus.

    The oesophagus remains wide open which allows stomach acid to get into the oesophagus.


    If the person is overweight the excessive fat in the abdominal cavity increases the pressure inside it.

    This causes the contents of the stomach to travel up into the gullet.

    Loss of weight reduces stomach acid reflux.


    Because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it, which increases the tendency to reflux.

    In addition, hormonal changes lead to relaxation of the oesophageal sphincter during pregnancy.


    The more the stomach is stretched by food, the higher the tendency to reflux. The tendency is also increased by eating fatty meals as fat delays gastric emptying.

    Try to avoid large rich meals, particularly in the evening and this will reduce the tendency to reflux.


    Chocolate, peppermint, coffee, fruit juices and alcohol prevent the oesophageal sphincter from working properly.


    Tobacco prevents the oesophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production.


    Constipation increases the tendency to reflux by raising pressure inside the stomach cavity.

    Lying down

    The tendency to reflux increases when you are lying down. This is just due to gravity.

    A simple way to change that is to use a pillow under the mattress or to raise the head of your bed by 10cm (4 inches) with blocks or a house brick under the bed frame.

    How are gastro-oesophageal reflux disorders diagnosed?

    The symptoms of gastro-oesophageal reflux may be so obvious that no tests are needed.

    If the doctor is in doubt, or if the symptoms are very troublesome, a gastroscopy will be considered. During the procedure oesophagitis, hiatus hernias, peptic ulcers and other conditions can be either found or ruled out.

    Another possibility is to measure the acidity in the lower end of the oesophagus during a 24-hour period. This will give an indication of how often and how long the reflux episodes last.

    Lastly, it is possible to measure the pressures within the oesophagus by means of a technique called oesophageal manometry. This is not often used in uncomplicated cases.

    The symptoms of gastro-oesophageal reflux can resemble those of a peptic ulcer, chest pains (angina pectoris), muscle pains, back problems, constipation, irritable bowel syndrome, gallstones, pancreatic disease etc.

    These conditions will sometimes have to be ruled out before the diagnosis can be made.

    What can be done to prevent gastro-oesophageal reflux?

    The following changes in lifestyle can reduce the risk of developing reflux:

    try to lose weight if you are overweight

    avoid large, high-fat meals and bedtime snacks

    limit coffee intake

    reduce alcohol consumption

    stop smoking.

    If the symptoms are not frequent – less than five times a month – they can be treated with over-the-counter medications such as antacids and histamine antagonists.

    Your doctor or pharmacist will be able to provide advice about the most appropriate ones for you.

    Delayed ejaculation (retarded ejaculation)

    When should the doctor be called?

    If the heartburn is frequent or the symptoms very unpleasant, see your doctor.

    He or she will consider whether further tests, such as a gastroscopy, should be carried out, and whether stronger medication is required.

    If you have any difficulty swallowing, you should see your doctor as soon as possible

    How are gastro-oesophageal reflux disorders treated?

    Gastro-oesophageal reflux disorders are mainly treated by medicines that reduce stomach acid.

    In most cases, antacids successfully control the symptoms. If simple antacids are insufficient to control the symptoms, then tablets to reduce acid secretion will usually be tried.

    This often starts with medicines called proton pump inhibitors such as Losec (Omeprazole), Zoton (Lansoprazole) or Protium (Pantoprazole). These are simple to use, usually taken once a day and can be taken long-term if required.

    Other treatments available include histamine H2 antagonists such as Zantac (Ranitidine) or Tagamet (Cimetidine), although these are now used far less frequently than they used to be because of the effectiveness of proton pump inhibitors.

    Severe cases of gastro-oesophageal reflux which don't respond to other treatment can be treated with a short course of prokinetics, which speed up the emptying of your stomach, meaning there's less opportunity for acid to irritate your oesophagus.

    In a small number of cases where medical therapy has been unsuccessful, the problem may be solved by a laparoscopical (key hole) surgical procedure in which the oesophageal sphincter is strengthened (fundoplication). Only a tiny percentage of people with GORD require this option though.

    A very new development that is showing promise in the treatment of severe GORD is called LINX reflux management system.

    In this, a small, flexible band of interlinked titanium beads with magnetic cores is placed around the oesophagus just above the stomach using keyhole surgery. This helps create a barrier to the reflux of acid and bile.

    Swallowing forces temporarily break the magnetic bond to allow food and drink to pass normally through the sphincter at the bottom of the gullet but the magnets then close this immediately after swallowing to restore the body's natural barrier to the reflux of acid and bile.

    Patients can usually resume a normal diet within a few hours of surgery and can usually return to normal activities in less than a week.

    Although not routinely available on the NHS yet, it's an exciting development in the future treatment of GORD.

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