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Gastroesophageal reflux disease (GERD) is a common and, for most sufferers, chronic condition. According to surveys, at least 20% of Americans suffer from symptoms of GERD at least once weekly. Symptoms of GERD are caused by backwashing of acid from the stomach into the esophagus (the tube that leads from the mouth to the stomach). The condition varies in severity, ranging from occasional mild heartburn to constant, nagging pain in the epigastrium (pit of the stomach). Since the lining of the esophagus is not designed to deal with acid from the stomach, some people with GERD develop complications, such as inflammation and ulcers in the esophagus, "Barrett's esophagus" (abnormal changes in the cells lining the esophagus), stricture (scarring and narrowing) of the esophagus, or even esophageal cancer.

Most people are familiar with GERD's most common symptom, heartburn. GERD sufferers experience regurgitation of acidic material into the back of the throat, burning in the pit of the stomach, indigestion, hoarseness, bad breath, a sense of a lump in the throat, or a frequent need to clear the throat. Chronic cough is sometimes caused by GERD. Occasionally, even pain in the ears is the result of reflux into the back of the throat. Symptoms are often worse after eating or when a person is lying down or bending over.

It is important to note that GERD symptoms vary depending on the age of the individual. Older people may not exhibit any of the usual symptoms, but instead may experience loss of appetite, weight loss, anemia (due to chronic blood loss from esophageal ulcers), vomiting, and difficulty swallowing. Often, older individuals have milder symptoms butupon further investigationmay actually have more severe disease. Because a person can have GERD without having any symptoms at alland because symptoms vary so widelyit is sometimes necessary to perform endoscopy (studying the esophagus through a long, flexible scope) to determine if GERD is really the cause of one's symptoms.

When a patient complains of heartburn or other symptoms consistent with GERD, doctors may recommend a proton pump inhibitor (Prilosec, Prevacid, Protonix, Aciphex, Nexium). These medications (PPIs) prevent the production of stomach acid, leading to significant improvement for most people. PPIs appear to be safe for long-term use. Studies show that none of the PPIs are more effective than others.

Physicians may use other medications, such as Tagamet, Zantac, Axid, Pepcid, or Sucralfate. Some of

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