What is GERD?
Gastroesophageal reflux disease or GERD occurs when the acidic gastric juices from the stomach repeatedly flow up into the esophagus. As the stomach acid is allowed to flow into and irritate the lining of the esophagus, a burning sensation is felt in the lower chest. If these symptoms of heartburn are not controlled with modifications in lifestyle, and over-the-counter medicines are needed two or more times a week, you should see your physician. When GERD or acid reflux disease are not treated, it can cause serious complications to occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (the narrowing of the esophagus), bleeding, or a pre-cancerous change in the lining of the esophagus known as Barrett's Esophagus.
What are the causes of GERD?
One possible GERD cause is the weakness of the muscle at the base of the esophagus that connects and controls the flow of food in to the stomach, known as the lower esophageal sphincter (LES). As food travels down the esophagus, the sphincter opens to let food flow into the stomach. Normally it closes as soon as the food enters the stomach. With heartburn, the sphincter does not close tightly. This causes stomach acid to flow back up into the esophagus (often called acid reflux), causing the GERD symptom of a burning sensation in the chest.
Other causes include excess acid production and other diseases that interfere with food passing through the esophagus.
Frequent heartburn is the most common GERD symptom. However, patients may also experience some of the following:
- sour or bitter taste
- bitter stomach fluid coming into the mouth, especially during sleep
- repeatedly feeling a need to clear the throat
- difficulty swallowing food or liquid
- wheezing or coughing at night
- worsening of symptoms after eating, or when bending over or lying down
Diagnostic tests for GERD may include:
- Upper GI Series-a series of x-rays of the upper digestive system taken after drinking a barium solution
- 24-hour pH Monitoring-a probe placed in the esophagus to keep track of the level of acidity in the lower esophagus. This is done over a 24-hour period.
- Manometry-measures muscle pressures of the lower esophagus (LES)
- Endoscopy-looking at the esophagus and stomach through a thin, lighted flexible tube that is passed down the throat
- Biopsy-removing a small sample of esophageal tissue to measure the amount of acid or pressure in the esophagus
Heartburn can feel like the pain associated with a heart attack. Never assume that chest pain is heartburn or indigestion. Seek medical care if you're not sure.
Complications occur when GERD is severe or long-standing. Constant irritation of the esophagus by stomach acid can lead to inflammation, ulcers, and bleeding. Anemia or low blood count may develop. Over time, scarring and narrowing of the esophagus can also develop, making it difficult to swallow and pass food through the esophagus. This narrowing is called a stricture.
Some patients develop a condition called Barrett's Esophagus, which is a serious change in the cells lining the esophagus. Beginning as what could be a natural defense, the cells in the esophagus exposed to the stomach acid for an extended period, begin to change in structure. These changes can temporarily relieve the symptoms, but are not good for the health of those cells. Barrett's Esophagus may be a precursor of esophageal cancer.
Certain diet and lifestyle choices can contribute to the condition. For example, certain foods increase acid production, and fatty foods increase the time food remains in the stomach. Chocolate, peppermint, coffee, alcoholic beverages, and especially nicotine in cigarette smoke weaken or relax the LES. Obesity places added pressure on the upper abdomen, and during pregnancy the LES weakens for unknown reasons.
When symptoms of heartburn are not controlled with modifications in lifestyle, and over-the-counter medicines are needed two or more times a week, or symptoms remain unresolved on the medication you are taking, you should consult your physician.
Treatment should be designed to: 1) eliminate symptoms; 2) heal esophagitis; and 3) prevent the relapse of esophagitis or development of complications in patients with esophagitis.
In many patients, GERD is a chronic, relapsing disease. The goals of long-term maintenance are to control the symptoms and prevent complications. Maintenance therapy will vary in individuals ranging from basic lifestyle modifications to prescription medication as treatment.
In order to decrease the amount of gastric contents that reach the lower esophagus, certain simple guidelines should be followed:
- Raise the Head of the Bed or use under-mattress foam wedge to elevate the head about 6-10 inches. Pillows are not an effective alternative for elevating the head in preventing reflux.
- Change Eating and Sleeping Habits. Avoid lying down for two hours after eating. Do not eat for at least two hours before bedtime. This decreases the amount of stomach acid available for reflux.
- Reduce your weight if obesity contributes to the problem.
- Change Your Diet. Avoid foods and medications that lower LES tone (fats and chocolate) and foods that may irritate the damaged lining of the esophagus (citrus juice, tomato juice, and probably pepper).
- Avoid Habits That Contribute to GERD. Both smoking and the use of alcoholic beverages lower LES pressure, which contributes to acid reflux.
- Avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages.
- Stop smoking. Tobacco inhibits saliva, which is the body's major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, permitting acid reflux to occur.
The goal of each treatment is to decrease the amount of acidic stomach fluid leaking back into the esophagus or make that fluid less irritating to the lining of the esophagus.
Your doctor may recommend avoiding:
- chocolate and peppermint
- spicy and/or tomato-based foods like pizza, wings, sausages
- fruits from the citrus family like oranges and tomatoes
- fried and fatty foods
- peppermint and spearmint
- whole milk
- cold cuts, bacon, fatty meat, chicken skin
- cream-based soups
Medical Treatment of GERD
GERD has a physical cause, and frequently is not curtailed by these lifestyle factors alone. If you are using over-the-counter medications two or more times a week, or are still having symptoms on the prescription or other medicines you are taking, you need to see your doctor. If results are not forthcoming, medications may be used to neutralize acid, increase LES tone, or improve gastric emptying. Promotility Agents increase lower esophageal sphincter pressure, which helps prevent acid reflux, and improves the movement of food from the stomach. H2 blockers and Proton Pump lnhibitors decrease the flow of stomach acid.