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In the Know - All about GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).  This backwash (acid reflux) can irritate the lining of your esophagus.

 

While many people experience acid reflux from time to time, GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.

 

Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications.  But some people with GERD may need stronger medications or surgery to ease symptoms.

 

Symptoms

Common signs and symptoms of GERD include:

  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night

  • Chest pain

  • Difficulty swallowing

  • Regurgitation of food or sour liquid

  • Sensation of a lump in your throat

 

In cases of nighttime acid reflux, one might also experience:

  • Chronic cough

  • Laryngitis

  • New or worsening asthma

  • Disrupted sleep

 

Seek immediate medical care in the case of chest pain, especially if shortness of breath, jaw or arm pain is also present.  These may be signs and symptoms of a heart attack.

 

Make an appointment with your doctor if you experience severe or frequent GERD symptoms, or take over-the-counter medications for heartburn more than twice a week

 

Causes

GERD is caused by frequent acid reflux.

 

When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.

 

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus.  This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

 

Risk factors

Conditions that can increase your risk of GERD include:

  • Obesity

  • Bulging of the top of the stomach up into the diaphragm (hiatal hernia)

  • Expectancy

  • Connective tissue disorders, such as scleroderma

  • Delayed stomach emptying

 

Factors that can aggravate acid reflux include:

  • Smoking

  • Eating large meals or eating late at night

  • Eating certain foods (triggers) such as fatty or fried foods

  • Drinking certain beverages, such as alcohol or coffee

  • Taking certain medications, such as aspirin

 

Complications

Over time, chronic inflammation in the esophagus can cause:

  • Narrowing of the esophagus (esophageal stricture).  Damage to the lower esophagus from stomach acid causes scar tissue to form.  The scar tissue narrows the food pathway, leading to problems with swallowing

  • An open sore in the esophagus (esophageal ulcer).  Stomach acid can wear away tissue in the esophagus, causing an open sore to form.  An esophageal ulcer can bleed, cause pain and make swallowing difficult

  • Precancerous changes to the esophagus (Barrett’s esophagus).  Damage from acid can cause changes in the tissue lining the lower esophagus.  These changes are associated with an increased risk of esophageal cancer

 

Diagnosis

 

Your doctor might be able to diagnose GERD based on a physical examination and history of your signs and symptoms.

 

To confirm a diagnosis of GERD, or to check for complications, your doctor might recommend:

  • Upper endoscopy.  Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach.  Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications.  An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett’s esophagus

  • Ambulatory acid (pH) probe test.  A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there.  The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder.  The monitor might be a thin, flexible tube (catheter) that’s threaded through the nose into your esophagus, or a clip that’s placed in the esophagus during an endoscopy and that gets passed from the body after about two days

  • Esophageal manometry.  This test measures the rhythmic muscle contractions in your esophagus when you swallow.  Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus.

  • X-ray of your upper digestive system.  X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract.  The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine.  You may also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.

 

Treatment

Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter GERD medications, many of which you can buy without a prescription.  All GERD medicines work in different ways.  You may need a combination of GERD medicines to control your symptoms.

 

If you don’t experience relief within a few weeks and your symptoms don’t go away, your doctor might recommend prescription medication or surgery.

 

Over-the-counter medication options include:

  • Antacids that neutralize stomach acid.  Antacids such as Maalox, Mylanta, Riopan, Rolaids and Tums may provide quick relief.  But antacids alone won’t heal an inflamed esophagus damaged by stomach acid.  Overuse of some antacids can cause side effects, such as diarrhea, constipation or sometimes kidney problems.

  • H2 blocker medications to reduce acid production.  These medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac).  H2 blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours.  They can also help heal the esophagus, although not as well as other medicines.  Stronger versions are available by prescription.

  • Proton pump inhibitor (PPI) medications block acid production and heal the esophagus.  These medications are stronger acid blockers than H2 blockers and allow time for damaged esophageal tissue to heal.  Over-the-counter PPIs include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).  PPIs are better at treating GERD symptoms than H2 blockers, but studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures.  You need to take these medicines on an empty stomach so that your stomach acid can make them work.

  • Prokinetics, which your stomach empty faster.  Prescription prokinetics include bethanechol (Urecholine) and metoclopramide (Reglan).  Both of these medicines have side effects, including nausea, diarrhea, fatigue, depression, or delayed or abnormal physical movement.  Prokinetics can cause problems if you mix them with other medicines, so tell your doctor about all the medicines you’re taking.

 

Prescription medications

Prescription-strength treatments for GERD include:

  • Prescription-strength H2 blockers.  These include prescription-strength famotidine (Pepcid), nizatidine and ranitidine (Zantac).  These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.

  • Prescription-strength proton pump inhibitors.  These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).  Although generally well-tolerated, these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency.  Chronic use might increase the risk of hip fracture.

  • Medication to strengthen the lower esophageal sphincter.  Baclofen may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter.  Side effects might include fatigue or nausea.

  • Antibiotics, including erythromycin, can help your stomach empty faster.  Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

 

Surgery and other procedures

The symptoms and causes of GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend:

  • Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.

  • The LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The Linx device can be implanted using minimally invasive surgery.

 

Lifestyle and home remedies

Lifestyle changes may help reduce the frequency of acid reflux.  Try to:

  • Maintain a healthy weight.  Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.

  • Stop smoking.  Smoking decreases the lower esophageal sphincter’s ability to function properly.

  • Elevate the head of your bed.  If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches.  If you can’t elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up.  Raising your head with additional pillows isn’t effective.

  • Don’t lie down after a meal.  Wait at least three hours after eating before lying down or going to bed.

  • Eat food slowly and chew thoroughly.  Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.

  • Avoid foods and drinks that trigger reflux.  Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.

  • Avoid tight-fitting clothing.  Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

 

Alternative medicine

No alternative medicine therapies have been proved to treat GERD or reverse damage to the esophagus.  Some complementary and alternative therapies may provide some relief, when combined with your doctor's care.

 

Talk to your doctor about what alternative GERD treatments may be safe for you.  The options might include:

  • Herbal remedies.  Licorice and chamomile are sometimes used to ease GERD.  Herbal remedies can have serious side effects and might interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.

  • Relaxation therapies.  Techniques to calm stress and anxiety may reduce signs and symptoms of GERD.  Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.