GERD

GERD is the acronym for gastroesophageal reflux disease, a condition in which stomach acid frequently splashes into the esophagus. GERD occurs when the valve connecting the stomach and esophagus becomes weak, turning the junction into a two-way street. Because the esophagus isn't well equipped to handle such a harsh liquid, GERD often causes burning pain and discomfort. Over time, it can even inflict lasting damage.

According to the National Institutes of Health, 60 million Americans have symptoms of GERD at least once a month. That includes former Baltimore Orioles Hall of Fame pitcher Jim Palmer, who has said the disease affected his pitching performance.

When researchers compared the answers of GERD patients to those of people with other illnesses, they found that some have a worse quality of life than patients with menopausal symptoms, peptic ulcers, angina, or congestive heart failure. If you're suffering from symptoms of GERD, don't ignore the problem. With a few lifestyle changes and a little help from your doctor, you can keep the acid where it belongs.

What are the symptoms of GERD?

Most people with GERD have frequent bouts of heartburn, typically a tight, burning pain behind the breastbone that moves up towards the neck. The pain usually flares up after meals (especially large meals) and lasts for as long as two hours.

Acid regurgitation is another very common symptom of GERD. This occurs when acid travels all the way to your throat, leaving a sour, bitter taste.

Heartburn and acid regurgitation are the hallmarks of GERD. If you frequently suffer from either of these symptoms, your doctor can confidently diagnose GERD and move ahead with treatment.

Some patients, however, have unusual symptoms that make diagnosis less certain. You may salivate more often than normal, have trouble swallowing, or feel like you have a lump in your throat. In such cases, your doctor may have to run tests to find the source of the problem.

What causes GERD?

Many different factors can weaken the valve between the stomach and the esophagus, setting the stage for GERD. Food may play a role in some people. According to the NIH, fried or fatty foods, chocolate, peppermint, alcohol, and coffee can all lower the pressure on your esophageal valve, making stomach acid more likely to seep through. You can open up the floodgates even more by smoking cigarettes. The condition is also common in people who are obese or pregnant.

Many patients with severe GERD also have a hiatal hernia, a condition is which a small portion of the stomach pokes through a hole in the diaphragm. In theory, the hernia may weaken the valve between the stomach and the esophagus. However, most people with hiatal hernias don't have GERD.

Is GERD serious?

Relief from heartburn isn't the only reason to take GERD seriously. Over time, acid can eat away at the lining of the esophagus, causing painful ulcers and even bleeding. This condition is called esophagitis. In a few people, the esophagus protects itself by producing cells that closely resemble cells from the intestine. This is called Barrett's esophagus. Barrett's esophagus, in turn, raises the risk of cancer of the esophagus. If you have Barrett's esophagus, your doctor will want to examine you regularly for signs of dysplasia, a precursor to cancer. This is done by surveying the area through endoscopy, in which a doctor slides a thin tube with a tiny camera at the end down the throat to take pictures and biopsy samples.

What can I do to control GERD?

A few simple lifestyles changes -- perhaps combined with a couple of not-so-simple changes -- often bring great relief from GERD. Even if your case is severe, a little self-help can go a long way.

Though a review of clinical studies showed little evidence that changing your diet can relieve GERD, it makes sense to avoid food that seems to increase your stomach upset. Foods that have historically been thought to cause symptoms include fatty foods, chocolate, caffeinated food and drinks, citrus fruit or juices, tomato-based products, alcohol, and spicy foods. Eat small meals rather than large ones, and don't lie down within three hours of a meal. If heartburn bothers you at night, try raising the head of the bed six inches, perhaps by sliding blocks of wood under the bedposts. (Putting an extra pillow under your head probably won't help, and can even aggravate the condition.) Sleeping on your left side may help, too.

Some people may need to make more serious changes to their lives. If you're a heavy drinker, GERD is a sign that it's time to cut back. Although studies have not been clear that stopping smoking will make your GERD go away, quitting has many other health benefits. So if you smoke, do whatever it takes to quit. If you're overweight, shedding a few pounds could make a big difference. According to Gary Gitnick, MD, co-chief of the division of digestive diseases at the University of California at Los Angeles School of Medicine, getting 30 minutes a day of exercise can help greatly. (In his book, Freedom From Digestive Distress, Gitnick explains that it's not known why exercise promotes normal digestive function.) Just make sure you go easy on activities that involve bouncing or jumping; they can aggravate your condition. Of course, these steps come with rewards that go far beyond treating your digestive distress.

Should I try over-the-counter remedies?

When GERD does flare up, an antacid usually brings quick relief. But such relief alone is often not long-lasting and is not a cure for GERD. Antacids work best when taken at the first sign of symptoms. Over time, however, regular doses of antacids can cause diarrhea and other side effects. In addition, a steady dose of antacids may so severely reduce stomach acid that your food won't break down and your body will lose valuable nutrients.

To prevent future attacks -- and break your antacid habit -- you can try an over-the-counter acid blocker such as Pepcid AD, Tagamet, Zantac, or Axid. Ideally, you should talk to your doctor before trying any of these remedies. If GERD is still a problem after two weeks of self-treatment, don't put off that appointment any longer.

What kind of tests will my doctor run?

If you have the classic symptoms of GERD -- frequent heartburn or acid regurgitation -- your doctor probably won't have to run any tests at all. But if there's any doubt about the cause of your symptoms, your doctor may conduct a barium x-ray or other test to confirm GERD. If you're over 50 and have had GERD for several years, your doctor may use an endoscope to check for Barrett's esophagus. If you have "red flag" symptoms such as dysphagia (difficulty swallowing), progressive weight loss, anemia, or recurrent nausea and vomiting, you should seek medical attention immediately.

What is the treatment for GERD?

The first line of defense is changing your diet and initiating some of the lifestyle changes suggested above. But if those things don't help or fail to provide enough relief, your doctor can offer several effective treatments. One option is a prescription strength histamine-2 receptor blocker, also called an H2 blocker. These drugs prevent or block the production of stomach acid. More severe cases usually call for drugs known as "proton-pump inhibitors" that strongly block the production of acid. PPIs provide quick relief of symptoms and help heal ulcers in the esophagus in most patients.

Prescription drugs for GERD are generally safe and easy to take. A few patients develop headaches or diarrhea. Less common side effects include nausea, gas, abdominal pain, constipation, and dry mouth.

If medications fail to control your heartburn, or if your symptoms come roaring back as soon as you stop taking medications, surgery may be your best chance for relief. Surgery may also be necessary if you have formidable damage to your esophagus, severe esophagitis, Barrett's esophagus, or other complications. Surgery can be helpful in some cases, though its effectiveness over the long term is uncertain. According to guidelines published in the American Journal of Gastroenterology, the more experience your surgeon has in the procedure, the better your chance for a good outcome.

The most common type of operation strengthens the valve between the stomach and the esophagus. Surgery can also repair severe hiatal hernias. These operations can be performed laparoscopically -- using thin surgical instruments inserted through a small incision. This type of operation keeps pain and recovery time to a minimum.

References

Mayo Clinic, GERD. http://www.mayoclinic.org/diseases-conditions/gerd/basics/treatment/con-20025201

National Digestive Diseases Information Clearinghouse. Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD).

Scott M and A Gelhot. Gastroesophageal reflux disease: diagnosis and management. American Family Physician. Vol. 59(5): 1161-1169.

Szarka LA et al. Diagnosing gastroesophageal reflux disease. Mayo Clinic Proceedings. Vol. 76: 97-101.

Gitnick, Gary MD with Cooksey, Karen, Freedom from Digestive Distress, Three Rivers Press..

DeVault KR, et al. Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease. Am J Gastroenterol, Vol. 100:190-200.

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