What Is GERD?
When digestion is functioning normally, food travels down the esophagus to the stomach, and the lower esophageal sphincter muscle at the base of the esophagus closes like a valve. When this muscle does not close properly or opens spontaneously, the stomach acid can leak back up into the esophagus.
This condition is known as gastroesophageal reflux. Over 60 million adults living in the US suffer from symptoms of heartburn or acid reflux on at least a monthly basis, and approximately 15 million are affected daily. While more common in people over 50, it can occur at any age.
Occasional heartburn or temporary acid reflux is not usually something that causes concern. However, when it continuously occurs more frequently than twice a week, it is diagnosed as gastroesophageal reflux disease, or GERD, a chronic disorder that can cause serious complications and requires medical attention.
The most common symptom of GERD is heartburn, an uncomfortable burning sensation that often begins in the chest behind the sternum, and can travel up to the throat. It is sometimes accompanied by an unpleasant sour or bitter taste in the mouth. However, many people who are diagnosed with GERD don’t exhibit the classic symptoms of heartburn. A significant number experience chest pains that can be mistaken for heart problems.
If the acid reflux reaches the larynx (the area in the throat that contains the vocal cords), it can give rise to a variety of symptoms including difficulty swallowing, hoarseness, chronic sore throat, cough, or laryngitis. In severe cases, it can even lead to laryngeal cancer. Asthma can result if the acid reflux enters the bronchial tubes. An estimated 70% of the cases of adult onset asthma may actually be caused by GERD.
While it is not clear why some people develop GERD, there are certain factors that are known to contribute to the disease, including smoking, obesity, and certain types of food. Physical abnormalities such as hiatal hernias can also be factors. Smoking exacerbates the symptoms of acid reflux disease in several ways.
Saliva plays an important role in protecting the esophagus by neutralizing stomach acid and helping to wash it down. Smoking decreases saliva production while increasing production of stomach acid, as well as causing changes in the composition of the acid that make it more harmful. Smoking can also cause the lower esophageal sphincter muscle to become weaker, and slows down the digestive process, causing food to remain in the stomach longer. Finally, smoking injures the esophagus, rendering it more susceptible to damage by stomach acid. Studies have indicated that obesity is a major risk factor for GERD.
Results of one comparison showed that severely obese men were 3.3 times more likely than normal-weight men to develop reflux disease. The increased risk was even more pronounced in women, where the severely obese group was 6.3 times more likely to develop GERD than their normal-weight counterparts.
Foods To Watch Out For
Certain foods can aggravate the symptoms of GERD including:
- acidic foods such as citrus fruits or tomatoes, garlic and onions,
- fatty or fried foods,
- spicy foods such as chili or salsa, chocolate, and
Lifting, bending over, or lying down immediately after a meal can also worsen reflux symptoms. In light of the fact that obesity and diet are two of the main contributing factors in the development of acid reflux disease, the upsurge of cases of GERD can be explained by the fact that obesity has reached epidemic proportions in the United States and other parts of the world, and that a significant percentage of the population habitually eats unhealthy foods such as those served at fast food restaurants.
Treatment If heartburn occurs several times per week or persists for more than two weeks and does not respond to treatment with over-the-counter antacid remedies, it is time to see a healthcare professional. There are a wide range of possible treatments to help alleviate the symptoms of GERD, but a crucial first step is to make changes in diet and lifestyle habits. Eliminate foods such as those mentioned above that commonly cause heartburn, and eat smaller amounts at each meal. Quit smoking and lose weight if applicable.
Wearing loose-fitting clothing that doesn’t restrict the stomach can be beneficial. It is also recommended to elevate the head of your bed by 6 to 8 inches by placing blocks under the frame, and wait for three hours after eating before lying down. For heartburn and mild cases of GERD, health care providers generally recommend over-the-counter antacids as the first line of defense. Antacids work by neutralizing stomach acid. Foaming agents can relieve symptoms of reflux by covering the contents of the stomach with foam to prevent the acid from rising up into the esophagus. H2 blockers act by decreasing the production of stomach acid.
They are available both over-the-counter and by prescription. These medications are effective for about fifty percent of individuals with reflux disease. More effective than the H2 blockers are a class of drugs called proton pump inhibitors, or PPIs. Also available in both over-the-counter and prescription strength, PPIs are not only relieve symptoms of reflux, but also aid in healing the lining of the esophagus. A different strategy of treatment involves prokinetics. Rather than focusing on decreasing stomach acid, this group of drugs acts to strengthen the lower esophageal sphincter muscle so that it is more likely to remain closed, and they also aid in causing the stomach empty faster. A drawback of prokinetics is that they can cause negative side effects, including fatigue, anxiety, depression, and impaired movement, making them a less desirable treatment option.
Doctors frequently prescribe a combination of different types of medication to relieve the symptoms of GERD, such as combining antacids with H2 inhibitors. The antacids act quickly to neutralize existing stomach acid, while the H2 inhibitors slow down further acid production. In cases where medication and lifestyle changes are not effective in alleviating the symptoms of GERD, tests are available to more accurately establish what is causing the condition.
Doctors may take x-rays or use an endoscope to look at the condition of the esophagus and detect whether a hiatal hernia is present. Surgery may be necessary to correct certain conditions. The most common type of surgical treatment is called fundoplication, a procedure in which the upper part of the stomach, called the fundus, is wrapped around the bottom of the esophagus so that food can pass into stomach, but stomach acid cannot back up into the esophagus.
If the patient has a hiatal hernia, it can also be repaired during the surgery. It is important to get prompt medical treatment for gastroesophageal reflux disease. If left untreated, it can lead to serious complications including asthma, scarring of lung tissue, ulcers, abnormal cells in the esophagus, or esophageal cancer.