It may first appear as a frequent tickle in the back of the throat, coughing that may last for weeks in the absence of known illness, hoarseness, even bad breath, or sour taste. Sometimes there may be mild or moderate back pain or chest pain that seems akin to a heart attack. The most common symptom is frequent heartburn. Millions of Americans, young and old, suffer daily with Gastroesophageal Reflux Disease or GERD. Untreated, GERD can be life threatening.
Gastric reflux occurs when stomach contents escape into the esophagus, the tube that carries food from the mouth to the stomach. The lining of the stomach protects it from digestive acids.
The lining of the esophagus does not provide the same protection. Stomach acid that enters the esophagus burns the lining and causes reversible changes called esophagitis. Continued acid assault of the esophageal lining may cause ulcers or even esophageal cancer.
The primary care physician often makes the diagnosis of GERD. A thorough medical history may reveal some of the symptoms in the above list. The physician will recommend treating the disease with dietary and lifestyle changes first. The dietary recommendations will include instructions to avoid foods that increase reflux such as fatty or fried foods, peppermint and spearmint, whole milk, oils, chocolate, creamed foods or soups, and most fast foods.
GERD sufferers should avoid foods that irritate the lower esophagus including coffee and black and green tea (regular or decaffeinated), citrus fruits and beverages including tomatoes and tomato products, carbonated beverages, spicy foods and alcohol. These restrictions only seem difficult until they bring relief. Then, they become a natural part of living pain free.
Recommended lifestyle changes include losing weight, not lying down right after a meal, cutting out late night snacks, avoiding tight fitting clothing, eating smaller meals and snacks, and elevating the head of the bed or sleeping on extra pillows. It is very important to quit smoking. Nicotine weakens the muscles of the lower esophagus causing or worsening reflux. Many GERD suffers find that dietary and lifestyle changes alone are enough to control their GERD.
When remedies that are more natural are not enough, many medications control or eliminate GERD. Liberal use of over the counter antacids decreases stomach acidity in the short term. Antacids such as Tums, Maalox, and Gaviscon, help people with occasional gastric reflux. Other medications such as Nexium, Prilosec, and Prevacid actually decrease acid production. If one of these medications does not work, another may. Together, antacid and acid reducing medications control more severe cases. Many GERD suffers find that they must continue taking these acid decreasing medications for the rest of their lives.
Please, do not treat frequent gastric reflux with over the counter remedies without consulting your physician. Just as gastric reflux pain may mimic pain caused by other conditions, another condition such as coronary artery disease, may feel like GERD.
Endoscopy is a visual examination of the esophagus. This exam is performed routinely for patients who have been diagnosed with GERD. Using an endoscope (a fiber optic camera) a physician may readily diagnose conditions such as esophagitis, ulcers, a pyloric valve that does not fully close (the valve that separates the stomach and the esophagus), and hiatal hernia (weakening of the diaphragm where the esophagus passes through). Patients are under general anesthesia during the procedure; it is quick, easy, and painless.
I write a column on dentistry, so there must be a dental connection to GERD. Here it is. In many cases of GERD, the acidic stomach contents regularly enter the mouth. Teeth are often affected. Dentists easily spot the dental effects of GERD – enamel erosion and a higher decay rate. Sometimes, dentists are the first to suspect that a patient has gastric reflux disease.
Erosion, the generalized loss of tooth enamel, may be caused by GERD, bulimia (the disorder of eating large amounts of food and then causing one’s self to vomit), even sucking lemons or limes. The pattern of erosion in cases of GERD and bulimia is similar, so the dentist must interview the patient carefully to differentiate the two.
Children with a high rate of tooth decay may be suffering with GERD. The dentist will need to know the facts of the child’s diet to differentiate between decay that is caused by diet and decay that may be due to reflux. If there is a question of the presence of gastric reflux, always consult thechild’s physician.
Dentists must treat patients afflicted by GERD in conjunction with treatment of GERD itself. The same acid that affects teeth will have a similar effect on the materials that dentists use to restore erosion and tooth decay. Patients with GERD often have a high rate of decay around fillings and caps or crowns.
Speak with the best medical doctor if you feel that you suffer with gastroesophageal reflux disease. If you believe that your teeth are extraordinarily sensitive, thin or very prone to decay, ask your dentist for their opinion.