Got GERD?

Got GERD?

Article Apr 30, 2005

Seems like no one gets ulcers anymore; now they get GERD. And while the name is funnier, there is nothing funny about the pain. If you’ve seen the commercial of the man drinking an orange juice glass of nails, from what I hear, it’s an accurate description. But anyone can have this potentially dangerous condition, including infants, children and pregnant women.

Also called acid reflux, gastroesophageal reflux disease, or GERD, “occurs when the lower esophageal sphincter (LES) does not close properly and the stomach contents leak back, or reflux, into the esophagus,” according to the website of the International Foundation for Functional Gastric Disorders (www.iffgd.org). When refluxed stomach acid touches the lining of the esophagus, it burns. When it’s low in the pipe, you experience it as heartburn; when it keeps coming up, it’s known as acid regurgitation.

It is not known what causes this sphincter—which should remain tightly closed to keep stomach contents in until swallowed food pushes it open—to malfunction. There is some evidence that a hiatal hernia may contribute, a condition that occurs when the upper part of the stomach squeezes itself through the opening (hiatus) in the diaphragm through which the esophagus passes, and bubbles next to the esophagus. GERD and hiatal hernia frequently occur together, but not always. On the other hand, everyone gets heartburn and indigestion now and then, without having either GERD or hiatal hernia. However, if you’re suffering with acid reflux two to three times a week, it should be treated before becoming a more serious health problem.

Symptoms

In addition to persistent heartburn and acid regurgitation, a range of other symptoms is also common, including dull and sharp chest pain (as opposed to burning), dysphagia, morning hoarseness, dry cough, bad breath and continuous belching. In small children, GERD may cause repeated vomiting, coughing and other respiratory problems. Often undiagnosed, most babies nonetheless grow out of it by their first birthday.

Many adults tend to suffer with the disease for a long time before seeking diagnosis and receiving appropriate treatment. Untreated, the continuous reflux of stomach acid into the esophagus can cause esophageal and respiratory damage, including Barrett’s esophagus, a pre-cancerous condition where cells in the esophageal lining take on the characteristics of stomach lining. Studies have even shown that asthma, chronic cough and pulmonary fibrosis may be aggravated or even caused by GERD, according to the IFFGD.

None of these conditions should be self-diagnosed. If you use antacids or other acid indigestion medications on a regular basis, it’s time to see your doctor. Better yet, visit a gastroenterologist, a specialist in diseases of the stomach and intestines.

Treatment

Spicy or acidic foods do not cause GERD, though they can be associated with reflux events and exacerbate the symptoms if you already have it. For that reason, most doctors recommend lifestyle and dietary changes, as well as medication to help sufferers minimize discomfort and damage.

Topping most lists of acid-producing foods that doctors say to avoid are fatty and fried foods, onions and chocolate. Other troublesome aggravators tend to be citrus fruits and drinks, tomato-based foods such as spaghetti sauce, chili and pizza; coffee, tea and cola; mint flavors, garlic and alcohol. But it varies by individual. In a nutshell: If it’s given you heartburn before, leave it alone.

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More important than what you eat, however, say experts, is how and when you eat. More frequent, smaller meals, eaten well before bedtime, will minimize pressure on the LES. Gravity works in your favor, so eat in an upright, relaxed posture, and avoid lying down until stomach contents have emptied—at least three hours. Meals should also be taken in relaxed, stress-free surroundings.

Certain medications such as potassium supplements and the antibiotic tetracycline can burn the esophagus if they stay there. Don’t lie down after taking them, and swallow them with plenty of water. Other conditions that may contribute to GERD include being overweight, pregnancy and smoking. Losing weight, giving birth and quitting smoking will often clear up heartburn.

Medications used to treat the disease include over-the-counter (OTC) antacids (Alka-Seltzer, Maalox, Rolaids, Tums, etc.) that neutralize stomach acid on contact; H2—or histamine—blockers (Tagamet, Zantac, Pepcid, Axid), which come in both prescription and OTC strength and inhibit the production of stomach acid in many people; and the more effective protein pump inhibitors (Prilosec, Prevacid, Protonix, Aciphex and Nexium) available by prescription only, which limit acid secretion and, authorities agree, at least one will prove effective for virtually everyone. All these drugs can be mixed and matched, but should not become staples in your diet in lieu of lifestyle changes.

Stronger measures such as surgery and the class of drugs called prokinetics (Urecholine, Reglan, Metaclopramide) can be tried in hopes of strengthening the sphincter, making the stomach empty faster and improving peristalsis in the alimentary canal, but these have limited usefulness. There are three relatively new (FDA-approved in 2000 and 2003) endoscopic procedures, which utilize radio frequencies, sutures or polymers to alter the mechanics of the LES, but these have not been well-studied and long-term data are lacking.

Anyone with chronic symptoms should see their doctor for diagnosis and treatment. Reflux will not resolve itself and can lead to more serious problems. Additional tests, such as a barium swallow radiograph, endoscopy or biopsy, might be needed if discomfort persists.

For more information, visit www.aboutgerd.org.

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