GERD (Gastroesophageal Reflux Disease)
GERD Symptoms & Treatment
Gastroesophageal reflux disease (GERD), or acid reflux, occurs when stomach contents and stomach acids flow back into the esophagus. GERD may also be referred to as heartburn or acid indigestion.
The esophagus is the tube that moves food from your throat to your stomach. A ring of muscles called the lower esophageal sphincter (LES) is located at the bottom of the esophagus. Normally, the LES closes tightly after food enters the stomach, which prevents the contents of the stomach and acids from backing up into the esophagus.
With GERD, however, the ring does not close tightly. Instead, it remains open and allows stomach contents and acids to pass back into the esophagus, which produces a burning discomfort in the chest area. In chronic cases of GERD, these stomach acids can damage the lining of the esophagus.
GERD is a common condition, affecting approximately 20% of the population. GERD can be prevented and its symptoms can be treated, but if it goes untreated, serious medical complications can occur.
GERD occurs when the ring of muscles at the bottom of the esophagus (lower esophageal sphincter or LES) doesn’t close like it should after eating, allowing stomach acids and contents to flow into the esophagus. The stomach acids irritate and damage the lining of the esophagus.
Factors that can cause the LES to weaken include:
- Being overweight or obese
- Certain medications
- Drinking alcohol
- Hiatal hernia
The major symptom of acid reflux is heartburn, which is felt as a burning pain behind the breastbone. If you experience symptoms more than twice a week, you may have GERD.
You may experience heartburn after eating, lying down, or bending forward. Heartburn from GERD usually occurs within two hours after eating.
GERD symptoms vary from person to person. Other symptoms of GERD can include:
- Sour or bitter taste in your mouth from the stomach acids
- Bad breath
- Hoarseness or laryngitis
- Sore throat
- Dry cough
- Difficulty swallowing
- Feeling like there is a lump in your throat
- Erosion of tooth enamel from the stomach acids
In addition, poor eating habits and certain foods can worsen reflux symptoms. Eating too much and eating before bedtime or lying down can cause food to back up from the stomach into the esophagus.
Irritating foods include:
- Acidic foods such as citrus fruits, tomatoes, and tomato-based foods, like spaghetti sauce, salsa, chili, and pizza
- Drinks with caffeine or alcohol
- Fatty and fried foods
- Garlic and onions
- Spicy foods
- Mint-flavored candy or food
Left untreated, GERD can cause complications such as:
- Esophagitis (inflammation of the esophagus)
- Esophageal stricture (narrowing of the esophagus)
- Respiratory problems (worsening asthma or chest congestion)
- Barrett’s esophagus
Your doctor may be able to diagnose GERD during an office visit by reviewing your medical history and symptoms. He may also recommend several tests to confirm the diagnosis and/or check for damage to the esophagus or other GERD-related problems:
The goals of GERD treatment are to reduce reflux, relieve symptoms, and prevent damage to the esophagus. Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medicines, surgery, or a combination of treatments.
If your GERD is mild, lifestyle changes may be enough to reduce reflux and relieve symptoms. These may include:
- Losing weight
- Quit smoking
- Refrain from drinking alcohol
- Avoid foods that irritate the esophagus
- Eat small meals throughout the day instead of large meals
- Avoid eating before bedtime or lying down after you eat
More severe cases may need prescription medication or surgery. Surgery is never the first treatment option for GERD.
If lifestyle changes alone do not work, you can use an over-the-counter antacid. Antacids work by neutralizing the stomach acid and coating the stomach. They relieve symptoms rapidly, but only temporarily. If you need antacids for over two weeks, you should contact your doctor and discuss other appropriate treatments.
Your doctor may also recommend you take a histamine-2 (H2) blocker such as Zantac®, Tagamet®, or Pepcid AC®, which decreases the amount of acid in the stomach and helps heal the esophagus. They prevent GERD because there is less acid to back up into the esophagus. These are available over the counter or in prescription strength.
If the acid blockers are not effective, your doctor might suggest a proton pump inhibitor (PPI), which also decreases the amount of acid in the stomach and helps heal the esophagus. Prilosec® is available over the counter. Others such as Prevacid® or Nexium® are available as a prescription.
Another medication option is a prokinetic, or promotility drug, which speeds up the rate that the stomach empties food and acid. These include Reglan® and Urecholine®.
You may need surgery if prescription medications fail and you are experiencing serious complications. The procedure for GERD is called a fundoplication. It involves tightening the LES and tying the stomach to prevent stomach acid from entering the esophagus. Fundoplication surgery is successful for most people.
Two new endoscopic techniques have been approved by the FDA for treating GERD. Endoscopic suturing and radiofrequency may help control GERD in a small number of people. Endoscopic suturing uses small stitches to tighten your sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten your sphincter muscle.
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