GERD, or gastroesophageal reflux disease, is a common disorder that causes acid reflux and frequent heartburn. GERD occurs when the lower esophageal sphincter relaxes at inappropriate times, allowing stomach contents to enter the esophagus.
Symptoms of GERD include a burning sensation in the chest and throat better known as heartburn.
Additional Symptoms of GERD may include:
- Chronic cough
- Feeling like there is lump in the throat
- Chest sensation or pain
- Chronic nausea and vomiting usually after meals
- Wheezing and choaking episodes when laying down
If GERD is left untreated, it can lead to more severe complications. The esophagus is made of three layers. These include an outer fibrous layer, middle layer of smooth muscle, and an inner membrane that contains tiny glands. When stomach enzymes back flow into the esophagus, the lining offers a weak defense. Prolonged untreated symptoms of GERD can lead to severe complications including severe in flammation and ulceration in the esophagus and narrowing in the lower end of the esophagus which can cause solid food to get stuck in the esophagus after swallowing (dysphagia).
Prolonged GERD can also be complicated by a change in the lower end of swallowing tube called Barrett's. This occurs in approximately 12% of patients with chronic GERD and can increase the risk of developing esophageal cancer. Therefore patients with prolonged GERD will be referred for a test called gastroscopy. The specialist will insert a tube with a camera in the esophagus to screen for the presence of Barrett's and complications of GERD. Samples (biopsies) will be taken to confirm the diagnosis and to check under the microscope for specific changes that can indicate progression towards cancer.
Patients with Barrett's will be advised to undergo followup gastoscopies and biopsies to detect any changes that indicate progression towards cancer(called dysplasia). The frequeny will be determined by the specialist.
First step is life style modification as follows:
The lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms:
- Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle.
- Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
- Do not lie down immediately after eating. Avoid late evening snacks.
- Avoid tight clothing and bending over after eating.
- Eat small, frequent portions of food and snack if needed.
- Lose weight if overweight. Obesity leads to increased reflux.
- Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
The following foods aggravate acid reflux, and should be avoided:
- fatty or fried foods
- peppermint and spearmint
- whole milk
- creamed foods or soups
- most fast foods
The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:
- citrus fruits and juices (grapefruit, orange, pineapple, tomato)
- coffee (regular and decaffeinated)
- caffeinated soft drinks
- other caffeinated beverages
Spicy or acidic foods may not be tolerated by some individuals.
If patients experience only occasional, mild heartburn,they may get relief from an over-the-counter (OTC) medication and self-care measures. OTC remedies include:
- Antacids such as Maalox, Rolaids and Tums, neutralize stomach acid and can provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea.
- When the above measures fail and if the heart burn is ferequent, your doctor will recommend prescription medications to supress acidity (H2 receptor blockers or proton pump inhibitors PPIs). Some patients will require treatment for life.
- Few patients who do not respond to the above measure will require a surgery to tighten up the lower end of the esophagus called esophageal fundoplication.