GASTROESOPHAGEAL REFLUX DISEASE

Occasional heartburn is common but does not necessarily mean one has gastroesophageal reflux disease. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems. Anyone, including infants, children, and pregnant women, can have GERD.

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a camera shutter between the esophagus and stomach. The esophagus carries food from the mouth to the stomach. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

What are the Symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

GERD in children is common and often overlooked in infants and children. It can cause repeated vomiting, coughing, and other respiratory problems. Children's immature digestive systems are usually to blame, and most infants grow out of GERD by the time they are 1 year old.

What Causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include:

  • alcohol use
  • overweight
  • pregnancy
  • smoking

Also, certain foods can be associated with reflux events, including:

  • citrus fruits
  • chocolate
  • drinks with caffeine
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, chili, and pizza

How is GERD Treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

  • If you smoke, stop.
  • Do not drink alcohol.
  • Lose weight if needed.
  • Eat small meals.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts--just using extra pillows will not help.
  • Medications

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.

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