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Learning to get a grip on GERD
“There it is again, that burning sensation in my chest and throat. I’m feeling it more and more often after eating or lying down. Is it just heartburn or is it something more serious?”
Pain in the chest area is always a symptom you should investigate. Most alarmingly, it could be a sign of cardiac disease. But once cardiac disease is ruled out by your physician, heartburn becomes a primary suspect. And for the most part, taking the occasional antacid will clear up an annoying bout of acid indigestion. But if the heartburn becomes frequent or chronic, it could be a symptom of GERD — gastrointestinal esophageal reflux disease.
GERD affects an estimated 5 to 7 percent of the world’s population. The most common symptom is heartburn, a burning sensation under the breastbone that happens after eating or at night. Some people experience regurgitation of partially digested food into the back of the throat, or a feeling that food is sticking in the chest after swallowing. Some less-common symptoms include sore throat, hoarseness, a sour taste in the back of the throat, and breathing problems similar to asthma.
With GERD, the liquid content of the stomach backs up into the esophagus. It is important to treat GERD because over time, the acid content of this liquid can damage the lining of the esophagus, cause sinusitis, erode a patient’s teeth and gums, create ulcers, and increase the risk of esophageal cancer.
GERD can be caused by several factors. A common culprit is a failure of the lower esophageal sphincter to completely close after food passes into the stomach. Sometimes, GERD results from esophageal muscles that are not strong enough to push refluxed acid back into the stomach. About 20 percent of patients who experience GERD have stomachs that empty too slowly after a meal, prolonging the period during which reflux is likely to occur. And finally, hiatal hernia, a condition in which a portion of the stomach protrudes upward into the chest, can also contribute to GERD.
So what are the treatments for GERD once it is diagnosed? Often, alterations in lifestyle can provide relief. Most people benefit substantially from weight loss. Other steps include: wearing loose-fitting clothing, eating the evening meal long before bedtime, removing spicy and fatty foods from the diet, and stopping smoking. Some patients find elevating the head of the bed six to eight inches useful in preventing reflux episodes.
The second level of treatment is drug therapy, starting with over-the-counter antacids or acid suppression medications. If these don’t relieve the symptoms, prescription medications may be necessary to further suppress stomach acid production. In some cases, a physician may also prescribe drugs that improve emptying of the esophagus and stomach. When prescription medications are needed for more than eight weeks, an exam called an upper endoscopy may be warranted.
An upper endoscopy is a 10-minute examination of the upper gastrointestinal tract using a tube-like instrument with a video camera on the end. Direct visualization allows biopsies and therapeutic interventions, such as dilation and cauterization to be performed. Each patient receives an individualized approach to treatment, depending on his or her anatomy and symptoms.
Fortunately, more than 95 percent of patients with GERD find that lifestyle changes and/or medical therapy are enough to stop the painful effects of GERD. However, it is important to notify your physician if your symptoms go beyond the mild and infrequent stage. Early diagnosis and treatment will often prevent more serious problems down the road. Again, if unsure, please check with your physician.