Gastroesophageal reflux disease, often referred to by the acronym GERD, is a medical condition becoming more and more common and which presently afflicts up to 20 million Americans.
Even small babies can suffer from GERD, and it can produce very distressing symptoms. These symptoms vary with individuals, while infantile GERD may present different symptoms to those seen in adults.
Gastroesophageal reflux disease [GERD] is a chronic medical condition caused by an abnormal state of the lower esophageal sphincter which is composed of a band of muscle. This surrounding muscle relaxes when we swallow to allow food to enter the stomach, after which it closes again. For people who experience GERD the sphincter is weakened, allowing the return of stomach acid back into the esophagus.
This stomach acid, though tolerated by the tough lining of the stomach, can be damaging to the delicate tissue of the esophagus. The damaging acid can even be regurgitated as far up as the mouth and can cause damage there.
SYMPTOMS OF GASTROESOPHAGEAL REFLUX
*Heartburn, a burning sensation at the back of the throat or in the chest, is the most common complaint.
*The pain may be experienced in the neck or the back. As these pains mimic the symptoms of a heart attack they must be investigated.
*Persistent sore throat.
*Regurgitation of food after eating.
*Asthma and wheeziness.
*Difficulties in swallowing [ dysphagia] because of an inflamed and sore esophagus.
*A distressing sensation of there being a lump in the throat.
*Nausea and unpleasant taste in the mouth
*Coughing, especially after meals.
*Hoarseness and/or changes in the voice.
SYMPTOMS IN INFANTS
*Refusal to feed.
*Cough
*Vomiting frequently.
*Asthma.
*Crying for no apparent reason.
*Difficulties in breathing.
*Unsatisfactory weight gain.
Babies who display any of these symptoms must be taken to a doctor who will be able to give advice regarding treatment. Infants with acid reflux problems will generally outgrow them as their digestive ability matures, often by the time of their first birthday.
CAUSES OF GASTROESOPHAGEAL REFLUX
It is not clear why so many people suffer from GERD, but there are certain factors which may put some individuals at high risk of developing the condition. The lower esophageal sphincter [LES] functioning poorly is the most common cause, where the sphincter relaxes too easily and allows stomach acid to escape. Certain substances may promote the relaxation of the LES and common among these are:
FOOD
*Tomato based dishes
*Spicy foods
*Citrus fruit juices
*Fried foods
*Onions and garlic
*Chocolate
*Peppermint
MEDICATIONS
Many commonly prescribed medications may contribute to a weakening of the LES.
*Calcium channel blockers given to treat high blood pressure and angina
*Nitrates for the treatment of angina
*Alpha blockers used to address prostate problems
*Theophylline prescribed as asthma treatment
*Biphosphonates given to treat osteoporosis
*Anti-inflammatories commonly used to treat arthritis and other conditions
IN ADDITION
*Obesity, which is an ever-increasing problem in many parts of the world.
*Overeating which contributes to stomach discomfort and obesity.
*Smoking: this aggravates a number of health problems; GERD may be one of them.
*Pregnancy: may provoke a temporary condition of GERD as the growing fetus creates pressure on the stomach.
*Hiatus hernia can increase the likelihood of GERD.
DIAGNOSIS
Initial diagnosis of GERD is usually based on the symptoms described. The doctor will prescribe medication to treat these symptoms and in most instances it will work satisfactorily. Many people will self-diagnose and will treat themselves, with the assistance of a pharmacist in choosing from the many available over-the-counter medicines.
If these initial treatments don't bring the desired relief, then your doctor will suggest tests which may be:
*Barium swallow, where the patient drinks a solution of barium. X-rays will then reveal a hiatus hernia, ulcers, strictures or unusual contraction of the esophagus.
*Esophageal monitoring where a test can measure the acid level in the esophagus over a set time period. Another form of monitoring can measure esophageal pressure when swallowing is taking place to test if muscles are working normally.
*Endoscopy is a procedure where [after sedation] a fiber-optic tube is inserted into the esophagus and the stomach allowing the physician to see clearly the tissues in question to check for ulcers and abnormal cells. This test would be performed in the case of GERD that develops after the age of 50, or that has other symptoms such as weight loss, anemia or bleeding.TREATMENT OF GASTROESOPHAGEAL REFLUX
1 The initial approach in the treatment of GERD will normally be a non-drug one, involving lifestyle changes which will often diminish the level of discomfort.
* Cut down or stop smoking; help is available to assist with this.
* Attain and maintain an ideal weight
* Adopt a low-fat diet; avoid take-out food
* Avoid food known to worsen symptoms such as fried foods, chocolate and caffeine
* Reduce alcohol consumption
* Check with your doctor that your painkillers or antibiotics aren't causing irritation
* Avoid eating large meals; try to eat smaller amounts more frequently.
*Raise the head of your bed by 6 or7 inches and simple gravity will keep acid down
2 MEDICATIONS
Many prescription drugs are available and also a great many over-the-counter remedies.
*Antacids: mild symptoms of GERD can be eased by such medication as Riopan or Alka-Seltzer. They neutralize stomach acid but may carry such side effects as diarrhea.
*Alginic acid is a foaming treatment [Gaviscon] that covers the stomach contents and decreases reflux.
*H2 blockers: famotidine or cimetidine, sold as Pepcid AC and Tagomet HB, can reduce acid production.
*Proton Pump Inhibitors have proved effective in reducing acid. They also promote healing of a damaged esophageal lining.
Always consult a physician for advice on drugs or drug combinations.
3 SURGERY
Modern drugs, especially the Proton Pump Inhibitors, together with lifestyle changes have made surgery less needed. It is still an option, however, for severe cases and a major advance has been the development of laparoscopic surgery. Small incisions are made to perform the Nissen fundoplication where an upper section of the stomach is wrapped around the lower esophagus to prevent reflux. New developments using radiofrequency energy, or sutures, to tighten the LES also offer possibilities of resolving GERD.
WHEN TO SEEK PROFESSIONAL HELP
Most problems with GERD are short-lived. If they prove severe and/or frequent you may need medical treatment and prescription medications. Visit your doctor if any of the following apply:
*Heartburn several times a week.
*Heartburn that keeps you awake at night.
*Difficulty in swallowing.
*Prescription medications not effective.
*Regurgitated blood is observed.
*Blood in stool [i.e. black stool].
*Weight loss.
Modern life places a strain on our bodies, and we abuse ourselves with alcohol, drugs and unwise eating habits. Occasional heartburn is not surprising but persistent discomfort should certainly be investigated.