GERD: Symptoms, Causes, and Treatment

An occasional episode of reflux is of no real concern, however if it occurs more than 2 times a week, one should see a doctor, as there are numerous treatments. Left untreated it may cause erosion (damage) to the lower esophagus which may lead to cancer.

GERD Signs and symptoms … Heartburn pain, discomfort, or a burning sensation behind the breastbone (near the heart) worse with bending over, lying down or eating some foods or alcohol.

Other symptoms:

• bad breath
• difficulty or pain when swallowing
• respiratory problems
• nausea or vomiting
• abnormal wearing of the teeth

What causes GERD?

According to the American College of Gastroenterology about 20% of Americans or 60 million get heartburn at least once a month. GERD is often due to overeating, lying down after eating, or eating spicy foods. It occurs when the valve at the top of the stomach fails to close properly and acid in the stomach can move/flow upward into the esophagus. The valve can be weak for unknown reasons. It can affect people of all ages (even babies).

However, it occurs more commonly in patients who …

• Smoke or are exposed to second-hand smoke.
• Are Overweight or obese, which placed more pressure on the abdomen forcing stomach contents upward into the esophagus.
• Pregnant - for the same reason as above.

• Have a Hiatal hernia an opening in the diaphragm where top portion of the stomach inches up into the chest cavity which lowers the pressure in the esophageal valve

• Some medications can cause reflux such as:  
• antidepressants
• antihistamines
• asthma medications
• calcium channel blockers
• sedatives

Diagnosis of GERD and Testing:

If you or someone you care about is getting frequent acid reflux you should talk to your doctor, for a referral to a gastroenterologist (specialist) for further exam and testing such as …

• Bravo wireless monitor:  a small temporary device attached to the esophagus to measure the pH or acid for 48 hours measures the amount of acid in the esophagus while, eating, resting or sleeping.
• Upper GI (gastrointestinal) endoscope is camera attached a tube and put down the throat to look at the esophagus. A biopsy (tissue sample) may also be taken at that time to measure damage
• Upper GI series – is a series of X-rays to look for abnormalities causing your GERD.
• Esophageal manometry - Can tell how strong the sphincter is while swallowing, by measuring muscle contractions in the esophagus

Certain changes in your lifestyle may help relieve GERD:

• stop smoking
• if overweight go on a diet and lose weight
• stop overeating: put smaller amounts of food on smaller plates and do not go back for seconds
• avoid trigger foods such as spicy, acidic, or greasy foods
• stop eating 2-3 hours before sleeping
• do not wear clothing that is tight around the abdomen
• sleep at a slight angle with the head slightly elevated

If you have GERD avoid the following:

• alcoholic drinks
• spicy foods
• greasy foods
• chocolate
• peppermint
• coffee
• tomato products

Medication Treatment of GERD:

• Over the counter Antacids are usually the first line of (self) treatment by most sufferers to try to counteract the acid in the stomach using these alkaline tablets; diarrhea and constipation can be their side effects.
• Proton pump inhibitors - are the main prescribed medical treatment. They reduce the amount of acid in the stomach.
• H2 blockers - also decrease acid production.
• Prokinetics - help the stomach empty faster however diarrhea, nausea, and anxiety may occur with their usage.
• Erythromycin – which is an antibiotic may also help the stomach empty faster, but long-term usage is not recommended.

Endoscopic surgical options for GERD when the above is not enough:

• stitching the top of the stomach around the esophagus to tighten the sphincter muscle
• radiofrequency treatment using heat to produce small puckers that help tighten the sphincter muscle.

• Fundoplication – During surgery the top part of the stomach is wrapped around the lower esophagus, thereby reinforcing or tightening the valve, preventing back flow but not swallowing. One may still require medication and 1 in 10 will require another surgery. The following can occur from the surgery. The patient might:

• Get an infection from the surgery
• Feel bloated
• Have a difficulty swallowing after the surgery