Gastroesophageal Reflux (GERD)

Gastroesophageal Reflux (GERD)

Are you troubled with frequent heartburn, difficulty swallowing, or tasting your food again after you've swallowed it? Do you have a hard time sleeping after eating, chronic coughing or wheezing, hoarseness or a sore throat at least once a month?

If you experience one or several of these symptoms, you may have a more serious condition than heartburn called gastroesophageal reflux disease (GERD).

Symptoms

Heartburn is a harsh burning sensation, usually located in the center of your chest. The sensation may move through your upper abdomen, chest, throat, or neck.

Food passes from your mouth through the esophagus, the tube connecting your throat to your stomach, and through a valve called the lower esophageal sphincter (LES) into the stomach. The LES is a one-way valve permitting food to pass to the stomach.

This valve normally prevents food from backing up or "refluxing" back into your esophagus. GERD occurs when the valve fails and stomach acids flow back and burn the lower esophagus.

If reflux persists over time, the esophagus becomes irritated and inflamed, causing heartburn and sometimes damage.

Causes

"People are sometimes born with a weak valve," explains Horacio Asbun, MD, FACS, medical director of the advanced laparoscopic surgery program at John Muir Health. "Others may be affected by eating fatty or spicy foods, taking certain medications, drinking alcohol…”

Sometimes there is a physical abnormality. “Some develop a hiatal hernia when an opening in the diaphragm enlarges and allows a portion of the lower esophagus and upper stomach to move into the opening," Asbun points out.

For others, the cause is not always clear. Factors that sometimes contribute to GERD include:

  • Obesity
  • Pregnancy
  • Smoking

Treatment

You and your physician can work together to treat GERD through three progressive steps: lifestyle changes, drug therapy, and when needed, surgical intervention.

The first step is to change your diet to reduce or ease symptoms. Certain foods can relax the LES or increase acid in your stomach.

Avoid carbonated drinks, coffee, and tea; chocolate; fatty and fried foods; onions; peppermint; spicy foods; and acidic food like oranges and tomatoes.

Lifestyle changes

To relieve the symptoms of GERD, Dr. Asbun suggests the following steps:

  • Eat several small meals daily instead of three large meals
  • After eating, avoid bending over, lying down, or sleeping for several hours
  • Stop smoking and drinking alcohol (both increase stomach acid and irritation, and alcohol opens the LES)
  • Maintain your recommended weight or lose weight if necessary
  • Exercise regularly after speaking with your physician about an appropriate program
  • Wear loose-fitting clothing and belts
  • Raise the head of your bed six to eight inches with books or blocks, or put a wedge under the head of your mattress or sleep over several pillows

Other treatments

If your symptoms persist after lifestyle changes, discuss drug therapy with your physician.

Antacids are usually the first drugs your doctor will recommend for mild symptoms of heartburn or GERD. Using antacids can help to neutralize and decrease stomach acids and relieve symptoms.

Half of all people with GERD find relief with drugs called H-2 blockers. H-2 blockers reduce the amount of acid your stomach produces.

Depending on your symptoms, your physician may prescribe more powerful medications called proton pump inhibitors. Proton pump inhibitors heal the esophageal lining in almost everyone with GERD.

Also check with your physician about avoiding taking aspirin or anti-inflammatory drugs that can irritate the protective lining of your stomach.

Surgery

If you do not respond well to lifestyle changes or drug therapy, you may consider undergoing surgery.

New, minimally invasive surgery uses a laparoscope to avoid a large abdominal incision. Pain is significantly less than other kinds of surgery, and the length of a hospital stay averages two days. Many can return to work within two weeks.

A surgeon performs this technique on the esophagus and stomach with the patient under general anesthesia. A laparoscope attaches to a camera that sends images to a video monitor. Through several tiny incisions, the surgeon repairs tissue in the abdomen.

This surgery is a safe and effective treatment for GERD when other medical management is insufficient.

Many studies show most patients who undergo surgery are either free of symptoms or have significant improvement of symptoms from GERD and usually do not require any further medications.

If you are concerned about GERD, talk with your physician.