By Nick Davis, MD
Everyone gets an occasional bout of heartburn, also called acid indigestion—that burning chest pain that sometimes comes after a big or acidic meal. But if you find you’re having more frequent bouts of indigestion, you might have a more serious condition known as reflux, or Gastro-esophageal reflux disease (GERD.) Fortunately, there are many effective treatments and lifestyle changes that can help you manage the condition. Read on to learn more about this common condition.
What is GERD?
GERD is the term for persistent acid reflux—when acid from the stomach refluxes into the esophagus. In patients with GERD, the muscle that adjoins the stomach and the esophagus, called the lower esophageal sphincter (LES) which allows the passage of food into the stomach, fails to close and allows acid to travel back into the esophagus. While the symptoms are consistent with heartburn (burning feeling in chest area, discomfort, belching,) reflux disease (more than an occasional bout of reflux) can be serious and should be properly diagnosed and treated.
What are the symptoms of GERD? What causes GERD?
Persistent heartburn-like symptoms: burning in the chest, discomfort, and an acidic taste. Symptoms might occur after a large meal, when lying down, during exercise or when bending over. Certain foods also can trigger reflux, such as chocolate, peppermint, coffee, tea, colas and alcohol – all of which can relax the LES and allow acid to reenter the esophagus. Acidic foods, such as tomatoes and citrus fruits or juices can also cause reflux. Smoking and obesity can also contribute to GERD.
Why is GERD more serious than heartburn?
Besides just being uncomfortable, patients with GERD are at greater risk for other conditions that can be very serious. The acid in our stomachs, while important for food digestion, can be dangerous in the more delicate environment of the esophagus. Persistent acid reflux into the esophagus can cause erosions in or even change to the cellular make-up of the esophageal lining, which can lead to a condition known as Barrett’s Esophagus or even esophageal cancer.
How is GERD diagnosed?
GERD can be diagnosed in your physician’s office, based on an examination and discussion about your symptoms. If your physician thinks your case is more severe or is not reacting to first line treatments, he or she might order an upper gastrointestinal endoscopy, where a doctor feeds a long tube through your mouth and throat to examine the lining of your esophagus to look for any inflammation or changes in the lining. Your doctor might also take a small biopsy of the tissue to review under a microscope.
How is GERD treated?
Fortunately, there are many effective, evidence-based treatments for GERD, and your doctor can help you decide which is best for you:
Lifestyle modifications: For patients with GERD, doctors suggest eating a low-fat diet, including smaller meals three to four hours apart. In addition, limiting alcohol, coffee, tea, soft drinks and acid drinks like tomato, spicy foods and citrus juices can be helpful. Maintaining a healthy weight and quitting smoking are also recommended. Some patients are advised to raise the head of their bed to allow gravity to help keep stomach acid from traveling back into the esophagus. Not eating for two hours before bedtime is also advised.
Medications: There are many over-the-counter products that can help with the symptoms of GERD. Antacids (like Tums or Mylanta) work by neutralizing the acid and reducing the burning feeling that comes with acid reflux. H2Ras are a class of medication that can help reduce the amount of acid being produced – drugs like Pepcid and Zantac. Proton Pump Inhibitors (PPIs, e.g., Prevacid, Prilosec) work in a similar fashion as H2RAs, but they have a different mechanism of action and are thought to block even more acid production. Some PPIs are available over-the-counter but usually directed at a reduced strength. Newer PPIs or larger doses of PPIs often require a doctor’s prescription.
Surgery: In a small number of cases, some GERD patients may opt for a non-invasive surgery to strengthen the LES to block the acid from refluxing into the esophagus. Called fundoplication, this laparoscopic surgery has a very high success rate (95% patient satisfaction and reduction/elimination of symptoms) and relatively short (2 – 3 days) recovery time. If you experience indigestion or heartburn-like symptoms more than once a week, talk to your doctor about treatments.