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GERD: Heartburn and more

Doctors call it gastroesophageal reflux disease, or GERD. Millions of people call it heartburn, and many others have coughing, wheezing, or hoarseness without realizing that GERD is to blame. By any name, GERD is common, bothersome, and sometimes serious. But once you know you have GERD, you can control it and prevent complications.

What is GERD?

Every time you swallow, the muscles of the lower esophagus (lower esophageal sphincter, or LES) relax so food can enter your stomach. When your stomach is full, a tiny amount of food can sneak back into the esophagus when you swallow — that’s normal. But in people with GERD, substantial amounts of stomach acid and digestive juices get into the esophagus. Its sensitive tissues are injured by acid, and, if the acid makes it all the way to the mouth, other structures can be damaged.

Causes

Poor function of the LES is responsible for most cases of GERD. A variety of substances can make the LES relax when it shouldn’t, and others can irritate the esophagus, exacerbating the problem. Other conditions can simply put too much pressure on the LES. Some of the chief culprits in GERD are shown below.

Common causes of GERD symptoms

Foods

  • Garlic and onions
  • Coffee, cola, and other carbonated beverages
  • Alcohol
  • Chocolate
  • Fried and fatty foods
  • Citrus fruits
  • Peppermint and spearmint
  • Tomato sauces

Medications

  • Alpha blockers (used for the prostate)
  • Nitrates (used for angina)
  • Calcium-channel blockers (used for angina and high blood pressure)
  • Tricyclics (used for depression)
  • Theophylline (used for asthma)
  • Bisphosphonates (used for osteoporosis)
  • Anti-inflammatories (used for arthritis, pain, and fever)

Other causes

  • Smoking
  • Obesity
  • Overeating
  • Tight clothing around the waist
  • Hiatus hernia (part of the stomach bulges through the diaphragm muscle into the lower chest)
  • Pregnancy

Symptoms

Heartburn and “acid indigestion” are the most common complaints. A burning pain is typical, and when it’s accompanied by burping or bloating, it points to GERD as the cause. But GERD can sometimes cause belly pain that mimics an ulcer. And if acid in the food pipe triggers esophageal spasms, it can cause a heavy or constricting pain that may feel like a heart attack.

Diagnosis

Most people with GERD don’t need any tests at all. If your symptoms are typical and mild, you may even be able to treat yourself. GERD can be puzzling, however, so if the diagnosis is uncertain, tests may be in order. The old standby is the barium swallow, or upper GI series. You’ll be asked to swallow a paste-like solution of barium while a technician takes x-rays to look for ulcers, strictures, a hiatus (also called hiatal) hernia, abnormal contractions of the esophagus, or reflux of barium from the stomach into the food pipe.

Esophageal monitoring is a better way to diagnose GERD. One type, pH monitoring, measures the level of acid in the lower esophagus over a 24-hour period, while manometry measures the pressure in the esophagus during swallowing.

Endoscopy is the best way to detect the complications of GERD, including inflammation, ulcers, strictures, and abnormal or malignant cells. After giving you sedatives and numbing your throat, your doctor will pass a fiber-optic tube through your mouth into your esophagus and stomach. Endoscopy allows the physician to inspect and photograph your tissues and to perform biopsies on any suspicious areas.

Therapy: Lifestyle

You can control many symptoms of GERD with simple lifestyle modifications. Here are some tips:

  • Don’t smoke.
  • Avoid foods that trigger GERD .
  • .Avoid large meals and try to be up and moving around for at least 30 minutes after eating.
  • Lose weight.
  • Avoid tight belts and waistbands.

Treatment: Medications

Here is a look at the five types of medication that can help:

Proton-pump inhibitors (PPIs). PPIs are the most effective medications for GERD. That’s because they are the best at shutting down the stomach’s acid production.

H2-receptor blockers. These popular drugs were the first to reduce the production of stomach acid. They are widely available OTC in low doses and by prescription in full doses.

Antacids. Antacids do not reduce the amount of acid produced by the stomach, but they do neutralize some of it. Many are available over the counter. They reduce acid faster than acid-suppressing medications but provide only temporary relief for mild heartburn.

Coating agent. Sucralfate (Carafate) is a prescription drug that protects the esophagus and stomach by forming a protective film on the surface. It is very safe, but long-term benefits are unclear.

Motility agent. Metoclopramide (Reglan), another prescription drug, promotes normal contractions of the esophagus and helps the stomach empty faster.

Treatment: Surgery

Lifestyle modifications and medications — particularly the PPIs — have produced such good results that surgery for GERD is recommended much less often than it used to be. But surgery has improved, too, and it can be very beneficial for patients with severe GERD who don’t respond fully to medical therapy and, perhaps, in young people who are leery of lifelong medication.

April 2008 update

Digestive Disease Health Report
Click to enlarge

The Sensitive Gut

1 in 4 people has frequent gastrointestinal (GI) problems that can severely disrupt a normal lifestyle. In The Sensitive Gut Report our doctors describe how to help prevent and treat common and not-so-common digestive problems ranging from heartburn to IBS. Read more

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