Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that occurs when stomach acid or, occasionally, stomach content, flows back into the esophagus. GERD is the most common gastrointestinal-related diagnosis made by physicians during clinical visits in the United States. It is estimated that up to 20% of the population in the United States suffers from GERD.

Causes of GERD

GERD is caused by a malfunction of the lower esophageal sphincter (LES). The LES is a muscle at the bottom of the esophagus that acts as a valve between the esophagus and the stomach. Normally, the LES opens to allow food to pass into the stomach and then closes to prevent the contents of the stomach from flowing back into the esophagus. In people with GERD, the LES does not close properly, allowing stomach acid and other contents to flow back into the esophagus.

Risk Factors for GERD

There are several factors that can increase the risk of developing GERD. These include obesity, pregnancy, smoking, certain medications, and certain foods. People with hiatal hernias, a condition in which part of the stomach protrudes through the diaphragm, are also at an increased risk of developing GERD.

Diagnosis of GERD

GERD is typically diagnosed based on the patient's symptoms. A doctor may also order tests such as an endoscopy or a barium swallow to confirm the diagnosis. In some cases, a doctor may also order a pH test to measure the acidity of the esophagus.

Complications of GERD

If left untreated, GERD can lead to serious complications such as esophagitis, Barrett's esophagus, and even esophageal cancer. Esophagitis is an inflammation of the esophagus that can cause pain and difficulty swallowing. Barrett's esophagus is a condition in which the lining of the esophagus is replaced by tissue similar to that found in the intestine. Esophageal cancer is a rare but serious complication of GERD.

Common Symptoms of GERD

• Heartburn: A burning sensation in the chest or throat that is caused by stomach acid flowing up into the esophagus.
• Regurgitation: The feeling of acid or food coming back up into the throat or mouth.
• Chest Pain: Pain in the chest that may be caused by the stomach acid irritating the esophagus.
• Difficulty Swallowing: A feeling of food sticking in the throat or chest.
• Hoarseness: A change in the voice caused by stomach acid irritating the vocal cords.
• Coughing: A dry cough that may be caused by stomach acid irritating the throat.
• Sore Throat: A sore throat that may be caused by stomach acid irritating the throat.
• Bad Breath: A foul odor in the breath that may be caused by stomach acid irritating the throat.

Less Common Symptoms of GERD

• Nausea: A feeling of sickness in the stomach.
• Vomiting: The act of throwing up.
• Appetite Loss: A decrease in appetite.
• Weight Loss: A decrease in body weight.
• Bleeding: Blood in the stool or vomit.
• Dysphagia: Difficulty swallowing.
• Esophagitis: Inflammation of the esophagus.
• Esophageal Stricture: Narrowing of the esophagus.
• Barrett's Esophagus: A condition in which the cells of the esophagus become abnormal.

When to See a Doctor

If you experience any of the symptoms of GERD, it is important to see your doctor. Your doctor can diagnose GERD and recommend treatment options. Treatment may include lifestyle changes, medications, or surgery.

Risk Factors

There are several risk factors that can increase the likelihood of developing GERD. These include:

• Being overweight or obese
• Smoking
• Eating large meals
• Eating certain foods, such as fatty or fried foods, garlic, onions, chocolate, peppermint, and spicy foods
• Drinking certain beverages, such as alcohol, carbonated drinks, and coffee
• Pregnancy
• Certain medications, such as aspirin, ibuprofen, and muscle relaxants
• Hiatal hernia

Lifestyle Changes

Making lifestyle changes can help reduce the risk of developing GERD. These include:

• Maintaining a healthy weight
• Quitting smoking
• Eating smaller meals
• Avoiding certain foods and beverages
• Elevating the head of the bed
• Avoiding lying down after eating
• Avoiding tight-fitting clothing

By understanding the risk factors and making lifestyle changes, it is possible to reduce the risk of developing GERD. However, if symptoms persist, it is important to speak to a doctor for further evaluation and treatment.

Diagnostic Tests for GERD

To diagnose GERD, your doctor may recommend one or more of the following tests:

• Upper Endoscopy: This test involves inserting a thin, flexible tube with a light and camera at the end (endoscope) down your throat to examine the inside of your esophagus and stomach.
• Esophageal Manometry: This test measures the pressure and muscle contractions in your esophagus to determine if the muscles are working properly.
• pH Monitoring: This test measures the amount of acid in your esophagus to determine if you have GERD.
• Biopsy: This test involves taking a small sample of tissue from your esophagus to check for signs of damage or infection.

Treatment for GERD

Treatment for GERD depends on the severity of your symptoms. Your doctor may recommend lifestyle changes, such as avoiding certain foods and drinks, quitting smoking, and losing weight. Medications, such as antacids, proton pump inhibitors, and H2 blockers, may also be prescribed to reduce stomach acid production and relieve symptoms.

Questions to Ask Your Doctor About GERD

• What is causing my GERD symptoms?
• What lifestyle changes can I make to reduce my symptoms?
• What medications can I take to reduce my symptoms?
• Are there any tests I should have to confirm my diagnosis?
• What are the potential complications of GERD?
• What is the long-term outlook for my condition?

It is important to be honest and open with your doctor about your symptoms and any lifestyle changes you have made to try to reduce them. Your doctor can help you develop a treatment plan that is tailored to your individual needs.

Lifestyle Changes

Making lifestyle changes can help reduce the frequency and severity of GERD symptoms. These changes include avoiding foods and drinks that trigger GERD symptoms, such as fatty or fried foods, citrus fruits, chocolate, caffeine, and alcohol. Eating smaller meals more frequently and avoiding lying down after eating can also help. Quitting smoking and losing weight can also help reduce GERD symptoms.

Medications

Over-the-counter medications, such as antacids, can help neutralize stomach acid and provide temporary relief from GERD symptoms. Prescription medications, such as proton pump inhibitors (PPIs) and H2 blockers, can also help reduce the amount of acid produced by the stomach and provide relief from GERD symptoms. In some cases, a combination of lifestyle changes and medications may be necessary to control GERD symptoms.

Surgery

In some cases, surgery may be necessary to treat GERD. Surgery can help strengthen the LES and prevent stomach acid from flowing back into the esophagus. Surgery is usually only recommended for people who have not responded to lifestyle changes and medications.

Treatment for GERD usually involves lifestyle changes, such as avoiding certain foods and beverages, and medications. Common medications used to treat GERD include antacids, H2 blockers, and proton pump inhibitors (PPIs).

Antacids

Antacids are medications that neutralize stomach acid. They are available over-the-counter (OTC) and are taken by mouth to quickly relieve occasional heartburn, the major symptom of GERD. Common antacids include calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), and aluminum hydroxide (Gaviscon).

H2 Blockers

H2 blockers, also known as histamine-2 receptor antagonists, are medications that reduce the amount of acid produced by the stomach. They are available OTC and by prescription. Common H2 blockers include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac).

Proton Pump Inhibitors (PPIs)

PPIs are medications that reduce the amount of acid produced by the stomach. They are available by prescription and are taken once or twice daily. Common PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

If lifestyle changes and medications do not relieve symptoms of GERD, surgery may be an option. Surgery for GERD is called fundoplication and involves wrapping the top of the stomach around the lower esophageal sphincter to strengthen it and prevent acid reflux.

Avoid Trigger Foods

Certain foods can trigger GERD symptoms, so it’s important to identify and avoid them. Common trigger foods include spicy foods, fatty foods, fried foods, citrus fruits, tomatoes, garlic, onions, carbonated beverages, and caffeine. It’s also important to avoid overeating, as this can put pressure on the lower esophageal sphincter and cause acid reflux.

Eat Smaller Meals

Eating smaller meals more frequently can help reduce the symptoms of GERD. Eating smaller meals can help reduce the amount of stomach acid produced, and it can also help reduce the pressure on the lower esophageal sphincter. Aim to eat five to six small meals throughout the day, rather than three large meals.

Choose Low-Acid Foods

Choosing low-acid foods can help reduce the symptoms of GERD. Low-acid foods include bananas, melons, oatmeal, grains, beans, lentils, and lean proteins such as chicken and fish. It’s also important to avoid foods that are high in fat, as these can increase the amount of stomach acid produced.

Eat Slowly and Chew Thoroughly

Eating slowly and chewing thoroughly can help reduce the symptoms of GERD. Eating slowly gives the stomach time to digest food properly, and chewing thoroughly helps break down food into smaller pieces, which can help reduce the amount of stomach acid produced. It’s also important to avoid drinking while eating, as this can cause the stomach to produce more acid.

Stay Hydrated

Staying hydrated can help reduce the symptoms of GERD. Drinking plenty of water throughout the day can help keep the stomach acid levels in check, and it can also help reduce the pressure on the lower esophageal sphincter. Aim to drink at least eight glasses of water per day.

Conclusion

Making dietary changes can help reduce the symptoms of GERD. Avoiding trigger foods, eating smaller meals, choosing low-acid foods, eating slowly and chewing thoroughly, and staying hydrated can all help reduce the severity of the condition. If you have GERD, it’s important to talk to your doctor about the best diet for you.

Eat Smaller Meals

Eating smaller meals more frequently can help reduce the amount of acid your stomach produces. Eating large meals can put extra pressure on the LES, making it easier for stomach acid to flow back up into the esophagus. Eating smaller meals can also help you maintain a healthy weight, which can reduce the risk of GERD.

Avoid Trigger Foods

Certain foods can trigger GERD symptoms, such as spicy foods, fatty foods, citrus fruits, tomatoes, garlic, onions, and carbonated beverages. Keeping a food diary can help you identify which foods trigger your symptoms so you can avoid them. You may also want to try eliminating certain foods from your diet for a few weeks to see if your symptoms improve.

Quit Smoking

Smoking can weaken the LES and increase the risk of GERD. Quitting smoking can help reduce your risk of GERD and other health problems. Talk to your doctor about ways to quit smoking, such as nicotine replacement therapy or medications.

Avoid Tight Clothing

Tight clothing, such as belts and waistbands, can put extra pressure on the LES, making it easier for stomach acid to flow back up into the esophagus. Wearing loose-fitting clothing can help reduce the risk of GERD.

Elevate Your Head

Elevating your head while sleeping can help reduce the risk of GERD. Place blocks or books under the legs of your bed to raise the head of the bed 6 to 8 inches. This can help keep stomach acid in the stomach and out of the esophagus.

Avoid Late-Night Snacking

Eating late at night can increase the risk of GERD. Eating close to bedtime can put extra pressure on the LES, making it easier for stomach acid to flow back up into the esophagus. Try to avoid eating at least two hours before bedtime.