GERD or Acid Reflux
Gastroesophageal reflux disease (GERD)
or acid reflux is a digestive condition where
the stomach’s acid backs up (or “refluxes”)
into and damages the esophagus.
Symptoms of GERD
The symptoms of GERD include:
- Frequent heartburn or pain in the chest and stomach, sometimes
- Bitter or sour taste in the mouth
- Difficulty swallowing
- Water brash or burst of saliva
- Sore throat
In many GERD patients, these symptoms are worse at night, when
they are lying down, and when they are bending over.
Left untreated, Gastroesophageal reflux disease can lead to Barrett’s
esophagus. Here, the lining of the esophagus become inflamed
and adopt a distinct pink color Barrett’s esophagus is a
pre-cancerous condition, and can lead to esophagus cancer.
How is GERD diagnosed?
Your doctor would look for the following signs of gasteresophageal
- Ulcer or damage to the lining of the esophagus
- Esophagitis or inflammation of the esophagus
- Stricture or narrowing of the esophagus
- Aspiration pneumonia or pneumonia caused
by stomach acid that drips down the lungs
Causes of GERD
In normal people, the lower esophageal sphincter (LES)
muscle, located at the base of the esophagus always tightens and
stays closed to keep the stomach content and acid. It only opens
to let swallowed food and drinks in.
In GERD patients, the LES often fails to remain shut. Stomach
acid seeps into the esophagus through the open LES. Over time,
the acid damages the lining of the esophagus, causing inflammation,
abnormal narrowing, and even ulcer.
Another cause of LES failure is hiatal hernia,
a condition where the stomach extends through the diaphragm and
prevents the LES from properly closing. Hiatal hernia is a very
common condition, affecting an estimated of 40% of people in the
United Sates. Fortunately, for most people, hiatal hernia does
not lead to gastroesophageal reflux disease.
Certain medications can promote reflux – these include:
- Calcium channel blockers
- Progesterone hormone
Other medicines can irritate the esophagus, and thus worsen GERD
symptoms – these include:
- Antibiotics, such as tetracycline and doxycycline
- Nonsteroidal anti-inflammatory painkiller drugs (NSAIDs)
- Potassium chloride
- Iron supplements
Prevention of GERD
Frequent gastroesophageal reflux disease sufferers can prevent
a recurring attack by:
- Avoiding certain foods and drinks that worsen GERD, including:
- Acidic, spicy and fatty foods
- Peppermint and spearmint
- Carbonated drinks
- Coffee and caffeinated drinks
- Alcoholic drinks
- Eating smaller portions, more frequently rather than eating
- Not eating 3 to 4 hours before bedtime.
- Raising the head of your bed at least 6 inches, thereby using
gravity to avoid stomach acid from seeping into the esophagus.
- Losing weight if you are obese, because obesity often prevents
the LES from properly closing.
- If you are taking NSAID as painkillers, consider other medications
that do not irritate the esophagus, such as acetaminophen. Be
sure to consult your physician before changing medications.
Treatment for GERD
Treatments for gasteroesophageal reflux disease include:
- Over-the-counter antacids (Maalox, Mylanta,
Rolaids, and Tums)
These medications neutralize acid and provide fast relief for
heartburn. However, they do not heal the damaged or inflamed
esophagus, and can only offer temporary protection from stomach
Note that antacids that cause magnesium can cause diarrhea,
whereas those that contain aluminum can cause constipation as
- Over-the-counter histamine receptor blockers
(Pepcid AC, Tagamet, and Zantac)
These medications block the H2 receptor that stimulate the secretion
of stomach acid, thereby causing less acid to be produced in
- Prescription medications
Prescription GERD drugs include:
- H2 receptor blockers
Usually the same active ingredients as the over-the-counter
version, but at higher doses.
- Proton pump inhibitors
These medicines turn off acid production in the stomach
and can be a very effective treatment for chronic heartburn.
- Prokinetic medicines
Some of these drugs strengthen the LES to keep acid from
seeping into the esophagus, whereas others speed up digestion,
thereby shortening the period of high acid content in the
- Mucosal protectors
These drugs protect and soothe the irritated lining of the
For severe cases of GERD, a surgical procedure called the
Nissen fundoplication can be performed.
Here, the fundus or top of the stomach
is wrapped around the esophagus, thereby creating a one-way
valve to prevent acid from refluxing.