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 at night
  • Vomiting
  • Belching
  • Bitter or sour taste in the mouth
  • Difficulty swallowing
  • Water brash or burst of saliva
  • Sore throat
  • Coughing
  • Wheezing

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 reflux disease:

  • 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
  • Bronchitis

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:

  • Nitrates
  • Calcium channel blockers
  • Antidepressants
  • Anticholinergics
  • 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)
  • Quinidine
  • 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
    • Onion
    • Peppermint and spearmint
    • Carbonated drinks
    • Coffee and caffeinated drinks
    • Alcoholic drinks

  • Eating smaller portions, more frequently rather than eating large meals.

  • 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 acid.

    Note that antacids that cause magnesium can cause diarrhea, whereas those that contain aluminum can cause constipation as side-effects.

  • 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 the stomach.

  • 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 stomach.

    • Mucosal protectors
      These drugs protect and soothe the irritated lining of the esophagus.

    • Surgery
      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.

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