Gastroesophageal Reflux Disease
By Alan S. Peterson, M.D.
What is gastroesophageal reflux disease?
Gastroesophageal reflux disease, or GERD, is a common digestive problem. Acid from the stomach flows backward and upward into the esophagus (food tube from the throat to the stomach).
The lining from the stomach is designed to handle the strong acids that break down food. However, the lining of the esophagus gets irritated when strong acid touches it. A muscle in the esophagus usually keeps stomach acid from flowing back into the esophagus. If you have GERD, this muscle does not close to the correct amount, and acid from your stomach gets into your esophagus and irritates its lining.
What are the symptoms of GERD?
The most common symptoms are heartburn and regurgitation. Heartburn is a burning feeling in your chest. This burning feeling may move up toward your throat. If you have regurgitation, stomach contents mixed with acid back up into your esophagus and cause a bad taste or even come back in your mouth.
Less common symptoms of GERD include too much saliva in your mouth and a feeling that you always have a lump in the back of your throat. Some people with GERD have an ongoing cough, a sore throat, or a hoarse voice. This can be mistaken for other diagnoses as many don’t realize they have GERD.
How is GERD diagnosed?
Most likely, your doctor will be able to tell you that you have GERD based on your answers to some questions and the results of your physical exam. You may need to have some tests if medicine does not make you feel better or if you have other symptoms (such as chest pain or choking). Sometimes these tests need to be done especially if heart disease or angina needs to be ruled out.
How is GERD treated?
Life-style changes may help some symptoms of GERD. Here are some of the things that you can try:
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Avoid foods that may make your symptoms worse, such as acidic foods like citrus and tomato-based products, alcohol, chocolate, caffeinated drinks, fatty foods, garlic, onions, and peppermint.
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Avoid large meals and do not eat anything for three to four hours before you go to bed.
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Lose weight, if you need to.
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Raise the head of your bed by four to eight inches. Pillows in the bed usually don’t work. You need to actually put something under the bed, at the head end, to raise it four to eight inches.
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If you smoke, stop.
Over-the-counter antacids are sometimes helpful in treating GERD. In addition, your doctor may prescribe a medicine that will help lower the amount of acid in your stomach. Surgery helps some people who do not get better with medicine and life-style changes.
How long does GERD last?
The right treatment usually relieves the symptoms of GERD within a few days. However, many people have GERD for a long time. It is common for people to get GERD again, perhaps life long.
Many gastroenterologists, who specialize in GERD treatment, suggest that anyone, who has symptoms of GERD for five or more years, should have upper endoscopy. This requires a tube to be placed into the esophagus for painless biopsies to be done to rule out Barrett’s esophagus or other abnormalities. This is a pre-malignant area in the esophagus. If this is found, this can be monitored carefully to make sure cancer does not develop. Those who have Barrett’s esophagus will need to take a prescription strength acid medicine for the rest of their lives to prevent changes that the acid causes that might lead to cancer.
When should I call my doctor?
You should call your doctor is you have heartburn or regurgitation plus any of the following “alarm” symptoms:
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Blood in your stools
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Chest pain
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Choking
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Early fullness after a meal
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Pain or difficulty when swallowing
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Unexplained weight loss
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Vomiting
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GERD symptoms lasting for five or more years
Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.