GERD is a recurrent condition where gastric
juices, containing acid, travel back from the stomach into the gullet (the
swallowing pipe called the esophagus).
The food in the stomach is partially
digested by stomach acid and enzymes (special chemicals that act on food to
break it down to simpler material that the body can use). Normally, the
partially digested acidic content in the stomach is delivered by the stomach
muscle into the small intestine for further digestion. In patients with GERD,
stomach acid content regularly refluxes backwards into the esophagus, causing
inflammation and damage.
How do you get GERD?
Doctors know that in western countries, 40% of adults suffer from heartburn,
the main symptom of GERD. About 50 % of patients with GERD also have
esophagitis or inflammation of the esophagus.
In most people, GERD is caused by the
digestive juices in the stomach, repeatedly moving upwards into the lower
esophagus (called acid reflux). The condition may be due to an abnormal
mechanical working of the esophagus (where it enters the stomach) since it can
normally squeeze itself together to act as a shut-off valve, or tap, to keep
stomach contents out.
It can occur in some people when the stomach
does not empty quickly enough and becomes overfilled with digestion contents.
GERD can also occur in people with a condition called a hiatal hernia (see
How serious is GERD?
In some patients, the damage to the esophagus can be seen during an endoscopic
examination. This involves a doctor feeding a tube with a special camera down
the patient's throat into the esophagus. However, even when damage cannot be
seen, patients can experience severe symptoms.
Heartburn is the most common symptom of
GERD, which is a burning feeling rising from the stomach or lower chest up
towards the neck. Other symptoms include regurgitation (food may come up into
the mouth), chest pain, a difficulty in swallowing (a condition called dysphagia),
hoarseness and asthma. If untreated, severe heartburn can reduce quality of
life for sufferers. In severe cases of oesophagitis, the lining of the
oesophagus may become ulcerated, leading to pain and possible narrowing due to
scarring (making the swallowing of food and sometimes even liquids difficult).
In people with esophagitis, there may be an
increased risk of cancer of the esophagus. Stomach acid also plays a
significant role in the development of peptic ulcers that can result in serious
complications like bleeding and perforation of the stomach wall.
How long does GERD last?
The symptoms of GERD are frequent and may last several weeks, months or longer
if left untreated. They can also re-occur after treatment.
How is GERD treated?
Medications commonly used in the treatment of GERD include:
- Acid suppressants, such as histamine H2-antagonists (blockers).
Histamine is a chemical released in the body under many different
conditions. In the stomach it can release more acid, so blocking histamine’s
action reduces acid production.
- Proton-pump inhibitors also work on the cells in the stomach wall,
which make acid, to reduce the amount of acid produced and released into
the stomach chamber.
- Other medicines (called pro-kinetic agents) increase the movement
of the stomach. They work by increasing the pressure of the lower
esophageal sphincter (the point where the esophagus joins the stomach) and
promote emptying of the stomach.
- Antacids are medicines that are commonly used to treat acid-related
symptoms, like heartburn or indigestion, and work by neutralising acid in
the stomach. However, they are not usually recommended to treat the
frequent heartburn suffered by people with GERD.
Living with GERD/Acid reflux
If you have symptoms of GERD you should consult your
doctor, who can confirm the diagnosis and provide you with a treatment plan.
Avoiding factors, which make acid reflux worse may help reduce the symptoms of
GERD but is not an alternative to treatment.
- You may find it useful to keep a diary of your symptoms and the
food you eat, so that you can see which foods affect you.
- Avoid eating too close to bedtime. Try to leave at least two to
three hours after a meal, before you go to bed.
- Avoid lying down after meals.
- Eat small regular meals.
- Do not wear tight clothing, which may increase the pressure on you
- Raising the head of your bed by four to six inches may help reduce
nighttime acid reflux.
A hiatal hernia is caused by a weakness or stretching of the hiatus (an opening
for the esophagus) located in the diaphragm (the broad, thin muscle separating
the chest cavity and abdominal cavity). When this opening becomes weakened,
gastric (stomach) acid flows backward from the stomach into the esophagus,
irritating the esophagus. The stomach may even protrude into the lower chest.
Frequent signs and symptoms:
The following symptoms usually develop within 1 hour or more after eating:
- “Heartburn” (a burning sensation in the area of the
heart and behind the breastbone). May be confused with heart attack
- Swallowing difficulty (rare)
Risk increases with:
- Congenital weakness in the muscular ring of the diaphragm through
which the esophagus passes and empties into the stomach.
- Abdominal injury, causing tremendous pressure that tears a hole in
some part of the diaphragm.
- Chronic constipation and straining during bowel movements.
- Constant straining or lifting with tightening of the abdominal
- Age over 50.
- No specific preventative measures.
Symptoms can usually be controlled. If symptoms cannot be controlled and it
appears that irritation of the esophagus is causing scarring and ulceration,
the condition can be corrected with surgery.
- Bleeding from the esophagus. This can be excessive, leading to
- Misdiagnosis as a heart attack.
For diagnosis, an esogastroscopy (passage of a viewing tube down the throat
into the esophagus) may be performed. If cancer is suspected, a small amount of
tissue may be removed for a biopsy. Manometry (pressure measurement) may be
performed to confirm the reduced pressure at the esophagogastric junction.
The primary goals of treatment are to
relieve symptoms and to manage and prevent complications. Medical therapy is
used first with surgery to close the weakness in the diaphragm being reserved
for severe cases. You can also help control your symptoms:
- Raise the head of your bed 4 to 6 inches. This allows gravity to
keep stomach acid away from the hernia.
- Don’t smoke
- Don’t wear tight pantyhose, girdles, belts or pants.
- Don’t strain during bowel movements, urination or lifting.
- Don’t bend over or lie down immediately after a meal.
- Avoid large meals. Eat 4 or 5 small meals a day instead.
Don’t eat anything for at least 2 hours before bedtime.
- Lose weight, if you are overweight. Frequently symptoms may disappear
below a specific weight.
- Avoid alcoholic beverages, caffeine-containing beverages (coffee,
tea, cocoa, cola drinks) and any other food, juice, or spice that
- Eat slowly.
Antacids are most effective for some persons when they take them 1 hour before
meals and at bedtime, however, others find them more helpful 1 to 2 hours after
meals and at bedtime. Try both ways to find the best schedule for you. You may
also be prescibed stool softeners and/or drugs which hasten gastric (stomach)
Notify our office If:
- You or a family member has symptoms of a hiatal hernia, especially
the sensation that food stops beneath the breastbone. Call immediately if
pain is accompanied by shortness of breath, sweating, or nausea.
- You vomit blood or have recurrent vomiting.
- Temperature rises over 100 degrees Fahrenheit.
- Symptoms don’t improve in 1 month with treatment.
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