Gastroesophageal reflux disease (GERD)

Physicians Health Network Health & Awareness Articles
nov2016_blog

Gastroesophageal reflux disease (GERD) is very common, affecting up to 1 in 5 or more of adult men and women in the U.S. and can also occur in children. While common, the disease is often unrecognized and its symptoms misunderstood, which is unfortunate because GERD is often a very treatable disease, but if it is not diagnosed and treated, serious complications can result.
GERD is a chronic digestive disease that occurs when stomach acid, or occasionally, stomach content flows back into your food pipe (esophagus). The backwash (reflux) from this condition irritates the lining of your esophagus and causes GERD. When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach and then it closes again. However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn.

Many people experience both acid reflux and heartburn from time-to-time, but heartburn is the most common symptom of gastroesophageal reflux disease (GERD), so talk to your doctor if:
• Your heartburn occurs two or more times a week.
• Your heartburn gets worse.
• Your heartburn happens at night and wakes you from sleep.
• You’ve had heartburn now and then for several years.
• You have difficulty or pain when swallowing.
• Your discomfort or pain interferes with your daily activities.

While chest pain may indicate acid reflux Vijay Khiani, MD, Gastroenterology, Columbia St. Mary’s, Sheboygan Outpatient Center that you seek prompt medical attention for this potential symptom. “People experiencing chest pain or discomfort should get an urgent medical evaluation to exclude a possible heart condition.”

In addition to chronic heartburn and acid reflux there are numerous less common symptoms that may also be associated with GERD.
• Frequent belching
• Difficulty or pain when swallowing
• Water brash (sudden excess of saliva)
• Dysphagia (the sensation of food sticking in the esophagus)
• Chronic sore throat
• Laryngitis
• Inflammation of the gums
• Erosion of the enamel of the teeth
• Chronic irritation in the throat
• Hoarseness in the morning
• A sour taste in your mouth

“GERD is often accompanied by the symptoms listed above, but sometimes there are no apparent symptoms, and is revealed only when complications become evident,” said Dr. Khiani.
A diagnosis of GERD should be made by a physician. “The disease can usually be diagnosed based on the presentation of symptoms alone, but when there are no apparent symptoms, tests may be needed to confirm or exclude a diagnosis or to look for complications such as inflammation, stricture, or Barrett’s esophagus,” said Dr. Khiani. Once the condition is diagnosed, your doctor will work with you on a treatment plan that may include lifestyle modifications, medications, surgery, or a combination of methods. Over-the-counter medications will only provide temporary symptom relief. “They do not prevent recurrence of symptoms or allow an injured esophagus to heal and should not be taken regularly as a substitute for prescription medicines – they may be hiding a more serious condition,” said Dr. Khiani.

To help reduce the frequency of heartburn you can incorporate these lifestyle modifications:
• Maintain a healthy weight. Excess weight puts pressure on your abdomen, pushing your stomach up and causing acid to back up into your esophagus. If you are overweight or obese, ask your doctor for help in devising a weight-loss strategy that is best for you.
• Avoid tight-fitting clothing. Clothes that fit too tight around your waist put pressure on your abdomen and the lower esophageal sphincter.
• Avoid foods and drinks that trigger heartburn. Everyone has specific triggers that can cause heartburn. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may worsen the discomfort.
• Eat smaller meals.
• Don’t lie down right after a meal. Wait at least three hours after you eat before lying down or going to bed.
• Elevate the head of your bed. If you regularly experience heartburn at night or while trying to sleep, put gravity to work for you. Raise the head end of your bed by 6 to 9 inches. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Elevating your head by using additional pillows is not effective.
• Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.

GERD is a recurrent and chronic disease for which long-term medical therapy is usually effective. It is important to recognize that chronic reflux does not resolve itself. There is not yet a cure for GERD; long-term and appropriate treatment is necessary.
Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications, but some may need stronger medications, or even surgery, to reduce symptoms. “Over time however, the inflammation can wear away the esophageal lining, causing complications such as bleeding, esophageal narrowing or Barrett’s esophagus (a precancerous condition), said Dr. Khiani.

Barrett’s Esophagus

In a small subset of patients diagnosed with GERD, a complication has been identified as a potentially pre-cancerous condition, called Barrett’s esophagus. “This condition occurs when a transformation takes place in the normal tissue lining of the esophagus and is a risk factor for the development of esophageal cancer,” said Dr. Khiani.
Most people with GERD have no such abnormality. In fact, approximately 10 percent of patients who have GERD will develop the condition and only about 0.5 percent per year of those individuals will develop esophageal cancer. “Not everyone with frequent or severe heartburn will develop Barrett’s esophagus; some people have heartburn and no esophageal damage, while other people have esophageal damage and no heartburn,” said Dr. Khiani.
Barrett’s esophagus can only be seen through an endoscope (a thin, flexible, device used to look inside the body) but always requires a biopsy to confirm the diagnosis.
Early detection and prevention of esophageal cancers caused because of GERD or Barrett’s esophagus are difficult. “Studies suggest that risk of esophageal cancer is amplified by factors that either increase reflux (e.g., tobacco, alcohol, high dietary fat, chocolate, caffeine, obesity, certain medications); or are genotoxic, which means capable of damaging DNA (e.g., a diet low in vegetables and fruits, tobacco use, dietary nitrosamines found in cured meat),” said Dr. Khiani.
In patients with Barrett’s esophagus, radiofrequency ablation is a method that is usually able to remove the abnormal tissue and can help decrease the risk in those more likely to progress to esophageal cancer,” said Dr. Khiani.”
The most important thing for you to understand if you suspect you may have GERD is that most people with this condition have a mild form of the disease that can be controlled through lifestyle changes and medication. “If you suspect you may have GERD, the first step is to consult your doctor to obtain an accurate diagnosis and to learn the best available treatment plan that is right for you,” said Dr. Khiani.

Resources
American Gastroenterological Association, https://www.gastro.org/
International Foundation for Functional Gastrointestinal Disorders (iffgd); http://www.aboutgerd.org
Gastroenterology Journal http://www.gastrojournal.org