Reflux Disease
Heartburn and Gastroesophageal Reflux Disease
Introduction to GERD
Gastroesophageal Reflux Disease
is more than just occasional heartburn. Although heartburn is the most common symptom, GERD is a condition in which stomach juices flow back into your food pipe (esophagus). The constant backwash or acid reflux can irritate the lining of your esophagus and cause inflammation. Such irritation can lead to complications such as narrowing of the esophagus, ulcers and even a slightly increased risk of esophageal cancer. Often, people can manage the discomfort of heartburn with lifestyle modifications and over - the - counter medications. For many others, these remedies may offer only temporary or partial relief. If you have GERD, you may need newer, more potent medications, possibly even surgery, to control symptoms and avoid complications.
Signs and Symptoms
Common signs and Symptoms of GERD include:
Heartburn
Burning sensation in your chest, sometimes going all the way to the throat, along with a sour taste in your mouth.
Chest Pain
especially at night while lying down or after large meals.
Difficulty Swallowing
(dysphagia)
Coughing, Wheezing, Asthma, Hoarseness or Sore Throat
Regurgitation
of food or sour liquid
Some factors that can worsen GERD symptoms include:
Large Meals
Lying Down
within 1-2 hours after eating
Fatty foods, spicy foods, chocolate, caffeine, onions, tomato sauce, carbonated beverages and mint
Alcohol
Cigarette Smoking
Certain Medications
including sedatives, tranquilizers and calcium channel blockers for high blood pressure
Risk Factors
Conditions that can increase the risk of GERD include:
Obesity
Pregnancy
Hiatal Hernia
When to seek medical advice
Most of the time heartburn is short-term and mild. Talk to your doctor if you have:
Heartburn several times a week
Heartburn that returns soon after your medication wears off
Heartburn that wakes you up at night
Difficulty Swallowing
Screening and Diagnosis
Usually a description of your symptoms and good response to medications will be all your doctor needs to establish the diagnosis of GERD. However, if your symptoms are particularly severe or don't respond to treatment, you may need to undergo other tests to check for GERD and other conditions:
Barium Swallow X-ray.
This test is mainly to look for and evaluate a hiatal hernia. It may also show a narrowing of the esophagus due to chronic scarring.
Endoscopy
This is a more direct test to evaluate the lining of your stomach and esophagus. A long flexible scope with a camera and light on the end can be inserted into your esophagus and stomach to inspect them directly, looking for damage. This is usually done in a hospital or endoscopy center and sedation is used to make the procedure more comfortable.
Ambulatory Acid (pH) Probe Tests.
This test is usually reserved for those in whom the diagnosis of GERD is still in question after the previous tests. A thin, flexible tube is positioned through the nose into the esophagus and will measure pH in the esophagus for 24 hours. The results are recorded on a small computer worn on your belt.
Esophageal Pressure Testing
People who are considering surgery for their reflux will usually need a test to evaluate the ability of their esophagus to contract normally. This is important to prevent swallowing difficulties after a reflux operation.
GERD Complications
Chronic reflux of stomach acid into your esophagus can lead to one or more of the following conditions if left untreated:
Esophageal Narrowing (stricture).
This is caused by scarring induced by acid damage to the
lining of the esophagus over a long period. It frequently leads to significant problems with swallowing.
Esophageal Ulcer.
Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
Barrett's Esophagus.
This is a serious, complication of GERD. In Barrett's Esophagus, the cells of the esophagus undergo changes in an effort to try to protect themselves from the acid. This condition is a serious risk factor in the development of esophageal cancer and requires long term monitoring. Some researchers feel that surgery for reflux may help cure Barrett's esophagus.
Treatment Options
Over - the - counter remedies. Mild GERD can often be effectively treated with over-the-counter (OTC) remedies such as:
Antacids
Antacids, such as Maalox, Mylanta, Rolaids and Tums, neutralize stomach acid and can provide quick relief. 
Drawbacks to these medications include: short term relief, inability to heal ulcers, side effects to chronic use such as diarrhea.
H-2-Receptor Blockers
Over - the - counter H-2-receptor blockers, such as Pepcid, Zantac, Tagamet are significantly better at controlling acid, and are adequate for many sufferers. You should consult with your physician if you need to use these medications regularly.
Proton Pump Inhibitors.
There are several of these type of medication currently available. Prilosec is the only one currently available over the counter. If you require these drugs to control your symptoms you should definitely see your physician to be screened for complications of GERD
Prescription - strength medications:
Prescription - Strength H-2-Receptor Blockers
These significantly reduce acid production and have few side effects. They include prescription - strength Axid, Pepcid, Tagamet and Zantac.
Prescription - Strength Proton Pump Inhibitors.
There are many of these drugs available and they are the most effective for the long term treatment of GERD. They are very successful in healing inflammation and ulcers of GERD.
Surgery
Most people don't require surgery for GERD. Those whose symptoms are not controlled by medications or suffer complications from GERD are candidates for surgery. Also, those who cannot afford lifelong medicines or who are young and do not want to take the medications for the rest of their lives can consider anti - reflux surgery. Most of the time GERD surgery can be done with several small poke holes in the abdominal wall. Rarely, a large incision in the middle of the abdomen is necessary. Most patients spend one night in the hospital following the operation. Possible side effects of the operation are difficulty swallowing, bloating, diarrhea and difficulty belching. Most of these will resolve spontaneously within a few months or can be managed with outpatient treatments. Research has shown that a very large majority of patients will have excellent and durable results with anti - reflux surgery.
Do it yourself
You may eliminate or reduce the frequency of heartburn by making the following lifestyle changes:
Control Your Weight
Not only will losing weight improve GERD symptoms, but will generally help with many common medical problems.
Eat Smaller Meals
This also helps with #1!
Eliminate Exacerbating Foods.
Common things such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.
Avoid Stooping or Bending.
Use common sense here. After all, we all have to tie our shoes!
Don't Lie Down After a Meal.
Wait at least two to three hours after eating before going to bed, and don't lie down right after eating.
Raise the head of your bed.
Blocks under the bed legs or a commercially available wedge can be very helpful
Don't smoke.
This is a no brainer. By now we all know how bad smoking is for a whole host of ailments.