Dr. Tariq Jagnarine
Family Medicine, Endocrinology / Diabetes
Acid reflux happens when contents from our stomach move back up into the esophagus. This action is also called acid regurgitation or gastroesophageal reflux.
Having symptoms of acid reflux more than twice a week may indicate the presence of a condition known as gastroesophageal reflux disease (GERD).
RISK FACTORS FOR GERD
While there’s no one cause of GERD, there are lifestyle choices and certain health factors that can make a diagnosis more likely. These include:
• Living with obesity
• Being pregnant
• Living with a connective tissue disorder
• Smoking
• Frequently eating large meals
• Consistently lying down or going to sleep shortly after eating
• Eating a lot of certain types of foods, like deep-fried or tomato products
• Drinking certain types of beverages, like soda, coffee, or alcohol
• Using an abundance of nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen
While there’s no single cause of GERD, there is a mechanism in the body that — when not functioning properly — can increase the likelihood of it.
The lower esophageal sphincter (LES) is a circular band of muscle at the end of the esophagus. When it’s working correctly, it relaxes and opens when swallowing. Then it tightens and closes again afterward.
Acid reflux happens when this muscle doesn’t tighten or close properly. This allows digestive juices and other contents from the stomach to rise into the esophagus.
Other possible causes include:
• Hiatal hernia. This is when a part of the stomach moves above the diaphragm towards the chest area. If the diaphragm is compromised, it can increase the likelihood that the LES can’t do its job correctly.
• Frequently eating large meals. This can cause the distension of the upper part of the stomach. This distension sometimes means there isn’t enough pressure on the LES, and it doesn’t close properly.
• Lying down too soon after large meals. This can also create less pressure than the LES needs to function properly.
GERD SYMPTOMS
The main symptom of GERD is acid reflux. Acid reflux can cause an uncomfortable burning feeling in the chest, which can move up into the neck and throat. This feeling is often known as heartburn. Persons may develop a sour or bitter taste at the back of their mouths. It might also cause the regurgitation of food or liquid from the stomach into the mouth.
Some other symptoms of GERD include:
• Nausea
• Chest pain
• Pain when swallowing
• Difficulty swallowing
• Chronic cough
• Hoarse voice
• Bad breath
Alcohol and GERD
Alcohol consumption and GERD have been connected in many studies, and it seems that the more alcohol used, the higher the likelihood of developing GERD.
While the connection is not crystal clear — does alcohol affect the LES directly, or do people who drink a lot of alcohol also have other behaviors that can lead to GERD? — what is clear is that limiting alcohol intake, or stopping it completely, after a diagnosis, may provide some symptom relief.
Dietary triggers for GERD
Some people who’ve been diagnosed with GERD find that certain foods and beverages can trigger their symptoms. While triggers can be very personal, there are a few foods that are routinely cited as more triggering than others. They include:
• High-fat foods (like fried foods and fast foods)
• Citrus fruits and juices
• Tomatoes and tomato sauces
• Onions
• Mint
• Coffee
• Soda
DIAGNOSING GERD
A physical exam and symptoms experienced may help to determine if someone has GERD. Along with some tests such as:
Your doctor may then recommend you to a gastroenterologist or may conduct certain tests themselves, including:
• Ambulatory 24-hour pH probe. A small tube is sent through the nose into the esophagus. A pH sensor at the tip of the tube measures how much acid exposure the esophagus is getting, and sends the data to a portable computer. An individual wears this tube for about 24 hours. This method is generally considered the “gold standard” for diagnosing GERD.
• Esophogram.
• Upper endoscopy.
• Esophageal manometry.
• Esophageal pH monitoring.
After Diagnosis the best treatment option is decided.
In most cases, lifestyle changes and medications are enough to prevent and relieve symptoms of GERD. But sometimes, surgery is needed.
GERD TREATMENT
To manage and relieve symptoms of GERD, doctors might encourage persons to make certain lifestyle changes, like:
• Maintaining a moderate weight
• Quitting smoking
• Avoiding big, heavy meals in the evening
• Waiting a few hours after eating to lie down
• Elevating the head during sleep (by raising the head of a bed 6-8 inches)
• Medication
Antacids
Antacids like Tums, gastrivol, or Pepto-Bismol are typically used for occasional and mild symptoms of acid reflux and GERD.
H2 receptor blockers
H2 blockers like Pepcid AC work to lower the amount of acid the stomach makes. Many H2 blockers are available OTC, while higher doses of these medicines can also be prescribed.
Proton pump inhibitors (PPIs)
PPIs like Prilosec also lower the amount of acid the stomach makes. Because they tend to work better than H2 blockers, they’re more helpful when it comes to healing the esophageal lining — which can become damaged when someone is dealing with GERD for a while.
Potential complications of GERD
In most people, GERD doesn’t cause serious complications. But in rare cases, it can lead to serious or even life-threatening health problems.
Potential complications of GERD include:
• Esophagitis, an inflammation of the esophagus
• Esophageal stricture, which happens when the esophagus narrows or tightens
• Barrett’s esophagus, involving permanent changes to the lining of the esophagus
• Esophageal cancer, which affects a small portion of people with Barrett’s esophagus
• Tooth enamel erosion, gum disease, or other dental problems
To lower the chances of complications, it’s important to take steps to manage and treat the symptoms of GERD.
Treating these occasional occurrences with OTC antiacids and some lifestyle changes, like waiting a few hours to lie down after eating, can usually create relief. However, if persons are experiencing heartburn more than twice a week and small lifestyle changes don’t seem to be fixing anything, they may be dealing with GERD.
Don’t let persistent heartburn get in the way of everyday activities. Talk with a doctor early if experiencing symptoms of GERD. Eat cautiously for the season!
