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Gastroesophageal Reflux Disease: GERD

1. What is GERD and its complications?

The esophagus is the tube that carries food from the throat to the stomach. The stomach makes acid to help digest the food. Sometimes, the acid can back up into the esophagus. This can cause symptoms and complications such as heartburn or even a sour taste in your mouth. When it happens often and over a long period of time, it is called GERD.

The complications may be an inflammation of the esophagus (esophagitis), a narrowing of the esophagus (stricture), ulceration of the esophagus, and Barretts Esophagus (pre-cancerous changes). The lining of the stomach is not the same as the food tube, and therefore, the esophagus can not tolerate the reflux of stomach acid.

Other complications can mimic or masquerade as heartburn or GERD. Chest pain resembling a heart attack, asthma, sore throat, hoarseness, bronchitis, or wheezing can all be signs of acid reflux into the esophagus and onto the vocal cords or into the lungs.

More than 60 million Americans experience heartburn at least once a month. Heartburn, or acid reflux, is defined as a rising burning sensation behind the breast bone. Frequent acid reflux symptoms that disrupts one's lifestyle suggests the diagnosis of GERD. Heartburn and GERD represent a spectrum.

An estimated 25 percent to 35 percent of the population will suffer from GERD in their lifetime. GERD is a disease and heartburn is its most common symptom.

2. What factors contribute to GERD or make symptoms worse?

The consumption of alcohol, being overweight, pregnancy and smoking can all contribute to GERD. There are also certain foods that can be associated with reflux events including citrus fruits, chocolate, caffeine, spicy foods, mint flavoring, fried foods and tomato-based foods like spaghetti sauce, chili and pizza. The other factors that contribute to GERD are tight clothing and eating before going to bed.

Some medications can also aggravate symptoms in people who have GERD, those include: NSAID's, or Aleve, Motrin, Advil, etc.; calcium channel blockers such as Nifedepine and Diltiazem; anticholinergics to treat urinary tract disease, allergies and glaucoma; Beta Adrenergic agonists for asthma; dopamine for Parkinson's disease and bisphosphonates used to treat osteoporosis. Some antibiotics, potassium and iron pills can aggravate GERD symptoms as well.

3: What is the difference between GERD and Hiatal Hernia?

Hiatal hernia refers to the dislocation of the stomach through the hiatus (opening) of the diaphragm and into the chest. This is a common condition that increases in frequency with age. It may or may not be associated with GERD. When GERD is severe enough to be complicated by erosive esophigitis seen as breaks in the lining in the esophagus, a hiatus hernia is usually present. However, most people with hiatus hernia do not have GERD.

4. My doctor told me I have GERD. What should I do now?

The following is recommended: Avoid food and beverages that worsen your symptoms. Lose weight if necessary. Eat small and frequent meals. Wear loose fitting clothing. If you smoke, try to stop. Avoid laying down for three hours after a meal. Raise the head of the bed by 6-to-8 inches by securing wood blocks under the bed posts. Just using extra pillows will not help.

For mild symptoms, you can take an antacid such as Alka Seltzer, Maalox, or Rolaids. There are also foaming agents such as Gaviscon, which works by covering your stomach contents with foam to prevent reflux.

H2 Blockers such as cimetidine (Tagamet), famotidine (Pepcid), etc., will decrease acid production, provide long-term relief and are effective for about half of those who have GERD symptoms.

There are proton pump inhibitors such as omeprazole (Prilosec), pantoprazole (Protonix) and esomeprazole (Nexium). The proton pump inhibitors are more effective than H2 blockers and require a prescription from your physician. Also refer to our Q&A: Medications for Acid Reflux.

There are prokinetics, which help strengthen the lower esophageal sphincter and make the stomach empty faster. These include bethanechol (urecholine) and metoclopramide (Reglan). Reglan also improves muscle action in the digestive track. Prokinetics have frequent side effects that limit their usefulness. Side effects from the prokinetics include fatigue, sleepiness, depression, anxiety and problems with physical movement. A combination of medications may help control symptoms as well.

There is also a surgical procedure called fundoplication. This involves wrapping the upper part of the stomach around the lower part of the esophagus to decrease acid reflux into the esophagus.

Endoscopic techniques are those procedures that require the utilization of an endoscope to perform anti-reflux operations such as placing stitches in the lower esophageal sphincter to create pleats that help strengthen the muscle or electrodes that create tiny burns on the lower esophageal sphincter. When the burns heal, the scar tissue helps to tighten the muscle; however, the long term effects of these endoscopic techniques are unknown.

5. I have a chronic cough. Could it be because of GERD?

There are many causes of chronic cough besides lung or heart disease. GERD can also cause a chronic cough. The mechanisms of reflux associated to chronic cough include: aspiration (stomach contents going into the lung), laryngeal injury and vagally mediated reflex.

If other causes of chronic cough have been eliminated, one could try a proton pump inhibitor (Protonix, Nexium, Prilosec, etc.) as a trial to see if the cough will resolve. This is an effective diagnostic strategy for GERD associated cough. If the chronic cough is because of GERD, the cough will be eliminated by taking the proton pump inhibitor.

In GERD-associated asthma, there is evidence of neurogenic inflammation. Medical or surgical therapy of GERD results in asthma symptom improvement in about 70 percent of patients.

Source: THe Sun, 05/05/2010

 

By Mortin - Copyright 2010
Last modification 19/05/2010