House Calls / Dr. Michael Schwartz
Gastro-esophageal reflux disease describes a syndrome of various symptoms caused by acid indigestion. GERD is a common ailment affecting more than 60 million Americans and is responsible for health costs of more than $75 billion per year relating to diagnosis and treatment of the disease.
Most commonly, GERD symptoms include heartburn, a sour taste in the throat and difficulty swallowing foods. However, there are several atypical symptoms associated with the disorder. For example, a chronic cough is often caused by reflux disease. Furthermore, it is very common for patients to complain of a sore throat, chest pain, a change in voice quality and even shortness of breath due to acid reflux. In some severe cases, GERD can lead to diffuse esophageal spasm. DES causes the food pipe to "cramp" resulting in chest pains and a sensation of food getting stuck in the chest. These symptoms can sometimes be so severe that they are mistaken for symptoms of a heart attack.
The cause of GERD is a function of acid moving backwards from the stomach into the esophagus (food pipe). Located between the stomach and the food pipe is a valve named the lower esophageal sphincter. This valve (doorway) opens to allow food and fluid to pass from the esophagus into the stomach and then closes to prevent food and fluid from backing up in the wrong direction. In some patients, this valve does not shut properly resulting in reflux. The stomach, which contains both acids and bile juices, is well suited to tolerate these abrasive substances. However, when refluxed into the esophagus, the food pipe is not designed to tolerate these acids or bile resulting in adverse symptoms.
There are many triggers that increase the risk of reflux disease:
Large meals, especially immediately before bedtime
Certain drug classes including anti-inflammatories, osteoporosis medications, specific blood pressure medications, certain vitamins and supplements, antibiotics, sleeping pills and some anti-depressants.
Certain bacterial infections including H. Pylori can increase the risk of GERD symptoms and also lead to ulcer disease.
Patients with chronic reflux symptoms may need to undergo a procedure called an endoscopy. Endoscopy is a simple procedure performed by a gastroenterologist in order to visualize the food pipe and stomach. Since chronic reflux disease has been associated with a higher incidence of esophageal cancer, endoscopic screening is recommended to monitor for changes in the lining of the esophagus suggesting early cellular changes (Barrett's Esophagitis). Once determined to exist, these abnormalities can be treated to decrease the risk of developing cancer.
Treatments are very effective and may include the following:
Antacids (e.g., Tums, Rolaids) -- basically these medications are made of "alkaline" which counter the effects of acid. They work rapidly to relieve symptoms, but improvement lasts for a very short period and frequently reoccurs.
Histamine-2 Blockers (e.g., Zantac OTC, Pepcid AC) -- this class of medication blocks receptors in the stomach and lowers acid levels thereby alleviating symptoms. They do not work as quickly as antacids, but have a much longer effect.
Proton pump inhibitors (e.g., Nexium, Prevacid OTC) -- these medicines block almost 100 percent of the production of acid in the stomach. They are extremely effective at alleviating most symptoms of GERD.
Aloe Juice -- This natural herbal supplement has shown evidence of reducing symptoms by "soothing" the lining of the esophagus thereby reducing inflammation. Studies are ongoing to determine efficacy.
Elevate the head of your bed by placing 3 inch blocks under the bed frame. This will enable gravity to prevent acid from refluxing into the esophagus and improve symptoms.
Weight loss decreases abdominal pressure and reduces acid flow.
Avoid eating within 2 hours of bedtime.
Chewing sugar-free gum may increase saliva secretion and help reduce the acid in the food pipe.
Avoid tight-fitting clothing to reduce pressure on the stomach thereby reducing the risk of acid reflux
Licorice has been shown to decrease reflux in some patients.
In severe cases that are not responsive to medical therapy, a laparoscopic gastric fundoplication may be performed. This procedure helps to reinforce the lower esophageal valve reducing the risk of reflux and consequently improving a patient's symptoms. New techniques allow doctors to perform this procedure without making any incisions; instead the physician uses an endoscope to close the valve. Patients usually experience immediate relief.
Heartburn can significantly affect your quality of life. Chest pain, chronic coughs and eating difficulties can all be associated with GERD. If your symptoms last for more than a few days, visit your doctor for an evaluation. Don't let heartburn impair your quality of life -- extinguish the fire today.