Kevin Lutz, MD, FACP
Mar 1 2019

GERD, also known as acid reflux, is a digestive issue that occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus.

Digestive System

GERD, also known as acid reflux is a digestive issue that occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The esophagus carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat, referred to as heartburn. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

What are the causes and risk factors of GERD?

There are numerous reasons that GERD occurs. A small number of people with GERD produce abnormally large amounts of acid, but this is uncommon and not a contributing factor in the vast majority of people. The most common factors that contribute to GERD are lower esophageal sphincter abnormalities, hiatal hernias, abnormal esophageal contractions, and slow or prolonged emptying of the stomach. Risk factors that may contribute to GERD include alcohol use, being overweight, pregnancy and smoking. Certain foods can be associated with acid reflux include citrus fruits, chocolate, drinks with caffeine, fatty and fried foods, spicy foods and tomato-based foods.

What are the symptoms of GERD?

Common symptoms include a burning sensation in your chest and upper abdomen which usually occurs after eating and can be worse at night. Irritation caused by refluxed stomach acid into your throat can lead to hoarseness or laryngitis, particularly in the morning. GERD can also cause difficulty swallowing, regurgitation of food, a dry cough, bad breath and feeling like there is a lump in your throat or food stuck in your throat

What are the complications of GERD?

If left uncontrolled, chronic GERD, can result in serious problems including esophagitis, Barrett’s esophagus and esophageal cancer. Esophagitis is when the esophagus is inflamed and swollen. Barrett's esophagus is a condition in which the esophagus changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine. People with Barrett's esophagus are at a much higher risk to develop esophageal cancer compared to those who don't have it.

How is GERD treated?

Lifestyle changes are the initial step in calming and relieving the symptoms of GERD. This includes achieving and maintaining a healthy weight, eating small and frequent meals as large meals may increase stomach pressure and, therefore, reflux. Maintain an upright posture while eating and for 45-60 minutes afterward. Avoid bending over or reaching below your waist after meals to do things like load the dishwasher, tie your shoes or pick up items from the ground. Fat takes the longest time to leave the stomach. Therefore, reduce the total amount of fat that you eat at a meal by decreasing the amount of margarine, butter, oils, salad dressings, gravy, fatty meats, and full-fat milk products such as sour cream, cheese, and whole milk. Reflux triggers vary from person to person. Try eliminating possible trigger foods for two weeks, then reintroduce one food at a time to determine your tolerance and evaluate severity of symptoms.                       

As far as medications go, various GERD medications work in different ways. Doctors often first recommend antacids to relieve heartburn and other mild GERD symptoms. Antacids include over-the-counter medications such as Mylanta and Tums. H2 blockers are another class of medications that decrease acid production. They provide short-term or on-demand relief. They can also help heal the esophagus. You can buy H2 blockers over-the-counter, examples include Pepcid AC and Zantac. If you get heartburn after eating, your doctor may recommend that you take an antacid and an H2 blocker. The antacid neutralizes stomach acid, and the H2 blocker stops your stomach from creating acid. By the time the antacid stops working, the H2 blocker has stopped the acid. Proton pump inhibitors (PPI’s) lower the amount of acid your stomach makes, these are often prescribed for long-term GERD treatment. Over-the-counter examples of PPI’s include Nexium 24 Hour and Prilosec OTC. If you have symptoms that persists after two weeks of PPI treatment, talk with your doctor.

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