ADC Allergy Patient Education
Straight Answers to Your Questions about Heartburn and GERD

How Common is Heartburn?

Over 60 million Americans experience heartburn at least once a month, and some studies have suggested that over 15 million Americans experience heartburn symptoms each day. Symptoms of heartburn, also known as acid indigestion, are more common among the elderly and pregnant women.

What is Heartburn?

Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid, digestive enzymes and other injurious materials. The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort. Many people describe this burning discomfort as localized behind the breastbone. Some even experience the bitter or sour taste of acid in the back of the throat. The burning and pressure symptoms of heart bum can last for several hours and often worsen after eating food.

What Are the Treatments for
Infrequent Heartburn?

In many cases, doctors find that infrequent heartburn can be controlled by lifestyle modification and proper use of over-the-counter medicines.

	Avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages.
	Stop smoking. Tobacco inhibits saliva, which is the body's major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, permitting acid reflux to occur.
	Reduce weight if too heavy.
	Do not eat 2-3 hours before sleep.
	For infrequent episodes of heartburn, you may get relief from an over-the-counter antacid or an H2 blocker, some of which are now available without a prescription.

What is GERD?

Gastroesophageal reflux disease (GERD) occurs when a muscular valve at the lower end of the esophagus -- called the lower esophageal sphincter or "LES" -- malfunctions. Normally, this muscle keeps the acid in the stomach and out of the esophagus. However, when the LES relaxes too frequently, it allows stomach acid to reflux, or flow backward, into the esophagus. GERD usually is associated with persistent heartburn episodes that occur two or more times a week.

What are the Complications of GERD?

When GERD is not treated, serious complications can occur, including: severe chest pain that mimics a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-cancerous change in the lining of the esophagus called Barrett's esophagus. Symptoms suggesting that serious damage may have already occurred include:

	Dysphagia -- difficulty swallowing or a feeling that food is trapped behind the breast bone
	Bleeding -- vomiting blood or having black bowel movements
	Choking -- sensation of acid refluxed into the windpipe causing shortness of breath, coughing or hoarseness
	Weight Loss

What are the Treatments for GERD?

Lifestyle Modification
Individuals seeking to alleviate the discomfort associated with GERD can follow the same guidelines of behavior modification that have been outlined to treat infrequent episodes of heartburn.

	Change eating and sleeping habits
	Avoid tight clothing
	Change your diet
	Curtail habits that contribute to GERD, such as smoking and use of alcoholic beverages

In addition, in order to decrease the amount of gastric contents that reach the lower esophagus it is suggested to raise the head of the bed.

	The simplest method is to use a 4" x 4" piece of wood with two jar caps nailed to it. The jar caps should be an appropriate distance apart to receive the legs or casters at the upper end of the bed. Failure to use the jar caps inevitably results being jolted from sleep as the upper end of the bed rolls off the 4" x 4."
	Alternatively, one may use an under-mattress foam wedge to elevate the head about 6" x 10" inches. Pillows are not an effective alternative for elevating the head in preventing reflux.

Medical Treatment of GERD
GERD has a physical cause and frequently cannot be curtailed by these lifestyle factors alone. If individuals are using over-the-counter medication more than twice a week or are still having symptoms on the prescription or other medicines they are taking, they need to see their doctor or it gastroenterologist.

What are Some Severe Complications and Atypical Manifestations of GERD?

GERD can Masquerade as Other Diseases

Chest Pain
Patients with GERD may have chest pain similar to angina or heart pain. Usually, they also have other symptoms like heartburn and acid regurgitation.

Asthma
Acid reflux may aggravate asthma. Recent studies suggest that the majority of asthmatics have acid reflux. Clues that GERD may be worsening your asthma include 1) asthma that appears for the first time during adulthood, 2) asthma that gets worse after meals, lying down or exercise, 3) asthma that occurs mainly at night, 4) asthma that is difficult to control.

Ear, Nose and Throat Problems
Acid reflux may be a cause of chronic cough, sore throat, laryngitis with hoarseness and frequent throat clearing. It may cause vocal cord spasm that may cause difficulty breathing.

People with Long-standing GERD Can Experience Severe Complications:

Esophageal Stricture
This condition is characterized by a narrowing of the esophagus in response to frequent acid reflux. Chronic acid injury and scarring of the lower esophagus causes this stricture. Patients may complain of food sticking in the lower esophagus. Heartburn symptoms may actually decrease as the esophageal opening narrows, preventing-acid-reflux.

Barrett's Esophagus
The most serious complication of chronic GERD is Barrett's Esophagus -- a condition in which the lining of the esophagus changes to resemble the intestine in an adaptation prompted by the recurring injury from acid reflux. Even though patients may complain of less heartburn with Barrett's Esophagus, this is a pre­cancerous condition.