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GERD

man clutches stomach

What is GERD?

Gastroesophageal reflux disease (GERD) happens 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 treatments for GERD?

  • Lifestyle Modification
    You 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
  • Raise the head of the bed in order to decrease the amount of gastric contents that reach the lower esophagus.
    • 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 you use over-the-counter medication more than twice a week or are still having symptoms on the prescription or other medicines you’re taking, see their doctor or 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.