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GERD
Gastroesophageal reflux disease, or GERD, occurs when the lower
esophageal sphincter (LES) does not close properly and stomach contents
leak back, or reflux, into the esophagus. The LES is a ring of muscle
at the bottom of the esophagus that acts like a valve between the
esophagus and stomach. The esophagus carries food from the mouth
to the stomach.
When refluxed stomach acid touches the lining of the esophagus,
it causes a burning sensation in the chest or throat called heartburn.
The fluid may even be tasted in the back of the mouth, and this
is called acid indigestion. Occasional heartburn is common but does
not necessarily mean one has GERD. Heartburn that occurs more than
twice a week may be considered GERD, and it can eventually lead
to more serious health problems.
What causes GERD?
No one knows why people get GERD. A hiatal hernia may contribute.
A hiatal hernia occurs when the upper part of the stomach is above
the diaphragm, the muscle wall that separates the stomach from the
chest. The diaphragm helps the LES keep acid from coming up into
the esophagus. When a hiatal hernia is present, it is easier for
the acid to come up. In this way, a hiatal hernia can cause reflux.
A hiatal hernia can happen in people of any age; many otherwise
healthy people over 50 have a small one.
Other factors that may contribute to GERD include
- alcohol use
- overweight
- pregnancy
- smoking
Also, certain foods can be associated with reflux events, including
- citrus fruits
- chocolate
- drinks with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, like spaghetti sauce, chili, and pizza
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How is GERD treated?
If you have had heartburn or any of the other symptoms for a while,
you should see your doctor. You may want to visit an internist,
a doctor who specializes in internal medicine, or a gastroenterologist,
a doctor who treats diseases of the stomach and intestines. Depending
on how severe your GERD is, treatment may involve one or more of
the following lifestyle changes and medications or surgery.
Lifestyle Changes
- If you smoke, stop.
- Do not drink alcohol.
- Lose weight if needed.
- Eat small meals.
- Wear loose-fitting clothes.
- Avoid lying down for 3 hours after a meal.
- Raise the head of your bed 6 to 8 inches by putting blocks
of wood under the bedposts—just using extra pillows will
not help.
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Medications
Your doctor may recommend over-the-counter antacids, which you can
buy without a prescription, or medications that stop acid production
or help the muscles that empty your stomach.
Antacids,
such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids,
and Riopan, are usually the first drugs recommended to relieve heartburn
and other mild GERD symptoms. Many brands on the market use different
combinations of three basic salts—magnesium, calcium, and aluminum—with
hydroxide or bicarbonate ions to neutralize the acid in your stomach.
Antacids, however, have side effects. Magnesium salt can lead to diarrhea,
and aluminum salts can cause constipation. Aluminum and magnesium
salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can
also be a supplemental source of calcium. They can cause constipation
as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents
with foam to prevent reflux. These drugs may help those who have no
damage to the esophagus.
H2 blockers,
such as cimetidine (Tagamet HB), famotidine (Pepcid AC),
nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production.
They are available in prescription strength and over the counter.
These drugs provide short-term relief, but over-the-counter H2 blockers
should not be used for more than a few weeks at a time. They are effective
for about half of those who have GERD symptoms. Many people benefit
from taking H2 blockers at bedtime in combination with a proton pump
inhibitor.
Proton pump inhibitors
include omeprazole (Prilosec), lansoprazole
(Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole
(Nexium), which are all available by prescription. Proton pump inhibitors
are more effective than H2 blockers and can relieve symptoms in almost
everyone who has GERD.
Another group of drugs, prokinetics, helps strengthen the sphincter
and makes the stomach empty faster. This group includes bethanechol
(Urecholine) and metoclopramide (Reglan). Metoclopramide also improves
muscle action in the digestive tract, but these drugs have frequent
side effects that limit their usefulness.
Because drugs work in different ways, combinations of drugs may help
control symptoms. People who get heartburn after eating may take both
antacids and H2 blockers. The antacids work first to neutralize the
acid in the stomach, while the H2 blockers act on acid production.
By the time the antacid stops working, the H2 blocker will have stopped
acid production. Your doctor is the best source of information on
how to use medications for GERD.
Surgery
Surgery is an option when medicine and lifestyle changes do not work.
Surgery may also be a reasonable alternative to a lifetime of drugs
and discomfort.
Fundoplication,
usually a specific variation called Nissen fundoplication,
is the standard surgical treatment for GERD. The upper part of the
stomach is wrapped around the LES to strengthen the sphincter and
prevent acid reflux and to repair a hiatal hernia.
This fundoplication procedure may be done using a laparoscope and
requires only tiny incisions in the abdomen. To perform the fundoplication,
surgeons use small instruments that hold a tiny camera. Laparoscopic
fundoplication has been used safely and effectively in people of all
ages, even babies. When performed by experienced surgeons, the procedure
is reported to be as good as standard fundoplication. Furthermore,
people can leave the hospital in 1 to 3 days and return to work in
2 to 3 weeks.
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Points to Remember
- Heartburn, also called acid indigestion, is the most common
symptom of GERD. Anyone experiencing heartburn twice a week or
more may have GERD.
- You can have GERD without having heartburn. Your symptoms could
be excessive clearing of the throat, problems swallowing, the
feeling that food is stuck in your throat, burning in the mouth,
or pain in the chest.
- In infants and children, GERD may cause repeated vomiting,
coughing, and other respiratory problems. Most babies grow out
of GERD by their first birthday.
- If you have been using antacids for more than 2 weeks, it is
time to see a doctor. Most doctors can treat GERD. Or you may
want to visit an internist—a doctor who specializes in internal
medicine—or a gastroenterologist—a doctor who treats
diseases of the stomach and intestines.
- Doctors usually recommend lifestyle and dietary changes to
relieve heartburn. Many people with GERD also need medication.
Surgery may be an option.
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