Gastroesophageal Reflux Disease (GERD)/Heartburn

What Causes GERD?

Under normal conditions, when you eat and drink, the muscle at the bottom of your esophagus closes off so food and liquids will remain in your stomach. This muscle is the lower esophageal sphincter (LES).

However, GERD occurs chiefly because of the following three reasons: The esophagus's normal defenses are overwhelmed by the acid content of the stomach, the contents of the stomach are too acidic, or the food is not cleared from the esophagus fast enough.

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 reach 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.

From : Sharon Gillson
Your Guide to Heartburn / GERD

Definition Of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Alternative Names Peptic Esophagitis; Reflux esophagitis; GERD; Heartburn - chronic Causes

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

Symptoms of GERD

* Heartburn
o Involves a burning pain in the chest (under the breastbone)
o Increased by bending, stooping, lying down, or eating
o Relieved by antacids
o More frequent or worse at night
* Belching
* Regurgitation of food
* Nausea and vomiting
* Vomiting blood
* Hoarseness or change in voice
* Sore throat
* Difficulty swallowing
* Cough or wheezing

GERD Exams and Tests

* A positive stool guaiac
* Continuous esophageal pH monitoring showing reflux
* Endoscopy showing ulceration or inflammation of the esophagus
* Esophageal manometry showing abnormal sphincter pressure
* A barium swallow showing reflux
* A positive Bernstein test for gastric acid reflux

Treatment of GERD ( Gastroesophageal Reflux Disease )

General measures include:

* Weight reduction
* Avoiding lying down after meals
* Sleeping with the head of the bed elevated
* Taking medication with plenty of water
* Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
* Avoiding alcohol and tobacco

Medications that alleviate symptoms include:

* Antacids after meals and at bedtime
* Histamine H2 receptor blockers
* Promotility agents
* Proton pump inhibitors

Anti-reflux operations ( Nissen fundoplication ) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.

Outlook (Prognosis) of GERD

The majority of people respond to nonsurgical measures with behavioral modification and medications.

Possible Complications

* Inflammation of the esophagus
* Stricture
* Esophageal ulcer
* Hoarseness, bronchospasm
* Chronic pulmonary disease
* Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)

When to Contact a Medical Professional

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.
Prevention

Avoid foods and activities that worsen symptoms. Maintain a healthy weight.

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology

Gastroesophageal reflux disease image

A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.

Normal anatomy

The esophagus is a narrow, muscular tube that leads from the mouth to the stomach. The esophagus carries food from the mouth to the stomach. A sphincter at the junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into the esophagus.

Indication

When the lower esophageal sphincter doesn't function properly, acid and food can reflux up from the stomach into the esophagus. This can lead to pain (heartburn) and damage to the lower esophagus. This damage can cause strictures (narrowing) of the esophagus, and eventually, cancer of the esophagus. Frequently, dysfunction of the lower esophageal sphincter is associated with a hiatal hernia, in which the lower esophagus and upper part of the stomach slips up into the chest.

From Sharon Gillson,
Your Guide to Heartburn / GERD.

6 Steps To Preventing Heartburn-
related Complications

There are several complications that can occur with long-term heartburn / acid reflux. These complications include Barrett's esophagus, esophageal cancer, esophagitis, and esophageal strictures. There are, however, six steps you can take that can drastically reduce your chances of developing one of these complications.

1. Make the necessary lifestyle changes
Heartburn symptoms can often be relieved if sufferers make a few lifestyle changes. Many people can significantly reduce the occurrence of symptoms by avoiding heartburn triggers and behaviors that contribute to acid reflux flare-ups.

2. Watch what you eat
If you suffer from acid reflux, you need to know what foods are safe to eat and what foods to avoid. Most heartburn sufferers indicate their heartburn is worse after eating. If you can reduce the occurrences of food-related heartburn, this can go a long way in reducing the risk of complications. For example, drinking carbonated drinks may increase your risk of esophageal cancer. There are the foods with little risk of causing heartburn, foods that can be consumed in moderation, and foods that should be avoided completely. Also, knowing how to prepare foods will reduce heartburn. Check out this recipe index for heartburn-free recipes. Another resource to help you with your dietary needs as a heartburn sufferer is the Dining Out Guide For Heartburn Sufferers.

3. Keep track of your heartburn triggers
When you experience chronic heartburn, the first step to controlling your heartburn is to record what may trigger your attacks, the severity of the attacks, how your body reacts, and what gives you relief. The next step is to take this information to your doctor so the both of you can determine what lifestyle changes you will need to make and what treatments will give you maximum relief, and prevent complications. You can use this heartburn record as an example of what to track.

4. Learn how to prevent heartburn before it happens
Here are a few tips to significantly reduce the occurrence of acid reflux symptoms, and in most cases prevent the acid reflux before it starts. With less acid reflux episodes, there is less chance of esophageal damage.

5. Reduce nighttime heartburn
Nighttime heartburn can be the most dangerous. If frequent nighttime heartburn occurs, the risk of complications increases. There are several reasons reasons for this. For example, refluxed acid tends to remain in the esophagus for longer periods, allowing it to cause more damage to the esophagus. There are, however, a few ways to prevent nighttime heartburn.

6. Take prescribed medications
You should always contact your doctor if your heartburn occurs two or more times a week. While under the care of your physical, he or she may prescribe prescription medications or suggest over-the-counter remedies. There are alternative "home" remedies for easing heartburn. Discuss these with your doctor also.

10 Lifestyle Changes That Can Prevent Heartburn

Heartburn symptoms can often be relieved if sufferers make a few lifestyle changes. Follow these ten suggestions to significantly reduce the occurrence of acid reflux symptoms.

Eat smaller, more frequent meals.
Large meals expand your stomach and increase upward pressure against the esophageal sphincter.

Limit your intake of acid-stimulating foods and beverages.
Eat foods that rarely cause heartburn and avoid those foods that will often cause heartburn.

Don't lie down for about two hours after you eat.
Gravity helps to keep the stomach juices from backing up into the esophagus and assists the flow of food and digestive juices from the stomach to the intestines.

Elevate your head a few inches while you sleep.
Lying down flat presses the stomach's contents against the LES.

Maintain a reasonable weight.
Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. According to some statistics, approximately 35% of overweight persons experience heartburn. The good news is that for many people, as little as a 10% decrease in weight will improve their heartburn symptoms.

Don't smoke.
Nicotine relaxes the esophageal sphincter. Smoking also stimulates the production of stomach acid. Read this article to learn other ways smoking can worsen heartburn.

Don't drink alcohol.
If you still want to drink alcoholic beverages, follow these tips.

Relax.
While stress hasn't been linked directly to heartburn, it is known that it can lead to behaviors that can trigger heartburn. Follow these relaxation tips to alleviate stress, and thus make stress-related heartburn less likely.

Don't wear belts or clothes that are tight fitting around the waist.
Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

Keep a heartburn record.
Record what triggered your acid reflux episodes, the severity of each episode, how your body reacts, and what gives you relief. The next step is to take this information to your doctor so the both of you can determine what lifestyle changes you will need to make and what treatments will give you maximum relief. To get you started, you can use this Heartburn Record