Gastroesophageal Reflux Disease

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Your doctor has determined that you have gastroesophageal reflux disease, or GERD, a condition marked by ongoing stomach acid reflux and inflammation of the lower esophagus. GERD is a very common disorder that affects more than 60 million American adults. It can also occur in infants and children.

About the Condition

The esophagus is a tube lined with muscles that contracts to transport food and liquids from the mouth to the stomach. The upper and lower ends of the esophagus are clamped together by specialized muscles, called sphincters. Normally the lower sphincter opens automatically to let food pass into the stomach and closes quickly to prevent stomach contents and acid from leaking back into the esophagus, or refluxing.

GERD occurs when acid reflux is frequent or constant and inflames the lower esophagus. The most common symptom is heartburn, a burning pain in the chest that may spread to the neck. Almost everyone has experienced heartburn at some point, but most GERD patients endure it on a continuing basis because of a weakened lower esophageal sphincter.

Other symptoms of the condition may include a dry cough, bitter taste in the mouth, feeling of a lump in the throat, shortness of breath, hoarseness and regurgitation of stomach acid, especially while bending over or sleeping.

Contributing factors to GERD include:

Lifestyle such as being overweight, eating large meals, lying down shortly after eating, drinking alcohol and smoking.

Medications including some blood pressure drugs, tranquilizers and antihistamines.

Other Medical Conditions such as pregnancy, diabetes and hiatal hernia.

If GERD is left untreated it can lead to other conditions. About 10% of people who suffer from severe GERD over a period of years develop Barrett's esophagus. This pre-cancerous condition results from damage to the cells lining the esophagus, but only rarely progresses into esophageal cancer.

GERD can also sometimes cause esophageal ulcers, or open sores, which may bleed and be painful. In addition, GERD can lead to narrowed areas, or strictures, in the esophagus, which are formed by scar tissue and can interfere with swallowing.

Treatment Options

The typical treatment plan for GERD seeks to reverse the condition by stopping the acid reflux. The following treatment possibilities are available:

Everyday Changes Patients can diminish symptoms by making specific lifestyle changes that help lessen stomach acid reflux. This may include losing weight, taking part in some form of exercise, avoiding certain foods and elevating the head of the bed.

Medication A variety of medications can be used to treat GERD, including antacids, acid blockers and proton pump inhibitors. Some patients can achieve quick pain relief by using over-the-counter (OTC) antacids, which neutralize acid in the stomach. Acid blocking drugs — often referred to as histamine or H2 blockers — work by decreasing the amount of acid the stomach produces. Proton pump inhibitors are even more powerful at suppressing gastric acid and work by stopping the action of acid "pumps" within specific stomach cells.

Surgery In rare cases when symptoms do not respond to drug therapy, anti-reflux surgery may be performed to treat GERD. The operation eliminates acid reflux by wrapping part of the stomach around the bottom of the esophagus to tighten the lower sphincter. This procedure is sometimes performed using a few small abdominal incisions to provide access for a camera (laparoscope) and surgical instruments.

What You Can Do

To reduce the symptoms of reflux and prevent other digestive problems, you should avoid potential stomach irritants such as smoking, alcohol, caffeine, chocolate, peppermint and fatty or highly seasoned foods. You should also eat smaller, more frequent meals that are high in fruits and vegetables, with the exception of citrus and tomato products.

Other steps you can take to maximize your health and minimize symptoms include:

•  Waiting at least three hours after you eat before lying down
•  Maintaining a healthy body weight
•  Drinking plenty of liquid when taking medications
•  Wearing loose fitting clothing without belts
•  Visiting your doctor regularly and promptly reporting any new symptoms that develop

In addition, pain relievers containing acetaminophen are generally recommended to use instead of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Talk with your doctor about what prescription and OTC medications are best for your individual situation.

Additional Resources

American College of Gastroenterology, 301.263.9000, http://www.acg.gi.org/
Digestive Diseases Information Clearinghouse, 800.891.5389, http://www.digestive.niddk.nih.gov/

This patient resource sheet is provided to you as a service of CBLPath® and is intended for information purposes only. It may not fully describe all aspects of your diagnosis and is not meant to serve as medical advice or a substitute for professional medical care. Your physician can provide you with a thorough explanation of your diagnosis and appropriate treatment options, which may vary. Only you and your physician can determine your best treatment plan.

Updated 9.07