Gastroesophageal reflux disease (GERD) or simply called acid reflux or heartburn, easy condition where acid from the stomach flows backward up into the esophagus
More than 15 million American experience heartburn every single day. Up to 60 daily and American experience heartburn at least once a month. It is lot more common in elderly and pregnant women.
There is valve at the lower end of the esophagus called lower esophageal sphincter or “LES” which is like a gatekeeper to prevent any acid flowing backwards into the esophagus from stomach. Acid reflux occurs when LES opens too frequently or if it is too loose. Another main reason for acid reflux is obesity where increased pressure in the abdomen overcomes the barrier between the stomach and the esophagus.
Hiatal hernia is where upper part of the stomach is displaced into the chest. Hiatal hernias do not always cause symptoms. In some cases though, it can cause acid reflux.
Heartburn is the most common symptom which is a feeling of burning discomfort, right behind the breast bone, that moves up toward the neck and throat. Some may experience chest pain, difficulty swallowing, frequent dry cough, frequent need to clear the throat, bitter or sour taste in the mouth.
Most often, GERD is diagnosed based on your symptoms. However, you may need additional tests if it is unclear whether your symptoms are caused by acid reflux or if you have any complications of GERD such as difficulty swallowing, bleeding, etc.
Upper endoscopy is sometimes recommended where a thin, flexible tube is passed through the mouth to evaluate upper GI tract. This is done under sedation and there is no discomfort associated with the procedure. Occasionally esophageal manometry or pH testing of the esophagus are recommended based on your symptoms.
Chronic acid reflux may cause scarring and narrowing of the esophagus making swallowing difficult. Acid reflux may cause bleeding, chronic cough, sore throat or laryngitis with hoarseness of voice. Acid reflux may cause irritation of the airways and asthma-like symptoms. Acid reflux can sometimes cause aspiration of acid into the lungs causing pneumonia.
The lining of the esophagus that is exposed acid damage for a long time, may and she a different type of lining called Barrett’s esophagus which is a precancerous condition. People who have Barrett’s esophagus have a small increased risk of developing esophageal cancer. Barrett’s esophagus can be diagnosed during upper endoscopy by taking biopsy samples.
Diet and Lifestyle changes-
Try to lose weight if you are overweight or have had recent weight gain.
Try to reduce the diet triggers such as fried or fatty foods, caffeine, spicy foods, carbonated beverages, chocolate, tomato sauce, etc.
Elevate the head of the bed by putting a 6 inch wooden blocks under the legs at the head of the bed or by using a wedge under the mattress.
Avoid going to bed immediately after a meal. Give at least 3-4 hours between dinner and going to bed at night, especially if you are having symptoms at night.
There are several medications depending on how frequent and severe your symptoms are. For occasional heartburn, you may take over-the-counter antacids. If you have symptoms at least 3 times a week, H2 receptor blockers such as ranitidine or famotidine are recommended. If you have more severe symptoms, medications known as proton pump inhibitors such as omeprazole, pantoprazole, etc. are recommended. Discuss with Dr. Kethu to decide what is the best option for your symptoms.