Gastroesophageal – Reflux Disease (GERD)

By Island Hospital   |   17.12.2018

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus and cause symptoms that affect your health.

Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.

  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or sour liquid
  • Sensation of a lump in your throat
  • Heartburn
  • Nausea
  • Acid-induced erosions of the teeth
  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  • A chronic cough
  • Disrupted sleep
  • Ulcers and strictures of the esophagus
  • Hoarseness
  • New or worsening asthma
  • Throat and laryngeal inflammation
  • Ear pain (a collection of fluid in the sinuses and middle ear)

Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don’t experience relief within a few weeks, your doctor might recommend prescription medication or surgery.

  • Over-the-counter medications
    • Antacids that neutralise stomach acid. These medications may provide quick relief, but antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
    • Medications to reduce acid production. These medications known as H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
    • Medications that block acid production and heal the esophagus. These medications known as proton pump inhibitors are stronger acid brokers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal.
  • Prescription medications
    Medication to strengthen the lower esophageal sphincter may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects might include fatigue or nausea.
  • Surgery and other procedures
    If medications don’t help or you wish to avoid long-term medication use, your doctor might recommend:
    Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
  • Lose weight
    Obesity is the leading cause of GERD. Extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus. “Lose weight if you’re overweight, and don’t gain weight if you’re not,” he says.
  • Avoid foods known to cause reflux
    If you’re at risk for GERD, avoid:
    • Fatty foods
    • Spicy foods
    • Acidic foods, like tomatoes and citrus
    • Mint
    • Carbonated beverages
  • Eat smaller meals
    Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
  • Don't lie down after eating
    Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.
  • Elevate your bed
    Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.
  • Review your medications
    There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus.
    These medications include:
    • Non-steroidal anti-inflammatory drugs, or NSAIDs-Calcium channel blockers (often used to treat high blood pressure)
    • Certain asthma medications, including beta-agonists like albuterol-Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
    • Bisphosphonates used to boost bone density-Sedatives and painkillers-Some antibiotics-Potassium-Iron tablets
  • Quit smoking
    Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
  • Cut back on alcohol
    As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
  • Wear loose-fitting clothes
    Do not wear tight clothing or belts that can constrict your stomach.
  • Try a gluten-free diet
    Do not wear tight clothing or belts that can constrict your stomach.
  • Tooth Decay
    Heartburn can also take a toll on your smile. Stomach acid can wear down enamel, your teeth’s hard outer layer. This can weaken teeth and lead to cavities
  • Esophagitis
    Stomach acid irritates the lining of the esophagus, causing it to swell. This inflammation is called esophagitis, which can lead to painful swallowing.
  • Esophageal ulcers
    GERD is the top cause of ulcers, or sores in the lining of the esophagus. Symptoms include painful swallowing, nausea, and chest pain. Your doctor will prescribe medicine to control your GERD and treat the ulcer.
  • Esophageal stricture
    Over time, the damage caused by stomach acid can scar the lining of the esophagus. When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight loss and dehydration.
  • Barrett's esophagus
    If left untreated for many years, constant acid reflux can cause precancerous changes in cells, a condition known as Barrett’s esophagus. The condition does not cause symptoms, but a doctor can diagnose it is by performing an endoscopy.
  • Esophageal cancer
    Symptoms of this type of cancer, such as trouble swallowing and chest pain, don’t appear until the disease reaches a later stage.
    That’s when it becomes harder to treat. Ask your doctor about getting screened if you have a higher risk for the disease. He may want to do an endoscopy regularly.
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