USF-COM
Department of Family Medicine
Patient Education Information on...
Index of
Patient Education Topics
What
is GERD?
Gastroespohageal Reflux Disease (GERD)
is a condition in which stomach juice flows backwards: from the stomach
to the esophagus. Normally, food travels from the mouth, through a long
tube (the esophagus) into the stomach, where it is digested by stomach
acid and enzymes, before traveling into the small intestine for further
processing.
A muscular valve (the Lower Esophageal
Sphincter, or LES) at the bottom of the esophagus will open to allow food
to pass into the stomach, but then close to keep stomach acid out of the
esophagus. In people with GERD, there is a change in this system that allows
stomach acid to damage the lining of the esophagus.
How
common is GERD?
More than 60 million Americans have
GERD at least once a month, while 25 million adults suffer daily from heartburn.
In some groups this condition is quite common: One in four pregnant women
experience daily heartburn due to GERD.
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What
causes GERD?
The changes that result in GERD involve
that muscular valve at the bottom of the esophagus, the LES. When the LES
cannot close tightly, or relaxes too frequently, stomach contents can flow
backwards (or reflux) into the esophagus. When the esophageal lining is
exposed to too _Ä much stomach acid for too long a period of time,
the lining can become damaged. A number of foods and drugs can weaken the
LES and allow this reflux to occur: chocolate, peppermint, fried or fatty
foods, coffee or sodas with caffeine, alcohol, and cigarettes.
Structural changes in the body can
also weaken the LES and cause reflux. It is thought that 80% of people
with GERD have an abnormality known as hiatal hernia. Hiatal hernia involves
the stomach and the diaphragm (a muscular sheet that separates the stomach
from the chest). A portion of the upper stomach passes through a small
opening in the diaphragm, resulting in easy reflux of stomach acid into
the esophagus. Conditions that cause increased pressure below the diaphragm,
such as pregnancy, being overweight, or chronic coughing, can result in
a hiatal hernia.
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What
are the symptoms of GERD?
Heartburn (acid indigestion), a burning
discomfort under the breastbone, is the most common symptom of GERD. The
pain of heartburn usually occurs soon after meals or when lying down, may
move upward into the neck or throat, produce a bitter or sour taste in
one's mouth and, in some people, can last as long as two hours. Other symptoms
of GERD include hoarseness, chronic cough, sore throat, dental diseases
and, very rarely, the vomiting of blood.
Asthma that develops in adulthood,
occurs mainly at night, or is most severe after meals or when lying down,
may in fact be associated with GERD.
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How
can I find out if I have GERD?
The diagnosis of GERD is suggested by
the presence of heartburn, cough, sore throat and other typical symptoms
described above. Specific tests performed by your doctor can confirm
the presence of GERD: Barium Upper Gastrointestinal Study - a liquid barium
meal is swallowed while a doctor observes the shape of the esophagus and
looks for reflux of barium from the stomach into the esophagus.
Endoscopy - A small, flexible,
lighted viewing tube is passed through the mouth into the esophagus and
stomach, allowing your doctor to look for abnormalities, and obtain tissue
samples from these abnormal sites.
Esophageal Manometry or Esophageal
pH Probe - A small, flexible tube is passed through the nose into the
esophagus and stomach to measure the muscular contractions of the esophagus
and study the function of the LES. The pH probe can determine the amount
of acid refluxed from the stomach into the esophagus.
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What
treatments are available for GERD?
The three goals of treatment are to
-
eliminate symptoms
-
heal the esophagus
-
prevent the return of symptoms and complications
of GERD
The majority of patients with GERD
can be treated successfully with Lifestyle Modifications.
-
Stop smoking.
-
Avoid foods and beverages that weaken
the LES (chocolate, peppermint, coffee, fatty foods, and alcohol) as well
as those that can irritate a damaged esophagus (tomato products, citrus
fruits and pepper).
-
Decrease portion size, and refrain from
eating 2-3 hours before bedtime.
-
Raise the head of the bed with 6-inch
blocks or purchase a foam wedge to help decrease reflux at night (extra
pillows are not recommended).
-
Avoid tight clothing, and lose weight
if too heavy.
-
Over-The-Counter Medications are an
option for patients with infrequent episodes of heartburn (less than twice
per week).
-
Antacids are inexpensive and safe, but
provide only short term relief of GERD.
-
H2-receptor antagonists (H2-Blockers)
reduce the production of stomach acid.
-
If you are using an over-the-counter
medication more than twice per week, you should consult your doctor, as
further testing and different treatments could help relieve your symptoms.
Prescription Medications
-
H2-Blockers
in higher dosages can decrease stomach acid and help heal mild to moderate
esophagitis.
-
Proton Pump Inhibitors
(PPI's) are more expensive than H2-Blockers, however these drugs
greatly decrease acid production and result in complete healing in 75%
of patients.
-
Promotility agents
strengthen the LES and improve movement of food from the stomach, thereby
decreasing GERD symptoms.
Surgery:
In patients with symptoms uncontrolled
by medication, or those who develop severe complications of GERD, a variety
of surgical procedures can prevent reflux by the creation of a physical
valve mechanism and repair of a hiatal hernia (if present).
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What
are the side effects of treatment for GERD?
The medications used in treating GERD
have very few side effect. H2-Blockers are generally effective and well
tolerated with rare side effects; however, people taking other medications
are encouraged to speak with their doctor regarding drug interactions (especially
when using Tagamet [cimetidine]). PPIÕs also have only rare side
effects: however, antacids can produce diarrhea or constipation. Side effects
of the promotility agents (Reglan, Propulsid) include insomnia, and anxiety.
Specific questions about rare side effects are best addressed by your doc
__tor. Surgery involves numerous risks, including bleeding, infection,
and reactions to general anesthesia. These risks vary with different procedures,
and are best addressed by a surgeon.
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What
are the complications of chronic GERD?
Chronic injury from acid reflux can
result in narrowing of the esophagus such that swallowing food becomes
difficult and choking may occur. Chronic GERD is thought to produce a precancerous
state known as ÒBarrettÕs esophagus.Ó These conditions
require close attention by a doctor with special training in treating the
complications of GERD.
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For
additional information you may wish to visit the following websites:
-
http://www.acg.gi.org/gerd/
- The American College Of Gastroenterolgy. This site is an excellent, basic
review of GERD in a Question and Answer format.
-
MedicineNet
- Gastroesophageal Reflux Disease (www.medicinenet.com)
- Medicinenet, Inc. Educational material written by physicians. A more
advanced discussion of GERD with special attention to an explanation of
medical therapies available for GERD. Hyperlink to PHARMACY of MedicineNet
provides detailed information on H2-Receptor Antagonists.
-
Gastroesophageal
Reflux Disease (Hiatal Hernia and Heartburn) (www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm)
- Concise, thorough review written for the lay reader with questions about
GERD. Superb source: The National Institute of Health's National Digestive
Diseases Information Clearinghouse.
-
Ask Dr. Weil
(www.hotwired.com/drweil) - Dr. Andrew
Weil (posted on 6/6/98) A well known authority on alternative (complementary)
medicine provides a straightforward explanation of GERD. Emphasis on lifestyle
modifications, modern pharmacology, and herbal remedies.