Gastroesophageal Reflux Disease and Heartburn (GERD)

What is GERD/ Heartburn?

Everyone has heartburn and acid reflux occasionally. Heartburn is extremely common; approximately 10% of the population experience it daily. Heartburn occurs when stomach acid flows upward (regurgitates) into the esophagus. Heartburn usually feels like a burning sensation or pain in the pit of the stomach or in the chest, behind the breastbone. Regurgitation of bitter tasting stomach acid can sometimes accompany heartburn. Heartburn usually occurs after a large meal containing fatty, fried foods or very acidic foods. Thankfully heartburn is rarely serious; it can however significantly impact your quality of life.

What Causes Heartburn
Heartburn is a symptom of gastroesophageal reflux disease (G.E.R.D.). Chronic acid reflux can be caused by a malfunction of a small valve at the base of the esophagus called the lower esophageal sphincter (L.E.S.). The L.E.S. muscle should only open when food or liquid is being swallowed and passing through to the stomach. Sometimes the L.E.S. is too weak to stay completely closed, and stomach acid can reflux back up into the esophagus. Your stomach produces a strong acid to help you digest your food; the stomach has a lining to protect itself from the effects of the acid. Unfortunately, your esophagus does not have this protective lining and can be easily irritated by the reflux of acid, causing painful symptoms. If the reflux is frequent and/or prolonged you may develop G.E.R.D., which refers to having severe damage, not just simple heartburn. The lining of the esophagus may become inflamed (esophagitis), which can cause significant pain, especially while swallowing. Ulcers may develop in the esophagus and, if not treated, they may cause significant bleeding.

Continuous inflammation over many years may cause scar tissue to develop, which may narrow the esophagus and make swallowing difficult. Some people complain of food getting stuck in their esophagus. Your doctor may need to dilate or “stretch open” your esophagus if it is difficult for you to swallow solid foods.

Chronic acid reflux over a long period of time can also lead to a condition called Barrett’s Esophagus. The risk of developing cancer of the esophagus is higher in people with Barrett’s. If you have Barrett’s Esophagus you will need to be screened regularly by your doctor.

There are several ways to evaluate heartburn and reflux disease.

  • Upper GI x-ray series – You will drink barium and x-rays will be taken of the esophagus and stomach to see how they are functioning.
  • Upper Endoscopy – a small, flexible fiberoptic instrument is passed through the mouth and into the esophagus and stomach; this is done while you are sedated. This test allows your doctor to directly visualize the lining and to take biopsies if needed.
  • BRAVO pH Capsule – a small capsule is placed in the base of your esophagus that will monitor the amount and severity of acid reflux over a 48-hour period. There are no uncomfortable catheters with this new state-of-the-art device. This is often placed at the time of an endoscopy, while you are sedated.
  • Esophageal Manometry – A catheter is placed through your nose and down your esophagus to measure the pressure within the esophagus and the L.E.S.

Treatment for acid reflux may be as simple as making some minor lifestyle changes such as changing your eating habits. Some general guidelines for treating heartburn and acid reflux are:

  • Avoid foods and substances that increase reflux of acid into the esophagus, such as:
    • Nicotine (cigarettes)
    • Fatty foods
    • Alcohol
    • Caffeine
    • Chocolate
    • Peppermint and spearmint
  • Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime or lying down.
  • Avoid bending, stooping, tight belts, and girdles, all of which increase abdominal pressure and cause reflux.
  • If overweight, lose weight. Obesity increases abdominal pressure.
  • Certain medications, such as intestinal anti-spasmodics, calcium channel blockers, and some anti-depressants weaken the lower esophageal sphincter muscle.
  • Elevate the head of your bed 8 to 10 inches by putting a wedge under the upper part of the mattress or placing blocks under the head of the bed. Gravity then helps keep stomach acid out of the esophagus while sleeping.

In mild cases of G.E.R.D. making the above modifications and taking occasional antacids (Tums, Mylanta, Maalox, Rolaids, etc.) may be sufficient. In more severe cases of reflux, stronger medication (Zantac, Tagamet, Prilosec, Prevacid, Aciphex, Nexium, Protonix) may be prescribed by your doctor to effectively reduce the secretion of stomach acid, thereby reducing acid reflux. Short-term use of these medications is very safe; the effects of long term use are not yet known.

Surgery is reserved for those patients with symptoms that cannot be handled with medications. Surgery for reflux disease can now be accomplished laparoscopically, which greatly reduces hospital stay and recovery times, making surgery a more viable option for many.