Gastroesophageal reflux disease (GERD) occurs when the stomach contents flow back up into the esophagus. The contents may come out of the mouth in some situations, but acidity and digestive enzymes can cause a burning sensation in the chest or throat and make it difficult to swallow. People with GERD may also have a bitter or sour taste in the mouth.
GERD occurs when the sphincter at the lower end of esophagus weakens and allows gastric acid to flow back into the esophagus. This is a common symptom of heartburn, and is characterized by the sensation of burning occurring in the chest and throat region, which tends to occur after eating large meals, lying down or leaning back. Heartburn may last for as little as 5 minutes, or as long as 3 hours.
Causes
There are many causes for GERD, one of which is genetics. Up to 40% of people with GERD are of Finnish descent and those with GERD have a higher incidence of esophagitis, Barrett's Esophagus and esophageal cancer (2).
GERD may result from excessive reflux caused by the following conditions:
digestive disorders like gastric outlet obstruction, gastroesophageal reflux disease (GERD), hiatus hernia or motility disorders. Symptoms may include: heartburn/acid regurgitation after eating, choking sensation when swallowing food or abnormal growths in the throat that can cause difficulty swallowing.
In 20% of GERD cases there is no known cause and GERD symptoms may arise simply due to the ageing process.
GERD can also be caused by drugs or alcohol, especially after heavy alcohol drinking. Drugs that may cause this include: steroids, marijuana and antibiotics. Some people may also have a slow emptying stomach or certain medications such as proton pump inhibitors (PPIs).
Symptoms
The pain associated with GERD will vary from person to person, but it will usually occur in the throat region and/or chest area and for some people it is excruciating pain. This can affect a person's ability to swallow and make eating or sleeping uncomfortable blocking the airway causing coughs/sighs of pain.
Heartburn is also a symptom of GERD and occurs when the acid from the stomach backs up into the esophagus and causes pain. A burning sensation also occurs in the chest or throat area, but it usually goes away within an hour or so.
The sensation associated with GERD is often referred to as "heartburn," although it does not literally come from the heart. The term heartburn is somewhat misleading, because although it does feel like a burning sensation in your chest, heartburn is not actually a direct result of problems with your heart itself. Most GERD symptoms are caused by the buildup of acid in the esophagus. This leads to discomfort, which is experienced primarily in the chest and throat.
GERD symptoms can vary from person to person. Some people with GERD experience a burning sensation in their throat, while others feel chest pain or heartburn. You may not experience all the typical symptoms of GERD at the same time.
GERD causes can vary from person to person. You may not experience all the typical GERD symptoms at the same time.
Sleep apnea may result in mild or no symptoms, but it can contribute to esophageal reflux and its progression to more serious conditions such as Barrett's esophagus or esophageal cancer . This is particularly true if sleep apnea is an ongoing problem, or if it has caused snoring and other sleep-related breathing disorders in the past.
Symptoms may include:
heartburn/acid regurgitation after eating, choking sensation when swallowing food or abnormal growths in the throat that can cause difficulty swallowing.
Decreased appetite, frequent heartburn or regurgitation of acid.
If you are experiencing symptoms of GERD or want to know more about your risk factors, see your doctor for an examination and evaluation.
Treatment
As a rule, the decision to treat GERD is based on your symptoms and your risk factors, rather than any specific diagnosis. Your doctor will make this decision based on your health history, risk factors including reflux esophagitis and esophageal cancer , and what is known about GERD's causes and severity.
You may be able to take over-the-counter acid-blocking drugs for mild or occasional symptoms of heartburn. These include:
Miscellaneous
The following medications are also used as anti-reflux therapy. Phenergan is a non-prescription medication that can be used in combination with other anti reflux medications for mild or occasional symptoms of heartburn. The dosage of Phenergan is started at 25 milligrams and can be increased to 50 milligrams for additional relief.
These medications are generally not used prior to and after most upper GI endoscopies, because they might interfere with the interpretation of the results.
This group includes a number of medications known as proton pump inhibitors (PPIs), including:
Pantoprazole, Rabeprazole and Dexlansoprazole.
Other available drugs include: Alginic acids, Antacids, H2 blockers, Prokinetics & Gamma-Esomatoprost. These formes are used in combination with one another for treating GERD.
Short Term recommendation:
The following is a list of medications that could be prescribed for minor symptoms of GERD:
Over-the-counter (OTC) and prescription anti-reflux medications are effective in treating GERD. PPI's drugs are best suited for long term use, some of which include: Omeprazole (Prilosec), Lansoprazole (Prevacid class), Esomeprazole (Nexium) and Dexlansoprazole. H2 blockers such as Famotidine, Prevacid or Pepcid can be used when the side effects have become intolerable with the PPI's. Acids such as Pepcid, Zantac or Orlanzapine can be used when the acidity is intolerable with the PPI's.
Eating a variety of foods at a regular and consistent meal schedule, avoiding foods that trigger your symptoms, and watching your diet may also help.
Some other medicines that may be prescribed include:
Antacids (for heartburn)
Tums (for heartburn)
Bismuth Subsalicylate (to relieve pain after meals)
Drugs like Baking soda (sodium bicarbonate) and food wraps can be bought over the counter or by prescription.
In order for you to get the best treatment for your heartburn, please visit your doctor to diagnose your condition and to determine which medication is best suited for you.
Prevent GERD?
At the time this article was written there was no definitive evidence as to how prevent or cure GERD. However, there are some prevention techniques that can be implemented in order to help prevent esophageal reflux:
What would happen if I stopped taking medication? If you continue taking acid-blockers even after an initial improvement in symptoms, it's very important that you continue taking them even after the symptoms have completely disappeared. Stopping medication can lead to symptoms returning, or to more severe or long-lasting symptoms if you have Barrett's Esophagus.
The goal of treatment is to relieve your heartburn and other GERD symptoms and control the damage that can be caused by reflux for as long as possible.
You may want to ask your doctor about natural ways to slow down acid secretion and lower its level in the stomach. As for medications that stop acid production, prescription PPI (proton pump inhibitors) drugs are the most effective. But these strong medications have side effects such as headache, nausea, abdominal pain and diarrhea. These can be minimized by taking them at the lowest effective dose and monitoring their side effects closely.
Avoiding foods that trigger reflux (i.e., acidic foods, citrus fruit juices and beverages) is another great way to prevent GERD symptoms. There are other lifestyle/dietary changes you can try as well:
Avoid liquid calories like soft drinks and fruit juices, which increase acid secretion, add excess weight to the stomach, and promote reflux-related damage to the esophagus .
Eating smaller meals more frequently helps prevent reflux from happening in the first place, since it slows down acid production from within the stomach .
Natural approaches such as herbal supplements may also be helpful in controlling GERD symptoms.
Is your heartburn severe enough for you to need medication? Or is it a chronic problem regularly causing symptoms? Although there isn't any hard and fast evidence, there are some things that can be done to lessen the severity of GERD. Some of these include:
You may want to ask your doctor about natural ways to lower acidity and control damage from reflux. As for medications that stop acid production, prescription PPI (proton pump inhibitors) drugs are the most effective. But these strong medications have side effects such as headache, nausea, abdominal pain and diarrhea. These can be minimized by taking them at the lowest effective dose and monitoring their side effects closely.
Reflux Esophagitis
Reflux esophagitis is an inflammation of the esophagus. When heartburn is accompanied by an inflammation of the lining of the esophagus, it's called reflux esophagitis. In about 40% of people with GERD, this inflammation is visible on endoscopy and in many individuals it responds well to medication.
Food and Medication
In order for you to get the best treatment for your heartburn, please visit your doctor to diagnose your condition and to determine which medication is best suited for you.
The goal of treatment is to relieve your heartburn and other GERD symptoms and control the damage that can be caused by reflux for as long as possible. Other conditions that may be involved with GERD include: Reflux oesophagitis, Barrett's esophagus.
Avoid foods that trigger reflux (i.e., acidic foods, citrus fruit juices and beverages) if possible.
Eating smaller meals more frequently helps slow down acid production from within the stomach.
Natural approaches can also be helpful in controlling GERD symptoms.
People with achalasia may be able to control their symptoms by avoiding foods (especially liquids) that trigger the spasms in their esophagus.
The treatment is aimed at eliminating or reducing the severity of the symptoms and preventing complications, such as:
Weight loss Difficulty swallowing Heartburn Inflammation of an area at the top of the stomach (the esophagus) called Barrett's esophagus, which increases your risk of developing cancer
Some people may need to take medications for GERD for a long time. In most cases, medicines are prescribed by your doctor or gastroenterologist (a specialist in digestive disorders).
Before making the decision to take medication for heartburn, you should consult with your doctor.
These medications may not be covered by insurance companies. Prescription drugs available include:
Drugs that suppress acid production in the stomach, such as:
H2 Blockers (ibuprofen) Proton pump inhibitors (PPI's). PPIs are sold under brand names such as Prilosec , Prevacid , and Zegerid . They work by blocking the action of an enzyme called the acid pump that produces acids from the stomach. Drugs that reduce stomach acid production, such as:
Antacids (e.g. Tums/Rolaids/Lomotil/Maalox) H2 blockers (e.g. Pepcid)
Prescription drugs may not be covered by insurance companies.
Drugs that control reflux associated heartburn:
H2 blockers (e.g. Zantac, Pepcid, Tagamet) Proton pump inhibitors (PPI's) (e.g. Prilosec). PPIs are sold under brand names such as Prevacid, Axid, and Omeprazole . They work by blocking the action of an enzyme called the acid pump that produces acids from the stomach.
There are currently no medications specifically approved by the FDA (Food and Drug Administration) for controlling GERD.
However, there are two medications that may offer some relief in controlling your symptoms. Each of these medications have been shown to have relief from symptoms associated with GERD when taken for a short time (2–4 weeks): Metoclopramide and Omeprazole. Antacids such as Tums/Rolaids/Lomotil/Maalox and H2 blockers can also provide some relief from GERD problems when taken regularly.
If you have reflux esophagitis, you may need to take these medications on a regular basis.
These medications should be taken only after checking with your doctor or gastroenterologist.
The goal of treatment is to relieve your symptoms and stop the damage that can be caused by reflux.
Natural approaches may also be helpful in controlling GERD symptoms.
A study published in the December 2005 issue of the "American Journal of Gastroenterology" found that people who had Barrett's esophagus, which is a pre-cancerous change to the lining of the esophagus, recovered more quickly after heartburn treatment.
The study also indicates that there is a connection between smoking and recovering from peptic ulcers and Gastric cardia adenocarcinoma. Researchers suggest that people who smoke should quit to avoid the risk of cancer, chronic heartburn and reflux alone.
Oxygen Therapy
It seems that the average person with heartburn symptoms will get better by changing their diet, avoiding certain foods and beverages, and taking antacids. But if symptoms persist, then the next step is to take medications. If you have severe symptoms you should consider seeking medical attention for your condition. If you can't get relief from your heartburn through diet changes and over-the-counter medicines, then talk to your doctor about prescription medicines that are available. Your doctor may also recommend surgery in rare cases. Although treatment of GERD is not always simple or easy, effective treatment be realized in most people who have an uncomplicated case of GERD.
The main goal of treatment is to relieve your symptoms and stop damage that can be caused by reflux.
Natural approaches may also be helpful in controlling GERD symptoms.
A study published in the December 2005 issue of the "American Journal of Gastroenterology" found that people who had Barrett's esophagus, which is a pre-cancerous change to the lining of the esophagus, recovered more quickly after heartburn treatment.
The study also indicates that there is a connection between smoking and recovering from peptic ulcers and Gastric cardia adenocarcinoma. Researchers suggest that people who smoke should quit to avoid the risk of cancer, chronic heartburn and reflux alone.
