What are the causes of GERD?
Gastrointestinal Esophageal Reflux Disease, also known as acid reflux disease, is a fairly common condition affecting over 60 million people in the U.S. alone. It is basically a chronic recurring condition in which gastric acid from the stomach travels backwards into the esophagus causing varying degrees of discomfort and eventually damaging the esophagus.
Our digestive system is set up such that when we eat, food travels down our esophagus into our stomach where it is digested using strong acids, enzymes and the mechanical contraction of the stomach muscles. The lower esophageal sphincter (LES), shown in figures one and two, prevents food from leaking backwards into the esophagus by contracting tightly. It helps to think of the LES as a door which only opens in one direction. However, sometimes the LES can become weak and instead of closing firmly, it stays slightly ajar allowing food to travel both ways. Other times the LES door is forced open due to increasing pressures in the stomach that might occur after eating a large meal. Knowing that the stomach requires room to expand and contract during digestion helps to understand why overfilling it could affect the LES function. When it is completely full, contraction causes the churned semi-digested food to push up against the LES and eventually break through into the esophagus. Other physical or structural mechanisms that increase intra-abdominal pressure can also cause GERD including obesity, pregnancy or hiatal hernias (protrusion of the upper part of the stomach). Also, several studies have shown that certain types of foods and habits might worsen the incidence or symptoms of reflux. These include but are not limited to the following:
- smoking
- drinking beverages containing alcohol and caffeine (some people report increased reflux with carbonated drinks)
- chocolate
- citrus fruits
- fatty and fried foods
- garlic and onions
- spicy foods
- tomato-based foods such as spaghetti sauce, salsa, chili, and pizza
What are the symptoms?
The esophageal lining was not designed with a protective layer to withstand acid from the stomach. The backed-up acidic food burns the esophagus which causes chest pain or heartburn. People usually describe this pain as a burning sensation in their chest which tends to travel up into their throat. They might also experience some bitter brackish water taste in their mouth and burp a lot. With chronic episodes of reflux, the lining of the esophagus gets so scared that it can begin to bleed, form ulcers (internals sores), or undergo changes that could eventually become cancerous. Other symptoms associated with GERD are flare-ups of asthma especially in children, dry coughs, and difficulty swallowing due to narrowing of the
How to prevent and treat GERD
- Eat smaller sized portions at a sitting and avoid foods that tend to upset your stomach
- Avoid lying down immediately after eating. Allow up to one to two hours between having a meal and when you lie down. The goal is to keep the stomach as erect as possible in order to reduce forces on the LES that can be increased when lying supine. Also, try propping up your head when lying down by using extra pillows.
- Try over-the-counter medicines such as antacids (e.g. Alka-Seltzer, Maalox, or Rolaids) or calcium carbonates (e.g. Tums) which work by reducing acid production in the stomach. It is time to talk to your healthcare provider if you find yourself taking antacids frequently or continuously for more than a week.
- Your doctor after performing a complete history, physical exam and imagining studies if needed, might recommend the following treatment options:
a) Medications (e.g. Pepcid, Zantac, prilosec, Prevacid, Protonix or Reglan)
b) Surgery. This is usually reserved for people who do not improve over a period of time after trial of lifestyle changes and medications. Overall, however, most people respond well to medications and will not require surgery.
For more information visit the following sites
1) National Digestive Diseases Information Clearinghouse at http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
2) WebMD Heartburn/GERD Guide at http://www.webmd.com/heartburn-gerd/guide/acid-reflux-symptoms
3) MayoClinic GERD at http://www.mayoclinic.com/health/gerd/DS00967
Links to figures:
1) http://www.riversideonline.com/source/images/image_popup/ans7_esophagus.jpg
2) http://graphics8.nytimes.com/images/2007/08/01/health/adam/19609.jpg