Gastroesophageal Reflux Disease

Gastroesophageal reflux disease, or GERD, is a digestive disorder that causes heartburn and indigestion. Gastroesophageal refers to the stomach and esophagus, and reflux means "to return." GERD is the return of the stomach's contents back up into the esophagus.

Causes

GERD occurs when the muscle connecting the esophagus with the stomach (the lower esophageal sphincter, or LES) weakens or does not work properly. As a result, the muscle cannot keep the contents of the stomach from going up into the esophagus (see illustration.)

There are many possible causes of GERD. Some doctors believe that a hiatal hernia may weaken the LES. Foods such as chocolate, peppermint, and fried or fatty foods may also relax the muscle, as can coffee and alcoholic beverages. Other contributing factors include cigarette smoking, obesity, and pregnancy.

Symptoms

The main symptom of GERD is heartburn, or acid indigestion. Heartburn feels like a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. Sometimes people who have GERD also have an acidic or bitter taste in the mouth.

Treatment

Treatment for GERD focuses on one of two things: (1) decreasing the amount of stomach contents that go back up to the esophagus or (2) reducing the damage to the lining of the esophagus. In many cases, dietary and lifestyle changes can help reduce the symptoms of GERD. Taking antacids can also help, but they should not be used long term because they can have side effects, such as diarrhea and a buildup of magnesium in the body. For chronic GERD discomfort, medications are available to reduce the production of acid in the stomach. These fall into two groups, H2 blockers and proton pump inhibitors (PPI).  H2 blockers are available OTC and have names such as famotidine, ranitidine, and cimetidine.  One proton pump inhibitor is currently available OTC, omeprazole.  The other PPIs are available only by prescription

Self-Care

• Avoid foods and beverages that can affect the LES or irritate the lining of the esophagus. Examples include fried or fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and citrus fruit juices, and tomato products.

• Lose weight if you are overweight. Your body mass index, BMI, should be less than 25.

• Stop smoking.

• Raise the head of your bed 6 inches. Use blocks or bricks to elevate the legs of the bed rather than using pillows to prop up your head.

• Avoid large meals. Instead, eat smaller, more frequent meals.

• Avoid lying down right after eating and avoid eating within 4 hours of bedtime.

• Use H2 blockers or antacids as directed.  If your physician has prescribed a proton pump inhibitor, take it as directed.