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About Allergies About Asthma About Rhinitis

GERD

(Gastroesophageal Reflux Disease)
John Hollingsworth, PA-C

 

 

Gastroesophageal reflux is a medical term describing the inappropriate movement of stomach
acid into the esophagus. This is often referred to as heartburn but may encompass a much
wider range of uncomfortable feelings in the chest, throat and abdomen.  People with GERD often feel that they have chest
tightness or discomfort. Sometimes they cough.  Some people experience increased mucus in their throat, and try to clear their
throat repeatedly.  GERD is most common in people over 40 years old, but can occur at any age.

Most people call GERD heartburn, because burning is one of the more common sensations
associated with it. The problem is that levels of acid in the esophagus are higher than normal.  This causes an uncomfortable feeling in the middle of the chest. Sometimes it causes so much pain it
feels like a heart attack, and other times it is simply a mild discomfort. It may also cause a sour
taste, belching or the feeling of food coming back up in the throat.

The esophagus is not designed to tolerate high acid levels like
the stomach is. The stomach has a very thick mucus layer protecting
the tissue from the acid it makes. When the mucus layer is reduced in
the stomach, pain often occurs and we call that type of pain gastritis,
or inflamed stomach tissue.

There is a muscular valve at the junction of the stomach and
the esophagus that opens when we swallow food, and then closes to prevent food and acid
from leaking back up into the esophagus.  It is called the lower esophageal sphincter or LES.
If the valve leaks, then acid can move back up into the esophagus. This is more likely to occur
after large meals, during exercise or when reclining. Gravity tends to keep the food and acid
in the lower portion of the stomach when sitting upright or standing, unless it is overfull.
When the esophageal sphincter leaks acid into the esophagus, the tissue becomes inflamed,
and irritated. Heartburn is a message. It is telling the victim to avoid that behavior because it is
causing damage to the esophagus.

Long-term inflammation has many negative effects. Any long-term inflammation of the tissue tends to cause changes
that are undesirable, like those changes we see so commonly in the skin of people who have frequent sun exposure.  These
changes are referred to as remodeling. Remodeling may take place in the esophagus when acid levels are chronically
high.  It is desirable to use appropriate avoidance measures and medications to control the problems associated with
inflammation. In the esophagus, there also appears to be a higher rate of cancer associated with the more serious cases of
chronic esophagitis (inflamed esophageal tissue).

Here are a few examples of complaints that may actually be caused or made worse by GERD, but are often attributed to other
causes, such as asthma:

Cough is one of the more common problems caused by GERD. The cough may range from very dry to very wet.
It often follows large meals or meals that are high in acid producing foods. The cough may also occur soon after reclining,
especially on the back, because the stomach leaks more acid into the esophagus when lying down, due to the effect of gravity.
Cough may also be associated with exercise induced GERD.

Chest tightness is also very common. It may be a very generalized feeling, or more specifically in the center of the chest.
Chest discomfort. A non-specific feeling of discomfort which may be generalized, very centralized, or in the lower chest
closer to the stomach.

Throat clearing. GERD may produce a very irritating feeling in the back of the throat as acidic fluid rises up, and may also
trigger post nasal drip. This often results in a frequent effort to clear these secretions by clearing the throat. Many people
associate this with specific foods or drinks, such as chocolate, milk, coffee, tea, orange juice, cola, alcohol, spicy foods,
tomatoes, fatty foods and many others.

When you experience symptoms like those mentioned above try taking a double dose of an over-the-counter liquid antacid.
If the antacid helps, you should discuss this with your medical care provider.

LIFESTYLE MODIFICATIONS

GERD may be partially or totally controlled through lifestyle modification.

EATING AND DRINKING MODIFICATIONS

  • Restrict or completely avoid certain foods that cause GERD:
  • Acidic foods and drinks like, citrus and tomato.
  • Fatty foods like cheese, pizza, garlic bread, creamy sauces and many salad dressings.
  • Spicy foods, including garlic, onion, peppers and salsa.
  • Peppermint and chocolate (the after dinner chocolate mint is a no-no).
  • Caffeinated beverages, like coffee, tea and colas.
  • Carbonated beverages (burping carries acid up into the esophagus).
  • Eat small meals; don’t over fill the stomach.
  • Don’t lie down or exercise right after eating. Wait a few hours.
  • Tobacco products increase acid, avoid them.
  • Alcohol relaxes the LES and increases the leak.  Restrict alcohol.
  • Raise the head of the bed about 6 to 10 inches.

Avoid tight belts and girdles. Allow the stomach to expand naturally with a meal and to contract naturally afterward.
If you’re overweight, losing weight will help. A long-term weight loss program with a permanent change of dietary habits can be incorporated at this time into your life style changes, resulting in an improvement in GERD symptoms.

PHYSICAL MODIFICATIONS

Raise the head of the bed 6-10 inches. Some people place the legs of the head of the bed on blocks. Whatever method you
choose be careful to do it safely.

Avoid tight fitting clothing around the abdomen, especially during and after meals. Suspenders help, so does loosening the belt.

Avoiding bending over after meals.

Don’t exercise vigorously after a full meal, after acidic drinks or food, or when the stomach or esophagus feel uncomfortable.

If exercise increases your GERD symptoms, try taking an OTC antacid 10-20 minutes before exercising.

MEDICATIONS

Antacids – may effectively relieve acid reflux side effects quickly and last up to 3 hours. (The maximum daily dose of
 antacids should be checked on the package and not exceeded.)

Over-the-counter (OTC) or non-prescription antacids like Tums, Maalox, Mylanta, Gaviscon or Rolaids may be helpful
because they temporarily neutralize acid. They work rapidly, giving relief in 5 –20 minutes. The effects wear off in 1-3 hrs.,
 and last longest if taken with food. They can cause acid rebound. After the acid is neutralized the body may raise acid levels
in the stomach rapidly an hour or so after the antacid is taken. They may prevent absorption of several medications if take
within a few hours of the medicine.

Pepto-Bismol has antacid effects, as well as anti-diarrheal effects. It may turn the stool black, which could be a little
frightening if unexpected.

Sodium Bicarbonate (Baking Soda)- Is an effective, fast acting antacid, but may raise blood pressure or cause swelling
due to the sodium.

Acid Blockers (H2 receptor blockers) may effectively reduce acid production for 8-24hrs. Most are OTC at lower
doses and prescription at higher doses.

Tagamet (Cimetidine) <OTC & RX> – Adult dosage 200mg to 1600mg per day, not approved in children. May interact
negatively with several important prescription medications.

Pepcid (Famotidine) <OTC & RX> – Adult dosages 10mg to 80mg per day, see pkg. for children’s dose. Few drug
interactions.

Zantac (Ranitidine) <OTC & RX> - Adult dosages 75mg to 600mg per day, see pkg. for children’s dose. Few drug interactions.

Axid (Nizatidine)<RX> - Adult dosage 150mg-300mg per day, not recommended for children. Few drug interactions

Proton Pump inhibitors <OTC/RX>- The strongest acid reduction medicines. Usually effective for 24 hours. Usually taken
on an empty stomach in the early morning, or upon waking, 30-60 minutes before eating the first meal of the day. May cause
 diarrhea, constipation, nausea or cramps and other complications.

  • Aciphex <RX>
  • Nexium <RX>
  • Prevacid<RX>
  • Prilosec (OTC)
  • Protonix<RX>

SURGERY

In some cases surgery may be required to correct a congenital abnormality, a severely damaged LES valve or a hiatal
hernia. A Gastroenterologist should be consulted for any advice regarding surgery.

PREGNANCY

In general, GERD is made worse by pregnancy.

Consult your obstetrician and or your primary care physician about the best methods of controlling GERD during pregnancy.

SUMMARY

1. GERD often complicates asthma.

2. GERD symptoms can include chest tightness and cough (so they can be confused with asthma or make asthma feel worse).

3. Life style changes may control GERD.

If lifestyle changes are not adequate, there are many medicines available to help manage GERD and improve or totally
alleviate the symptoms.

Surgical options may be available for severe cases.

Pregnancy often makes GERD worse.
 

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