SIMPLY HEALTH: Got GERD? It's More Than Burps and Belches

posted 08/04/2008
Too many curly fries at the fair? The occasional burp or belch is not a problem but if it happens weekly or more often, take note. Up to twenty percent of the adult population experience regular acid reflux and it can also affect infants and children. Symptoms include burning pain or pressure in upper chest, a feeling of something stuck in the throat or a sour mouthful of acid. The pain can sometimes be indistinguishable from severe cardiac chest pain and often sends people to the emergency room. What is going on here?

Reflux of stomach acid or gastroesophageal reflux disease (GERD) is not a minor problem and symptoms can be quite severe. The stomach is made to withstand stomach acids-the esophagus is not. This is what causes the burning sensation and damage to the esophagus. A tight sphincter muscle at the lower esophagus usually keeps the stomach contents in place.

But this muscle sometimes fails to hold back the acid, especially if a person is overweight or pregnant. Going to bed with a full stomach, consuming too much alcohol, or chronic coughing also weaken the muscle. Smoking causes relaxation of the sphincter muscle and allows stomach contents and acid to reflux. Spicy food, rich and high fat foods, chocolate, peppermint, tomato products, coffee and alcohol are common triggers for heartburn. GERD may also trigger adult asthma.

GOT GERD?

Chronic cough or clearing throat.

Chronic hoarseness or sore throat.

Burning pain in upper chest, throat.

Feeling like something "stuck"

Difficulty swallowing

Choking spasms.

Stomach acids increase after meals but are highest during the night. This is when most reflux and acid damage occurs. Going to bed with a full stomach aggravates the problem. It is best to wait two to three hours after a meal before lying down and follow the "water only after 8 p.m." rule.

If untreated, GERD can damage the esophagus and cause hoarseness and recurrent coughing or throat clearing. More severe acid damage causes difficulty swallowing from scarring, bleeding from acid ulceration, and choking or spasms of the esophagus that create acute breathing difficulty. If untreated for many years, GERD causes cellular changes that may lead to cancer of the esophagus.

Treatment starts with reducing the acid levels in the stomach and then focuses on preventing reflux. For the occasional minor indigestion, antacids like Tums and Mylanta work fine to temporarily neutralize acid. Ranitidine (Zantac) and famotidine (Pepcid) are more effective and work by reducing acid production.

However, chronic symptoms require more intensive treatment to avoid the severe side effects of long term acid damage. Omeprazole (Prilosec), a more potent acid reducer, is available over-the-counter. Highly effective if taken daily, especially at bedtime, this medication can heal the effects of an acid-damaged esophagus in six to eight weeks. Seek medical evaluation before you diagnose yourself though, as that chest pain might be heart trouble and not reflux.

Reduce Reflux

Stay upright for 2-3 hrs after eating.
Avoid overeating and feeling stuffed.
Limit coffee, spicy and fried foods.
Losing weight reduces reflux triggers.
Wear clothing with looser waistline.
Quit smoking; limit alcohol intake.
Water only after 8 pm.

Symptoms that do not respond to treatment certainly need additional evaluation. A scoping to visualize the esophagus from the vocal chords to the stomach can evaluate the extent of acid-induced damage. Additional prescriptive drugs may be necessary to promote emptying of the stomach. Occasionally, surgery may be indicated. However, medications do not cure the most frequent causes of the acid reflux-the smoking, drinking, overeating or eating before bedtime. That part is up to us.

For additional information see the following excellent website. "The Word on GERD" by the American College of Gastroenterology at www.gi.org/patients/gerd/word.asp.

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