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Gastroesophageal Reflux Disease (GERD)

If you feel a painful burning sensation in your chest after you eat, you may have gastroesophageal reflux disease (GERD). Heartburn is a classic symptom of GERD, but you may have other symptoms as well. Some Common Symptoms:

  • Frequent heartburn or burping
  • Sour-­‐tasting fluid backing up into your mouth
  • Symptoms that get worse after you eat, bend over or lie down
  • Difficulty or pain when swallowing
  • Chest pain may also be caused by heart problems. Be sure to have all chest pain evaluated by a doctor.

 

Physiology of GERD

After you eat, food travels from your mouth down the esophagus to your stomach. Along the way, food passes through a one-­‐way valve called the lower esophageal sphincter (LES), the opening to your stomach. Normally the LES opens when you swallow. It allows food to enter the stomach, then closes quickly. With GERD, the LES doesn’t work normally. It allows food and stomach acid to travel back (reflux) into the esophagus.

 

Relieving Discomfort

Work with your doctor to find the treatment options that best relieve your symptoms. These may include lifestyle changes, medication and possibly surgery.

 

Lifestyle Changes for Controlling GERD

When you have GERD, stomach acid feels as if it’s backing up toward your mouth. Whether or not you take medication to control your GERD, your symptoms can often be improved with lifestyle changes. Talk to your doctor about the following suggestions, which may help you get relief.

 

Raise your head

Reflux  is  more  likely  to  strike  when  you’re  lying  down  flat,  because  stomach  fluid  can  flow  backward  more easily. Raising the head of your bed 4-­‐6 inches can help.

To do this: Slide blocks or books under the legs at the head of your bed. Or, place a wedge under the mattress. Many foam stores can make a suitable wedge for you. The wedge should run from your waist to the top of your head.

Tip: Don’t just prop your head on several pillows. This increases pressure on your stomach. It can make GERD worse.

 

Watch your eating habits

Certain foods may increase the acid in your stomach or relax the lower esophageal sphincter, making GERD more likely. It’s best to avoid the following:

  • Coffee, tea and carbonated drinks (with and without caffeine)
  • Fatty, fried or spicy food
  • Mint, chocolate, onions and tomatoes
  • Any other foods that seem to irritate your stomach or cause pain

 

Relieve the pressure

  • Eat smaller meals, even if you have to eat more often.
  • Don’t lie down right after you eat. Wait a few hours for your stomach to empty
  • Avoid tight belts and tight-­‐fitting clothes
  • Lose excess weigh

 

Tobacco and alcohol

Avoid smoking tobacco and drinking alcohol. They can make GERD symptoms worse.

Medications for GERD

GERD can be treated with several types of over-­‐the-­‐counter or prescription medications. In many cases, medications may be used together to help treat your GERD. Your doctor will tell you which medication is best for your symptoms.

 

Antacids

Many over-­‐the-­‐counter antacids are available. These neutralize or weaken stomach acid. You don’t need a doctor’s prescription to buy them. You should take these antacids only when you need to, according to your doctor’s advice.

Side effects may include constipation or diarrhea. If you have high blood pressure, check with your doctor. Antacids can be high in sodium.

 

H‐2  blockers

If antacids alone don’t work, your doctor may recommend stronger medications called H-­‐2 blockers. These medications suppress most of the stomach’s acid production. Many of these medications are now available at a lower dosage without a doctor’s prescription.

Note:  H-­‐2  blockers  are  mainly  used  short  term.  They  may  cause  confusion  in  elderly  patients.  Some  can  also increase  the  effects  of  alcohol.

 

Proton-­pump inhibitors

These medications reduce stomach acid even more than H-­‐2 blockers. They are available over-­‐the-­‐counter and by prescription. Your doctor may prescribe one of these medications for you to help control the symptoms of GERD.

Note: These medications are mainly used short term. Side effects can include stomach or abdominal pain, diarrhea, and nausea.

 

Prokinetics

Some medications strengthen the squeezing action of the esophagus. Some make the stomach empty faster. These medications are usually used with H-­‐2 blockers. They are available only with a prescription.

Prokinetics can have many side effects: Including tiredness, depression, anxiety and problems with physical movement. They also can cause abdominal cramps, constipation, diarrhea and the “jitters.”

Medications to Avoid: Aspirin and anti-­‐inflammatory medications like ibuprofen reduce the protective lining of your stomach, which can lead to more irritation. Be sure to check with your doctor or pharmacist before taking any new medications.

 

Surgery for GERD

During this surgery, called a fundoplication, your lower esophageal sphincter (LES) is re-­‐created by wrapping the top of your stomach around the esophagus. It can sometimes be done with a laparoscope through several small incisions instead of a single long one, as in the traditional open procedure. As a result, there is less pain, a quicker recovery time, a shorter hospital stay, and lower risk of infection.

  •  Lifting the Esophagus-If the opening of the hiatus is too large (hiatal hernia), the doctor may tighten it with a few stitches (sutures). This repairs the hiatal hernia. Then the esophagus is lifted out of the way for a short time.
  • Laparoscopic Surgery‐You will be given anesthesia and any other medications through an intravenous tube. You will be asleep during  surgery.
    • Your abdomen will be inflated with carbon dioxide gas to provide more space for your surgeon to see and work. (The gas is removed at the end of surgery.)
    • The laparoscope, which has a camera attached, is then inserted through an incision to send images to a video screen. Small surgical instruments are  inserted through other incisions.
  • Open Surgery-­If your surgeon feels it isn’t safe to continue with a laparoscopic procedure once surgery has started, he or she will complete the operation through a larger incision in your chest or abdomen. This is called an open procedure.
    • This surgery requires a longer recovery time, up to 1 week in the hospital and from 4-­‐6 weeks at home.

 

Risks and Complications of Surgery

  • Injury to the liver, spleen, esophagus or stomach
  • Infection
  • Increased gas or bloating
  • Bleeding
  • Inability to vomit
  • Difficulty swallowing
  • Failure of the operation to eliminate GERD

 

Helpful Links

Suburban Gastroenterology