GERD



	What is GERD When food is swallowed it travels down the esophagus to the stomach. The esophagus is a long tube that connects the back of the mouth to the stomach. Muscles at the bottom of the esophagus tighten and relax in order to let food into the stomach at the appropriate time and tighten in order to keep the food from coming back up into the stomach once you have finished eating. Stomach is a big bag of acid. It grinds the food in acid and dissolves it and gets it ready for digestion. Stomach is lined with specialized cells that can withstand the mechanical and acidic environment they are surrounded by. From time to time the muscles in the esophagus relax at inappropriate times causing the noxious fluid from the stomach to come up. This causes heart burn related to gastro-esophageal reflux disease (GERD). Over time untreated GERD can have serious medical consequences. Symptoms of GERD 1. Pain and/or burning behind the sternum (breast-bone) 2. Symptoms worsens with food 3. Feeling of fullness 4. Hoarseness 5. Weight loss 6. Globus tightness in the throat, feeling like food is stuck in the throat 7. Sour taste in the mouth What can worsen your Symptoms? Overeating Eating too fast Bending forward or lying down after a meal Drinking liquids with meals, specially with starch based foods such as bread, rice and pasta. Carbonated beverages Caffeinated beverages Chocolate Highly acidic foods: citrus, tomatoes,… Nicotine Alcohol Obesity Pregnancy Peppermint Garlic Stress Some medication May worsen GERD Verapamil, Diltiazem, Norvasc Fosomax Narcotics Ibuprofen, Advil, .. Potassium, vitamin C and iron supplements Asthma medications Anti-histamines DHEA What to do about it Depending on how typical symptoms are and whether there is a history of cardiac disease or risk factors it may be prudent to rule out cardiac causes of chest pain prior to treatment for GERD. Once the diagnosis is settled then a course of treatment starting with lifestyle modification and progressing to stronger and stronger medications may be appropriate. More frequent, smaller meals Avoid irritants (see list above) No food 2 hours prior to going to bed/lying down No drinks with or for at least one hour after a meal Weight loss Avoid wearing tight clothing Avoid chewing gum Eat "slowly" and avoid inhaling as you eat Nicotine and alcohol cessation Sleeping in semi-upright position Lie on right side at night Over the counter antacids Prescription antacids Drink 2 glasses of water before eating anything in the morning. This will dilute the acid that builds up in your stomach overnight. Drink 2 glasses of water a few minutes before each meal Individuals who do not respond appropriately to lifestyle changes and over the counter medication may benefit from blood testing for H Pylori infection and treatment. If despite all these measures relief of symptoms can not be achieved then endoscopy or X-rays may be indicated. Medical Therapy For the majority of patients therapy should be short term and directed towards curing infections and reducing stomach acid for 6-12 weeks in order to expedite healing of the stomach and esophageal lining. During this time patients should make appropriate changes in their food and drink consumption, stress management strategies and lifestyles. Subsequently, patients should attempt to discontinue the acid reducers gradually. Most patients are able to manage acid reflux without medications unless serious mechanical problems such as large hiatal hernias or esophageal stricture or advanced liver disease prevent this from happening. Over the counter antacids such as TUMS contain calcium based salts like calcium carbonate. These remedies help to neutralize acid thus relieving the symptoms immediately for a short period. They do not alter acid secretion but reduce the amount that is free to irritate stomach lining. Their effect is short lasting and is not ideal for those with mechanical problems or symptoms related to an ongoing problem such as stress or a mechanical problem leading to heart burn. These medications should not be used at the same time as many medications as calcium can bind to and render some medications ineffective. Histamine blockers like zantac, pepcid, cimetidine.... reduce acid production in the stomach for 12-24 hours. They are not as potent as PPI's but are effective with a single dose achieving as much acid reduction as the 10th dose therefor these agents are used effectively on as needed basis for those with only occasional heart burn with dietary indiscretion. Proton Pump Inhibitors PPI's like prevacid, prilosec, nexium,...are the most potent agents for reducing stomach acid. These medications are more valuable as maintenance therapy when a 6 to 12 week course is recommended. These medications have an accumulative effect with each dose shotting down10-20% of acid production in the stomach for 10-14 days with each dose. As such, their maximal effect may not be realized for up to one week after start of therapy. So when need for acid suppression is intermittent these are not the best choice for therapy. Gaviscon over the counter taken after meals to prevent reflux. It forms a coating on top of the meal preventing return of food into the esophagus regardless of the acid status of the stomach. Sucralafate (Carafate) over the counter taken before meals to coat the stomach and reduce irritation from food. It is usually used as a short term adjunct to PPI's to reduce symptoms until enough healing has occurred in the stomach lining to relieve symptoms. Warning Signs signaling serious complications of GERD Persistent daily symptoms with severe, escalating pattern can be a manifestation of serious medical problems. Persistent nausea, fullness, hoarseness, pain with swallowing can over time lead to erosions in the esophagus. Same pathology that can lead to GERD also causes gastric ulcers and gastritis. These conditions can lead to hemorrhaging from various parts of the gastrointestinal system manifested by black tarry stools, blood in vomitous or stool, diarrhea, fatigue, shortness of breath and dizziness. If any of these symptoms occur immediate medical attention is necessary.