Across the United States, millions of people suffer from gastroesophageal (acid) reflux disease (GERD). However, there are not always indications as to the cause of the flare-ups that occur in GERD patients. Read on to find out more about GERD, its causes, and what to do.
What is GERD?
GERD refers to the situation where stomach acid backs up into the esophagus. As you can imagine, this is not supposed to happen. Yet, this regurgitation of acid does occur frequently. The chronic condition of this occurring is GERD.
Normally, food travels from the mouth, through the esophagus, and into the stomach. This should result in a normal downward trajectory. At the bottom of the esophagus is a ring of muscle known as the lower esophageal sphincter (LES). The LES is responsible for contracting in order to keep the stomach's contents -- particularly the acid within the stomach -- from refluxing or coming back up the esophagus. If you've got GERD, your LES doesn't close right and you have acid reflux.
The esophagus lining is incredibly sensitive and a negative reaction occurs when stomach acid touches it. The best way to understand this reaction is to consider what occurs when lemon juice gets in your eye. This makes it easier to understand the frequent characterization of GERD as a burning sensation. This burning sensation is also known as heartburn.
It is normal for us to have occasional heartburn. However, if it occurs at least twice per week, the cause may be GERD. If it's not treated, there are potential complications. For example, there may be permanent damage to the esophagus lining, which could cause esophagitis. This condition is simply the inflammation of the esophagus. This is not a common occurrence.
Another possibility is Barrett's esophagus. This is a pre-cancerous condition and requires routine endoscopic surveillance by a GI specialist. The surveillance is done to check for the development of cancer. Other possible complications include ulcers, asthma, inflammation of the laryngeal and throat (named laryngopharyngeal reflux or LPR), lung inflammation and infection, and sinus and middle ear fluid collection.
Who gets GERD or LPR?
GERD can happen to anyone, regardless of gender or age. However, some populations are particularly susceptible to GERD, such as overweight people and pregnant women. The higher risk in these populations is because of the pressure placed on their stomachs. Moreover, it is acknowledged that GERD isn't considerate of age. Frequently, GERD is overlooked in children and infants. In this group, GERD can lead to respiratory problems (including ear infections and sore throat), coughing, and repeated vomiting. However, most infants outgrow GERD by their first birthday.
What are the symptoms of GERD or LPR?
There are numerous symptoms of GERD. These may include nausea, persistent heartburn, or acid regurgitation. Regurgitation can be into the throat and/or mouth. However, heartburn sometimes doesn't occur with GERD and, instead, chest pain is felt. At times, this pain is mistaken for a heart attack. Other symptoms of LPR may include hoarseness upon awakening, chronic cough, chronic throat clearing, laryngospasm and/or trouble swallowing. In other cases, people may feel like they are choking or have food stuck in their throat. There are also cases where people report symptoms of burping, blood in stools or vomiting, bloating, persistent hiccups, or weight loss that cannot be explained.
What causes GERD and LPR and how can it be prevented?
GERD can be caused by a malfunctioning or abnormal LES, slow stomach emptying, abnormal contractions in the esophagus, or hiatal hernia. However, lifestyle factors and the consumption of certain foods/drinks can also contribute to GERD and can be remedied by the person. For example, lifestyle factors include obesity, smoking, alcohol use, or pregnancy.
You can also avoid certain foods and drinks. These include:
- Caffeine (including caffeinated drinks)
- Citrus fruits
- Garlic and onions
- Fatty and fried foods
- Mint flavorings, specifically peppermint
- Tomato-based foods, like spaghetti sauce or chili
- Spicy foods, such as taco meat
- Carbonated drinks
It is also recommended that those with GERD eat small meals slowly and wear clothing that is loose.
How is GERD or LPR diagnosed?
LPR can be diagnosed by symptoms as well as an endoscopic visualization of the larynx and lower throat in the office by an ENT physician. GERD is diagnosed and/or evaluated through clinical observation and patient response to a medication trial as well as an upper endoscopy by a GI specialist. Some medical providers may order additional testing, such as an endoscopy of the esophagus, x-ray, biopsy, manometry, Bernstein test, studies of emptying of the stomach, and esophageal acid testing over 24 hours. Some tests may involve light sedation or an outpatient hospital setting.
Most GERD can be treated through lifestyle changes and medication. However, there are some cases where surgery is required. Lifestyle changes may involve weight loss, smoking cessation, wearing loose clothing, raising of the head while in bed, no eating at least three hours prior to bed, and limiting certain foods.
Medications may include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barriers. Not all of these are prescription based. In fact, many can be bought without a prescription, such as Tums, Rolaids, Prilosec, and Nexium.
If surgery is required, procedures are conducted with the purpose of tightening the LES. This can be done by fundoplication or endoscopy, depending on the method used by your doctor.
When should I see a doctor?
You need to see a doctor if you have heartburn at least twice per week, experience frequent chest pains after eating, have persistent nausea, trouble swallowing or an unexplained cough, hoarseness or sore throat. These symptoms are the hallmarks of GERD or LPR and treatment is necessary, which will alleviate your symptoms and reduce the likelihood and severity of complications.
How can my ENT help?
ENTs can help because of their extensive experience in diagnosing and treating laryngopharyngeal reflux (LPR), including complications of GERD.
GERD can be a problematic condition. However, it doesn't have to be. You can get treatment and enjoy food again, within certain constraints. Your ENT can help you determine if you have LPR or GERD and how it should be treated most effectively. Treatment is needed and can lead to improved quality of life, as well as reduction of discomfort and pain. Therefore, if you experience frequent symptoms of GERD, make an appointment today.