Treatment options for GERD

Treatment for gastroesophageal reflux disease can be tricky. With different levels of severity of GERD comes the decision of which option is best for the patient. The primary treatment options include medications, surgery, and lifestyle changes. Another factor to take into account is that sometimes certain treatments don’t work for some patients, but do for others. You don’t want to jump straight to trying surgery for a patient who could benefit from simple lifestyle changes, but trial and error can take a long time.

There are a few types of medications commonly used to treat GERD. Sometimes a simple over-the-counter antacid, such as Pepto-Bismol or Tums, taken after meals can help people suffering from GERD. Antacid can sometimes cause diarrhea or constipation, but those are more common when the antacids are taken too frequently. H2 Blockers reduce the amount of acid produced by the stomach. H2 Blockers can be over-the-counter (ex: Zantac 25), but higher dosage H2 Blockers are prescription medications. H2 Blockers can sometimes cause headaches, constipation, diarrhea, nausea, and vomiting. If side effects are experienced often, talk to the doctor. Proton pump inhibitors (PPIs) are mostly all prescription medications and they limit acid secretion longer than H2 Blockers. PPIs can cause diarrhea, nausea, vomiting, abdominal pain, upset stomach, headaches, and in rare cases can cause an increased risk for pneumonia and bone fracture. As with H2 Blockers, talk to the doctor about side effects if you experience them often. One type of medication does not necessarily work better than another. It all depends on the person taking it and what the doctor feels is best. 

There are different types of surgery that can be performed for treating GERD. If a person has GERD due to a hiatal hernia, hernia repair surgery can help. There are a few different surgeries that can be done to reinforce the lower esophageal sphincter. One type involves installing a small ring around the outside of the sphincter. It keeps the sphincter closed until food comes down the esophagus and then as the sphincter opens the ring stretches. Another type of surgery called fundoplication involves taking the top of the stomach (called the fundus) and wrapping it around the lower esophageal sphincter. This reinforces the sphincter like the ring, and can also be performed after a hiatal hernia repair. Side effects are rare with these surgeries, although it is common for patients to have difficulty swallowing for the first couple months afterwards and occasionally patients feel slightly bloated.

Lifestyle changes principally involve the person’s diet. Watching what you eat and how much is very important with GERD, but I will go into more detail about diet considerations later. Since obesity has been linked to GERD, losing weight is a must if you are overweight and suffering from GERD. Other lifestyle changes include watching your posture, quitting smoking, raising the head of your bed, and being careful of when you exercise. Keeping good posture after meals and not lying down makes it harder for food to travel backwards. Allow time for food to digest before lying down. The International Foundation for Functional Gastrointestinal Disorders says “Don't lie down within 3 hours of eating. That's when acid production is at its peak, so plan early dinners and avoid bedtime snacks.” Raising the head of the bed is helpful for people who experience GERD at nighttime. It makes it harder for stomach acid to flow back into your esophagus while you are lying down. Scheduling when you exercise can make a difference. Exertion after eating can put stress on your esophagus, so exercising immediately after meals is probably not a good idea. Wait a couple hours to allow the food to digest. 

The main premise for treating GERD is to watch what you are putting down and doing to your esophagus and to talk to your doctor about what is best.

jacksonville.com,. (2015). New device at Mayo Clinic 'a game changer' for acid reflux. Retrieved 18 October 2015, from http://jacksonville.com/news/health-and-fitness/2012-04-18/story/new-device-mayo-clinic-game-changer-acid-reflux

Signs and Symptoms of GERD

There are numerous signs and symptoms of gastroesophageal reflux disease. Some of these signs and symptoms may be experienced by people who do not have GERD,  so oftentimes a person with GERD won’t identify their symptoms as anything abnormal until they get worse. 

Common signs and symptoms of GERD include: bad breath, nausea, pain in chest or upper abdomen (heartburn), difficulty with swallowing, painful swallowing, respiratory problems, vomiting, belching, water brash (sudden excess of saliva), feeling of lump in throat, chronic sore throat, laryngitis, inflammation of gums, erosion of the enamel of the teeth, hoarseness in morning, earache, and a sour taste in mouth. To experience some of these symptoms occasionally is normal; however, if they persist for long periods, it could be an indication that someone has GERD. 

Some of the unusual symptoms such as tooth erosion and ear pain can be confusing for some people. I know I was confused how ear pain can be related to GERD. Stomach acid is a powerful agent. If you are having stomach acid flow backwards, it can reach your mouth and eat away at your tooth enamel. If stomach acid goes far enough up the throat, it is actually possible for it to reach the eustachian tube which connects to your inner ear, causing earache. 

All these symptoms are due to the mighty power of stomach acid. Bad breath? Stomach acid. Heartburn? Stomach acid. Sore throat? You guessed it, stomach acid. Belching? Stomach acid bubbles! Some people experience symptoms of GERD worse than others, and there are even some partially lucky people who don’t experience symptoms at all. I say partially lucky because having symptoms is what is going to prompt you to speak to your doctor about them, getting you one step closer to helping your body. 

A blogger named Holle Abee has a great article on some of the symptoms of GERD and a short story of one of her bad experiences with it. You can read her article at: http://habee.hubpages.com/hub/Symptoms-of-GERD

RefluxMD,. (2015). GERD symptoms 101: What to do about the symptoms of GERD disease. Retrieved 18 October 2015, from http://www.refluxmd.com/learn/resources/2013-03-22/1745/gerd-symptoms-101-what-do-about-symptoms-gerd-disease

How is GERD diagnosed?

There are many ways that gastroesophageal reflux disease can be diagnosed. Often times a person suffering from GERD can correctly diagnose themselves; however, the best way is to go to your physician and ask him or her about GERD before you start trying to treat yourself. Mayoclinic.org lists five diagnosis options for GERD: by symptoms, acid in esophagus monitor, x-ray of upper digestive system, endoscopy, and a test to monitor the movement of the esophagus. 

When visiting your primary care physician, you can describe to him your symptoms. Based on what you tell him, it is possible to diagnose you as having GERD. If your doctor wants to rule out other gastrointestinal diseases (as I talked about earlier, it is often hard to distinguish between gastrointestinal disorders),  he may recommend some of these other tests. 

Monitoring the amount of acid in the esophagus is called an ambulatory acid probe test. It measures acid in the esophagus for 24 hours. “The device identifies when, and for how long, stomach acid regurgitates into your esophagus (Mayoclinic.org)." This is done using a thin and flexible tube which goes through the nose and down the esophagus and is attached to a small computer worn around the waist. It can also be done using a small clip inside the esophagus (placed there during an endoscopy) which transmits information to a computer. After a couple days the clip falls off and is digested. 

An x-ray of the upper digestive system is also called a barium swallow. The patient drinks a solution of barium sulfate which coats the inside of the upper digestive system. The x-ray can then get a silhouette of the system and identify any abnormalities.

An endoscopy is a procedure to view the inside of the esophagus and stomach and can also be used to obtain a sample of tissue for a biopsy. During an endoscopy, a thin, flexible tube with a light and a camera on the end is inserted down the patient’s throat. The physician slowly maneuvers the scope through the system. If a biopsy is needed, a thin instrument is threaded through the scope and comes out the end of the tube to collect the sample. 

Esophageal motility testing (manometry) is particularly useful in determining whether or not the lower esophageal sphincter is working properly. The test measures activity in the esophagus, specifically movement and pressures.

As I said before, you can likely speculate whether or not you have gastroesophageal reflux disease, but the only way to truly know for certain is to go to your physician and ask. It is up to your doctor to then decide if she is comfortable diagnosing you based on your reported symptoms or if she wants to do more testing to be sure.

Ascentxmedical.com,. (2015). G125 for GERD - Ascentix Medical. Retrieved 18 October 2015, from http://ascentxmedical.com/technology-platform/G125-for-GERD/

What Causes GERD?

Typically, there isn’t just one cause of gastroesophageal reflux disease. As the International Foundation for Functional Gastrointestinal Disorders states: “It occurs when the esophageal defenses are overwhelmed by gastric contents that reflux into the esophagus.” This can be because of many reasons. The main problem is that the lower esophageal sphincter doesn’t work like it should. In a normal person, the lower esophageal sphincter contracts to prevent backflow of stomach contents into the esophagus. In a person with GERD, the sphincter fails to contract, or fails to contract completely, and stomach contents flow backwards into the esophagus, causing erosion of the lining. 
There are many risk factors that can lead to gastroesophageal reflux disease or make it worse. Genetics is a major risk factor. According to the Keck School of Medicine of the University of Southern California, genetics is probably the leading cause of GERD. The more people in your family who suffer from GERD, the higher your chances are for getting it. 
Another common cause of GERD is a hiatal hernia. A hiatal hernia is when part of your stomach pushes up through the diaphragm muscle. Normally, there is a small opening (hiatus) in the diaphragm through which the esophagus travels through to connect to the stomach. With a hiatal hernia, the stomach pushes through this opening creating a hiatal hernia. 
Zollinger-Ellison syndrome is another cause of gastroesophageal reflux disease. According to the U.S. National Library of Medicine (MedlinePlus), Zollinger-Ellison syndrome is a condition caused by tumors. It causes the stomach to produce too much of the hormone gastrin. This means the stomach is producing more acid than normal. Where is that extra acid going to go? It’s going to fill up your stomach, and then when the lower esophageal sphincter opens to allow food into your stomach, that acid is going to backflow into the esophagus and weaken the sphincter.
Other risk factors for GERD include, but are not limited to: obesity, smoking, asthma, diabetes, delayed stomach emptying, connective tissue disorders (ex: scleroderma), hypercalcemia (high levels of calcium in the blood), pregnancy, and certain medications. There are risk factors to making GERD worse. Overeating, tight clothing, and bad posture can worsen GERD symptoms. These risk factors put extra pressure on the stomach making it easier for stomach contents to push back into the esophagus. 

With all of these risk factors, it is surprising to me that more of us don’t have gastroesophageal reflux disease. It is impressive that so many things can lead to the damage of one sphincter and create a lifetime of heartburn and ulcers. It may seem like a lot to watch for in your lifestyle, but the result of not taking care of your stomach and esophagus can have serious lifelong repercussions.

Gastrodigestivesystem.com,. (2015).GERD Causes | Gastrodigestivesystem. Retrieved 18 October 2015, from http://gastrodigestivesystem.com/esophagus/gerd-causes

Who Gets Gastroesophageal Reflux Disease?

How prevalent is gastroesophageal reflux disease? It is hard to say exactly just how many people have GERD. What makes it so difficult is trying to figure out who actually has GERD. Some people may have symptoms, but don’t go to the doctor to get diagnosed. It is also possible for people to have symptoms of GERD but have something else altogether. One gastroesophageal problem may look a lot like another. It is common to experience gastroesophageal reflux (GER) occasionally, but GERD is more serious and lasts longer. The difference between GER and GERD is that GERD is a disease. That may seem obvious since the last part of the abbreviation is disease, but telling them apart can be difficult.

With this in mind, many studies have done their best to figure out the epidemiology of gastroesophageal reflux disease. According to the Healthcare Cost and Utilization Project, “60 percent of the population at some time during the year, and 20 to 30 percent weekly, experience symptoms of gastroesophageal reflux disease (GERD), such as heartburn and acid regurgitation.” GERD has been linked to obesity, and with the rise of obesity comes an increase in GERD. On the other hand, a rise in GERD medications has lead to a decrease in GERD hospitalizations (which means fewer people getting diagnosed). The Healthcare Cost and Utilization project found that GERD is more common in females than it is in males.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states that approximately 20% of the US population is affected by GERD. The NIDDK also says that you are more likely to suffer from GERD if you are overweight or obese, a pregnant woman, taking certain medications, or are a smoker or regularly exposed to secondhand smoke.

Healthline.com states that gastroesophageal reflux disease is commonly genetic. “In fact, the University of Maryland Medical Center (UMMC) estimates that about 30 to 40 percent of reflux may be hereditary.” Through all my research I have found that it is not possible to say exactly how many people have GERD, or how many new cases there will be each year. Although this may be the case, it is easy to say that it is not an uncommon disease, and all my sources seem to agree that around 20-30% of the US population suffers from GERD to varying degrees. Many people are able to go on with their daily lives without going to the doctor to get diagnosed or treated for GERD, whether they are aware they have it or not. 

Healthline,. (2015). GERD by the Numbers: Facts, Statistics & You. Retrieved 17 October 2015, from http://www.healthline.com/health/gerd/facts-statistics-infographic#2