Gastroesophageal reflux disease (GERD) may be known by several names including heartburn, indigestion and acid reflux, but they all refer to unpleasant sensations related to digestive acids in the stomach backing up into the esophagus.
GERD is a common condition that affects about 10 to 20% of people in the United States, but various treatments can help reduce its frequency and relieve symptoms. In this video, San Diego Health host Susan Taylor talks with Franklin Tsai, MD, a gastroenterologist at Scripps Clinic Torrey Pines, about what causes GERD and what to do about it.
When digestive acids from the stomach enter the esophagus (called acid reflux), they typically cause a burning sensation in the chest known as heartburn. It also may feel like food is coming back up into the chest. Less common symptoms of GERD may include chest pain, having a sour taste or lump in the throat, nausea, coughing, hoarseness of the voice, or trouble swallowing. Symptoms may last from a few minutes to hours.
For some people, certain types of foods are likely to trigger an episode of GERD. The most common food triggers include spicy foods, fatty foods, chocolate, citrus fruits, tomatoes, coffee and alcohol. However, food is not the only culprit. Eating too close to bedtime (and the lying down before your food is digested) or overeating can be triggers as well, as can smoking.
While GERD can affect anyone, certain factors can raise the risk. Obesity places increased pressure on the stomach, as does pregnancy. Other conditions that might increase the risk include diabetes, asthma and connective tissue disorders.
“Without treatment, severe or chronic GERD can cause complications such as acid damage, inflammation or scarring of the esophagus,” says Dr. Tsai. “It can even cause precancerous changes in the esophagus, such as Barrett’s esophagus, that could increase one's risk of esophagus cancer.”
In most cases, the first step in treating GERD is to make lifestyle changes.
“I would advise patients with GERD to avoid eating acid-forming foods. Also, avoid eating two to three hours before bedtime,” says Dr. Tsai. “Though it’s not easy to give up that chocolate or alcohol, often with diet and lifestyle modifications you can control the acid reflux.”
Dr. Tsai also encourages weight loss; losing 10 pounds will take a lot of pressure off of the stomach and reduce the likelihood of acid reflux.
If diet and lifestyle changes aren’t effective or people have a physical condition that raises the risk of acid reflux, medication may be necessary. Over-the-counter antacid medications may help relieve symptoms. Stronger medications also are available by prescription.
“If you have severe or persistent symptoms that aren’t responding to antacids or diet changes, new unusual symptoms after the age of 50, or worrisome symptoms, such as vomiting, bleeding, black tarry stools, anemia, unexpected weight loss, or sensation of food getting stuck when you swallow, you should see your doctor,” says Dr. Tsai.
For patients with more severe acid reflux that doesn’t respond to dietary changes or medication, surgical options, including outpatient surgery, can tighten the valve that lets acid back into the esophagus.
Newer minimally invasive procedures that repair the esophagus valve include a laparoscopic surgery that places a ring of magnets in the lower esophagus. Another procedure allows the physician to use a scope to tighten the valve with staples. Patients typically return to normal activities in a few days, although they may be on a soft diet for a few weeks.
If you experience moderate to severe GERD symptoms, especially chest discomfort, make an appointment with your doctor or gastroenterologist to rule out other conditions and develop a treatment plan.