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    Heartburn or GERD?

    Andrew Benton, MD Family Medicine, Deaconess Clinic Gateway 11/11/2017

    When is heartburn more than just heartburn? The quick answer is when the heartburn happens two or more times per week over several weeks, your taco dinner with hot sauce isn’t to blame and it may be time to talk to your doctor about GERD.

    What is GERD?
    Heartburn is typically described as a burning sensation in the upper chest/throat, usually after a meal. Gastroesophageal reflux disease, GERD, can be a serious form of heartburn that can lead to complications as serious as esophageal cancer. It is typically recognized as a condition that develops when reflux from the stomach causes heartburn-like symptoms usually two or more times per week.
    Other symptoms include:

    • A small amount of regurgitation, which is the feeling/taste of refluxed stomach contents like acid and undigested food into the mouth. (Basically, it feels like you “threw up” a little in your mouth.)
    • A frequent sour or bitter taste in the mouth
    • Coughing, bad breath and other similar symptoms
    • If your symptoms have been present for a while, they can lead to inflammation which causes difficulty swallowing or pain when you swallow.

    Causes/risk factors of GERD
    GERD typically occurs in adults, and becomes more common in middle age, or with certain conditions such as pregnancy.

    Risk factors for GERD include:•Being overweight or obese. Extra weight—especially around the middle—puts pressure on the stomach and can cause gradual weakening of the sphincter (sort of a valve at the top of the stomach) that allows food and stomach acid to go back up the esophagus.

    • Pregnancy (again, because of that added pressure in the abdomen)
    • Hiatal hernia (where the stomach is bulging internally through muscles inside the chest)
    • Smoking
    • Diabetes (which can damage the nerves of the stomach)

    How is GERD diagnosed?
    Most of the time, GERD is diagnosed based on discussion of your symptoms, a medical history with your doctor and a physical exam. Testing may be needed to rule out other possible causes of your symptoms that could be related to heart, lung or gallbladder problems.

    Sometimes patients need a test where sensors are inserted down the nose, into the throat, and into the stomach to detect stomach acid as it comes up the throat.

    If GERD is particularly severe, or there are worrisome symptoms (such as problems swallowing), a doctor may recommend an EGD, also known as an “upper endoscopy.” During this procedure, sedatives are given so the patient is relaxed and semi-conscious. Then, a long flexible camera is inserted into the mouth, down the esophagus, and into the stomach to look for signs of inflammation or damage. Occasionally, tissue biopsies are taken. The patient is released to go home after the procedure.

    Complications of GERD
    The stomach acid that is responsible for most of the GERD symptoms can cause serious damage to the esophagus over time. GERD can lead to tooth decay and other oral health problems because of the ongoing tissue damage from the stomach acid.  A chronic cough can also develop from the constant throat irritation.

    A serious complication of GERD is Barrett’s esophagus, which is the development of scar tissue in the esophagus. This can lead to problems with swallowing, or painful swallowing. Over time, Barrett’s esophagus can be a concern for the development of esophageal cancer, which can lead to the loss of being able to eat (needing a GI tube for nutrition) or even death.

    Treatment options
    GERD is more than just uncomfortable or unpleasant—it’s serious and should be treated. There are several lifestyle choices that can help improve GERD and heartburn in general. They include:

    • Weight loss – If you are overweight, losing weight can reduce pressure on the stomach and improve symptoms.
    • Sit up after eating - Try not to lie down soon after a meal to give food a chance to empty from the stomach.
    • Prop up the head of your bed – This is most easily done by putting platforms or even pieces of scrap wood under the legs at the head of the bed.
    • Stop smoking – This seems to help reduce symptoms.
    • Take over-the-counter medicine – Over-the-counter antacids like Tums or Rolaids are a good option for immediate relief but are not a long term solution.

    There are also 2 main classes of medication that reduce the amount of stomach acid your body makes. The first consists of H2 blockers like Zantac or Tagamet. The second class contains PPIs, proton pump inhibitors, such as Prilosec or Protonix. H2 blockers can be a first-line medicine (try them first), but PPIs are generally regarded as more effective and more convenient with once a day dosing. Patients generally complete a 6-8 week course and then see if symptoms return.

    Note:  Pregnant women experiencing heartburn/GERD symptoms should not try to lose weight, and should talk with their doctor about any medication decisions.

    Avoiding certain food and beverages can help with GERD symptoms. Items to avoid include:

    • Spicy foods
    • Fried/fatty foods
    • Alcohol
    • Carbonated drinks (sodas)
    • Peppermint (although some people say it works for heartburn, so try it and see what happens for you)
    • Acidic foods, such as tomatoes, citrus fruit/juice, vinegar in foods/salad dressings

    This, on top of weight loss, smoking cessation and appropriate medication, can do a lot for helping to resolve many if not most cases of GERD.

    If GERD is resistant to all therapies offered, there are surgical procedures for selected patients which can be done to essentially tighten the muscles at the bottom of the esophagus.

    The bottom line with heartburn and GERD is to pay attention to your symptoms. When they continue long after your body has processed spicy food or some orange juice, make an appointment with your doctor to find out what’s going on. You can also schedule a new patient appointment online with Deaconess Clinic Gastroenterology.  


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