When we hear about GERD, or gastroesophageal reflux disease, we typically think about heartburn, which is a burning- and painful- sensation in the middle of your chest and in the middle of your stomach. However, not all adults that have GERD experience heartburn.
Some of the other very common symptoms of this condition include the following:
- Nausea
- Difficult/painful swallowing
- Bad breath
- Pain in chest/upper area of abdomen
- Vomiting
- Wearing away of teeth
In some cases, the symptoms of GERD are due to the complications it brings with it, including adversely affecting your lungs.
Causes of GERD
Gastroesophageal Reflux Disease occurs when the lower sphincter of your esophagus relaxes when it shouldn’t be or becomes weak.
This results in the contents of your stomach rising up into your esophagus. This weakening or relaxing can be caused by the following:
- Obesity or pregnancy causing an increase in pressure on your abdomen
- Specific medications such as the following:
- Those used to treat asthma
- Those that treat high blood pressure
- Allergy medications
- Sedatives
- Painkillers
- Smoking or being around a smoker and inhaling second-hand smoke
In addition to the above, GERD can be caused by a hiatal hernia, which is a condition where the opening in your diaphragm allows the upper portion of your stomach to rise up into your chest, which results in lowering the pressure of the esophageal sphincter.
When to Visit a Physician
If you notice that you have any of the signs and symptoms of this condition, and you are unable to obtain relief with OTC medications or by changing your diet, you should visit your physician to find out about treatment options.
In addition, contact your physician immediately if you experience any of the following:
- Vomiting large amounts
- Regular, projectile vomiting
- Vomit that is green/yellow
- Vomit that has the appearance of coffee grounds
- Vomit containing blood
- Have difficulty breathing after you vomit
- Pain in your mouth/throat when eating
- Difficulty swallowing
- Pain when swallowing
Diagnosing GER and GERD
Most of the time, your physician will be able to diagnose GER, or gastroesophageal reflux, by simply taking some time to review your medical history as well as your current symptoms.
If you have been unable to improve your symptoms by making changes in your medications and/or lifestyle, your physician may order further testing.
On the other hand, your physician is most likely to recommend testing for GERD if your symptoms do not improve with treatment, or if they return on a regular basis, or if you have difficulty swallowing.
He/she may send you to a specialist, called a gastroenterologist, to diagnose and treat GERD.
Tests Used to Diagnose GERD
There are several different tests that your gastroenterologist can use to diagnose GERD- he/she may recommend more than one test to reach an affirmative diagnosis.
Upper GI endoscopy/biopsy
With an upper GI, your surgeon or gastroenterologist, or other trained professional will use an endoscope in order to see the inside of your upper GI tract.
This will take place at an outpatient center or a hospital, depending upon what your medical team decides.
The medical team will place an IV needle into your arm to give you a sedative, which will keep you comfortable and relaxed during the procedure.
In some cases, your physician may be able to perform this procedure without sedating you.
The physician performing the procedure will give you a liquid anesthetic that you will either spray on the back of your throat or gargle.
He/she will then very carefully feed the endoscope down your esophagus and into your stomach and upper GI tract.
A very small camera is mounted on the endoscope and will send a video image to a monitor, which will allow the physician to make a careful examination of your upper GI.
The endoscope also gently pumps air into your stomach and upper GI, which will make it easier to see.
In addition, the physician may perform a biopsy with the endoscope. It will take a very small piece of tissue from the lining of your esophagus.
You’re not going to feel it and pathologist will take the tissue to the lab for examination.
In most cases, an upper GI will only be able to show a diagnosis of GERD if your symptoms are moderate to severe.
Upper GI series
This test will take a look the way your upper GI tract is shaped and will be performed by an x-ray technician either at an outpatient center or at a hospital, depending upon your physician’s preference.
A radiologist will then read and report on the images. For this test, you won’t need any anesthesia because it’s just an x-ray.
However, there are some things that you will be instructed to do in order to prepare for it.
During an upper GI series, you will be instructed to sit or stand in front of an x-ray machine.
You will also need to drink barium in order to the lining of your upper GI tract. As the barium moves through your GI tract, a technician will be taking several x-rays.
An upper GI series won’t reveal GERD in your esophagus- however, since the barium shows up on the x-ray, it will reveal related issues such as the following:
- Ulcers
- Esophageal strictures
- Hiatal hernias
After the procedure, for a very short time, you may experience some nausea and bloating.
Additionally, for several days following the procedure, you might have very light-colored to white stools- this is due to the barium.
Your physician or other healthcare professional will let you know what you need to do about taking medications, drinking, and eating following the procedure.
Esophageal pH & impedance monitoring
When it comes to testing for GERD, the most accurate procedure is monitoring impedance and esophageal pH.
This procedure measures the amount of acid in your esophagus while you go about your normal activities such as sleeping and eating.
A gastroenterologist will perform this procedure at an outpatient center or a hospital in conjunction with an upper GI endoscopy. Most of the time, you can stay awake during this procedure.
The gastroenterologist will place a thin tube through your mouth or nose and into your stomach. He/she will then pull it back and tape it to your cheek to hold it down and keep you from accidentally pulling it out.
This tube will measure how much acid is coming into your esophagus and when and the other end will be attached to a monitor that you will wear for 24 hours before returning to the outpatient center or hospital to have the tube removed and the results read.
This procedure works best when you take the time to write down how much food, when, and what you’re eating and the symptoms you experience after eating.
Then, the gastroenterologist can compare that information to what the monitor says- which will also help to figure out whether your acid reflux is also triggering respiratory problems.
Bravo wireless esophageal pH monitoring
With this procedure, the pH in your esophagus will be measured and recorded in order to diagnose GERD.
During an upper GI endoscopy, a physician will temporarily attach a small capsule to the wall of your esophagus, which will measure the pH in your esophagus and then send that information to a receiver.
This receiver is approximately the size of a pager and you will wear it on your waist.
With Bravo wireless esophageal pH monitoring, you will be able to go about your normal activities. This procedure will last approximately 48 hours.
There are several buttons on the receiver that you will press in order to record your symptoms such as heartburn.
Your healthcare professional will let you know what symptoms you need to be recording.
In addition, you’ll need to keep a diary of when you start eating/drinking and when you stop eating/drinking, as well as when you are lying down and when you get back up.
To get ready for this procedure, you’ll need to tell your physicians which medications you are taking and he/she will let you know if you will be able to eat or drink during the procedure.
In about 7 to 10 days, the capsule will end up falling off and passing through your digestive tract.
Esophageal manometry
This procedure is used to measure the muscle contractions in your esophagus. If you’re considering having surgery to correct your acid reflux condition, your gastroenterologist is likely to recommend this procedure.
An esophageal manometry can be done during an office visit. Your healthcare professional will either have you gargle a liquid anesthetic or spray one on the back of your throat.
Once your throat is numb, your gastroenterologist will slide a soft, thin tube through your nasal passages and into your stomach. As he/she begins to pull it back into your esophagus, you will swallow.
This will help to measure and record muscle contractions in the various areas of your esophagus.
This procedure will reveal if your symptoms are occurring because your sphincter muscle is weak.
Also, your physician can use the procedure to diagnose any other issues with the esophagus that bring about symptoms similar to heartburn.
As with the other procedures, your physician will let you know what you need to do regarding taking your medications before and after the procedure as well as eating and drinking.
Controlling GERD
There are some things that you can do to help keep your GERD under control. They are as follows:
- Avoid eating/drinking things that cause your symptoms
- Avoid eating too much
- Avoid eating 2 or 3 hours before going to bed
- Lose some weight if you’re overweight or obese
- Quit smoking and avoid inhaling secondhand smoke
- Take acid-reducing OTC medications
Medical Treatment for GERD
Of course, medical treatment will depend heavily upon the symptoms you’re experiencing.
Your physician may recommend that you make some changes in your lifestyle, start taking medications, surgery, or a combination of the above.
Changes in Lifestyle
Simply making a few very simple changes in your lifestyle can do wonders for controlling your GERD. Some of these changes include:
- Losing weight
- Stop wearing clothing that is tight around abdomen
- Remain in an upright position approximately 3 hours after eating
- Avoid slouching/reclining when sitting down
- Sleep on an incline- you can do this by placing blocks under the legs at the head of your bed
- Quit smoking
Prescription & OTC Medications for GERD
There are OTC medications available that you can obtain without getting a prescription from your physician.
However, if you have persistent symptoms, consider speaking with your physician about getting a prescription.
Keep in mind that all GERD medications have different ways of working. It is possible that you will need more than one to get your symptoms completely under control.
Antacids
In most cases, physicians recommend antacids as the first line of defense against the symptoms of GERD, such as heartburn. However, keep in mind that antacids can have some side effects including constipation and diarrhea.
H2 Blockers
These medications are made to decrease the amount of acid that your body is producing and can provide on-demand, short-term relief for many individuals who have GERD.
Additionally, they can heal your esophagus, though not as effectively as other medications. These are available by prescription and OTC.
If you tend to experience heartburn after you eat or drink, your physician may recommend a combination of H2 blockers and antacids.
The antacid will neutralize the acid in your stomach and the H2 blocker works to keep your stomach from creating more. This way, when your antacid wears off, the H2 blocker will have taken effect.
Proton Pump Inhibitors
A proton pump inhibitor, or PPI, will reduce the amount of acid that your stomach produces.
These are more effective at treating the symptoms of GERD than the H2 blockers, plus, in most cases, they heal esophageal lining.
On the other hand, those who take these for an extended period of time or take them in high doses are much more likely to experience spinal, hip, and wrist fractures.
In order for these to work, you will have to take them on an empty stomach. These are available in higher strengths by prescription, but you can get lower strengths OTC.
Prokinetics
These will help facilitate the emptying of your stomach to make it go more quickly. However, you should keep in mind that these medications do bring side effects along with them including the following:
- Fatigue
- Nausea
- Anxiety
- Diarrhea
- Delayed/abnormal physical movement
- Depression
You should also be aware that these can have some problematic interactions if you take them with other medications, so be sure to discuss all other medications you are taking with your physician.
Antibiotics
These medications also help your stomach to empty more quickly and does seem to have less side effects than prokinetics, but diarrhea is one of those that it does cause.
Surgery
If your symptoms do not improve with any of the above treatments, your physician may recommend that you have surgery to correct your condition.
However, something important to keep in mind is the fact that you’re much more likely to have complications from surgery than from taking medications.
Fundoplication
This is the most common surgery for GERD and in most cases, it does lead to control of acid reflux over the long term.
A surgeon will perform this surgery using a laparoscope, which is a very thin tube with a tiny video camera.
During this procedure, your surgeon will sew up the top of your stomach around your esophagus.
This adds pressure to the lower end of your esophagus- which reduces reflux. This will be performed at a hospital where you will be placed under general anesthesia.
You will stay in the hospital for 1 to 3 days and will be able to return to your daily routine in 2 to 3 weeks.
Endoscopic Techniques
The most common type of endoscopy is radiofrequency and sewing and has helped to control GERD in a very small group of people this procedure uses small stitches to tighten your sphincter muscle.
The radiofrequency is used to create heat sores to tighten your sphincter muscle. Your surgeon will perform both of these using an endoscope either at an outpatient center or a hospital.
You will be placed under general anesthesia. The results achieved with this procedure are not as good as those achieved with fundoplication. Therefore, these are not used very often.
Using Diet to Control GERD
It is possible to make some changes in your diet and therefore be able to control GERD.
You will most likely need to avoid specific foods/drinks that cause symptoms to flare up.
Additionally, some other changes in your diet can reduce symptoms such as:
- Decreasing/avoiding fatty foods as much as possible
- Eating smaller, more frequent meals instead of three large ones each day
Things to Avoid if You Have GERD
If you have GERD, there are certain things that you should avoid to keep from making your condition worse:
- Coffee
- Alcohol
- Greasy/spicy foods
- Tomatoes/products containing tomato as primary ingredient
- Chocolate
- Peppermint
Try to make sure that you’re eating a healthy and balanced diet, especially if you have GERD.
Additionally, if you are overweight/obese, speak with your physician or a dietitian about making some changes that will help you to lose weight and control your symptoms.
Sources:
http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1
http://www.mayoclinic.org/diseases-conditions/gerd/basics/definition/con-20025201
