Maybe you just got back from celebrating with your friends or you wake up in the middle of the night with a strange burning pain in your chest. You had this sensation before. You saw your doctor and he or she did a full cardiac work-up and reassured you that the pain is not from your heart. You think back to what did you did earlier. Did you eat a bit heavier or richer than you normally do? Did you drink a couple more drinks than you should have? You answer yes to both. You reach for you antacid and hope for relief.
If this sounds familiar, then you have gastroesophageal reflux or GERD, which is often called heartburn.
Heartburn is a symptom that is felt when there is a backflow of acid from the stomach up into the esophagus. The esophagus runs through the middle of the chest, behind the heart. The experience is a burning sensation, thus called heartburn. More than 60 million Americans experience heartburn at least once a month and some studies suggest that more than 15 million Americans experience heartburn symptoms each day.
Causes of Heartburn
To understand GERD, it is first necessary to understand what causes heartburn. Most people will experience heartburn when the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid, digestive enzymes and other injurious materials. The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort.
Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or “LES”—keeps the acid in the stomach and out of the esophagus. In GERD, this sphincter relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.
Common Symptoms of GERD
GERD can present in several ways. Some of the common symptoms are:
* Burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours.
* Chest pain, especially after bending over, lying down, or eating.
* Burning in the throat or a hot, sour, acidic or salty-tasting fluid at the back of the throat.
* Difficulty swallowing or a feeling of food “sticking” in the middle of the chest or throat.
* Chronic cough, sore throat or hoarseness.
Steps to Avoid GERD
Now that you know what GERD is, here’s how can you take care of it:
* Avoid foods and beverages that contribute to heartburn, such as chocolate, coffee, peppermint, greasy or spicy foods, tomato products, and alcoholic beverages.
* Stop smoking. Tobacco inhibits saliva, which is the body’s major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, permitting acid reflux to occur.
* Lose weight if you are overweight.
* Do not eat two to three hours before sleep.
* For infrequent episodes of heartburn, take an over-the-counter antacid or an H2 blocker, some of which are now available without a prescription.
When Symptoms Aren’t Easily Controlled
When symptoms of heartburn are not controlled with modifications in lifestyle and over-the-counter medicines are needed two or more times a week, or symptoms remain unresolved or get worse (including trouble swallowing, choking, weight loss or bleeding from an esophageal ulcer), you should see your doctor.
The doctor may prescribe acid blocker medications such as Prilosec, Prevacid, Nexium, Zegrid or Protonix. These medications are known as proton pump inhibitors. Because these medications completely shut down the production of acid in our stomach, they may make you feel better and may allow you to eat foods that cause GERD.
In recent studies, however, we now realize that long-term use of these medications may increase our risk to other illnesses, such as nutritional deficiencies, hip fractures and infections. So it is important to follow the lifestyle modifications outlined above as much as you can to see if you can ease your symptoms without long-term use of proton pump inhibitors.
But it is important to do something under a doctor’s supervision. When GERD is not treated, in the long run serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture, bleeding from esophageal ulcers, Barrett’s esophagus and even esophageal cancers.
Now you know what, why and how to manage your GERD.
Lisa Ganjhu, DO is a Gastroenterologist and Hepatologist at St. Luke’s Roosevelt Hospital Center.