The Basics of GERD and Its Management

Gastroesophageal reflux disease, more commonly known as GERD, affects 20-30% of the adult population on a weekly basis1. GERD occurs when acid from the stomach moves up into the esophagus, which causes inflammation in the lining of the esophagus, which isn’t protected from acid like the stomach. Many people experience this phenomenon called acid reflux. Mild acid reflux that occurs at least twice a week or moderate to severe reflux developing at least once a week, is classified as GERD2.

Symptom of GERD

Common signs and symptoms of GERD include2:

  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or sour liquid
  • Sensation of a lump in your throat

Less common GERD symptoms could include a chronic cough, laryngitis, new or worsening asthma, or disrupted sleep2.

Causes

A few different problems can cause GERD. First, the sphincter at the lower part of the esophagus just above the stomach can become weak or too relaxed. Consequently, this allows food contents or acid to flow back up into the esophagus. You are more at risk of developing GERD if you are overweight, have a hiatal hernia, are pregnant, or have delayed stomach emptying2.

Lifestyle choices can significantly impact GERD. Smoking, eating large meals, eating spicy foods, drinking caffeine and alcohol, or taking certain medications such as Aspirin can induce GERD symptoms. Luckily, with some lifestyle modifications, you have help reduce the frequency or severity of GERD.

GERD symptoms are troublesome enough but untreated GERD can have unpleasant symptoms that can reduce the quality of life. GERD can be mild and infrequent but consistent and more severe GERD symptoms can lead to significant complications if not addressed swiftly and properly. GERD can lead to a plethora of issues including the narrowing of the esophagus, esophageal ulcers, and a diagnosis called Barrett’s esophagus (associated with an increased risk of esophageal cancer)2.

Initial Management of GERD

For mild and infrequent GERD symptoms most people will use an over the counter antacid such as TUMS or Rolaids. These medications neutralize the acidity in the stomach and can help to eliminate reflux. This type of medication is taken once symptoms develop. If you notice the need to take antacids with increased frequency or that GERD symptoms are occurring more often, then it is time to visit your doctor. Initially, being evaluated and treated by a primary care physician is appropriate. For more severe cases or when management by a primary care physician fails to resolve symptoms, then a referral to a gastroenterologist is appropriate.

A GI doctor might prescribe either an H2 blocker or a proton pump inhibitor (PPI) if antacids become ineffective in controlling symptoms of GERD. H2 blockers work slower than antacids but work longer and help to reduce the amount of acid produced in the stomach. PPI medications are stronger than H2 blockers and help to significantly reduce acid production to allow the esophagus to heal. Many H2 blockers and PPI medications are available over the counter. A GI doctors will likely want to trial a PPI for four to six weeks to see how you respond. If symptoms resolve, you can continue the medication at the lowest effective dose under the supervision of your physician. If symptoms improve but don’t resolve, a GI doctor could either try a different medication or increase the dose of the PPI.

PPI medications are commonly prescribed for GERD management. It is vital to take these medications 30-45 minutes before meals. Usually, PPIs are taken before breakfast if taken once daily. PPIs can be taken before breakfast and supper if taken twice daily. This helps to maximize the effectiveness of the medication. For more severe cases prescription strength medications are available and surgical options could be considered as well.

Lifestyle Modifications

As mentioned previously, many lifestyle factors can be implemented to help reduce GERD symptoms including:

  1. Losing weight: excess weight can put more pressure on the stomach causing acid to more easily move up into the esophagus.
  2. Raise the head of your bed: gravity can work for or against you. Simply raising the head of your bed or sleeping in a recliner can help to reduce or eliminate GERD symptoms. It is recommended that you raise the head of your bed by 6-9 inches.
  3. Quit smoking: smoking inhibits the ability of the esophageal sphincter to function properly.
  4. Don’t lie down after meals: wait at least three hours after meals to go to bed or lie down.
  5. Avoid certain foods: certain foods can induce reflux. Spicy food, fried food, chocolate, alcohol, and caffeine have been known to induce reflux symptoms.
  6. Avoid tight-fitting clothing: tight-fitting clothing can put additional pressure on the abdomen and esophageal sphincter.

Lifestyle modifications can help to reduce acid reflux symptoms for people who have infrequent or even mild reflux. It is good to know that simple changes in behavior can help to address health issues related to GERD.

As always, if you start to experience acid reflux or GERD symptoms be sure to let your physician know. If you start any medications on a consistent basis, your primary physician should know about it. It is not a good idea to try to manage GERD without proper supervision from a physician.

1. https://www.healthline.com/health/gerd/statistics#1
2. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

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