Heartburn/GERD

At the entrance to the stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn’t close all the way or if it opens too often, acid produced by the stomach can move up into the esophagus. This can cause symptoms such as a burning chest pain called heartburn. If acid reflux symptoms happen more than twice a week, you have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

• Risk factors for acid reflux disease:
• Eating large meals or lying down right after a meal
• Being overweight or obese
• Eating a heavy meal and lying on your back or bending over at the waist
• Snacking close to bedtime
• Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
• Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
• Smoking
• Being pregnant
• Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications

Symptoms of acid reflux are:

• Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
• Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include:

• Bloating
• Bloody or black stools or bloody vomiting
• Burping
• Dysphagia — a narrowing of your esophagus, which creates the sensation of food being stuck in your throat
• Hiccups that don’t let up
• Nausea
• Weight loss for no known reason
• Wheezing, dry cough, hoarseness, or chronic sore throat

Diagnosis and testing:

It’s time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don’t bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.

If these steps don’t help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:

• Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
• Esophageal manometry can check the function of the esophagus and lower esophageal sphincter.
• pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus.

Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.

A biopsy may be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.

Treatment:

One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms.

Here are other steps you can take:

• Eat smaller meals more frequently throughout the day.
• Quit smoking.
• Put blocks under the head of your bed to raise it at least 4 inches to 6 inches.
• Don’t eat at least 2 to 3 hours before lying down.
• Try sleeping in a chair for daytime naps.
• Don’t wear tight clothes or tight belts.
• If you’re overweight or obese, take steps to lose weight with exercise and diet changes.
• Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease
• In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, or Rolaids, can neutralize the acid from your stomach. But they may cause diarrhea or constipation, especially if you overuse them. If antacids don’t help, your doctor may try other medications. Some require a prescription. Your doctor may suggest more than one type or suggest you try a combination of medications such as these:

• Foaming agents (Gaviscon) coat your stomach to prevent reflux.
• H2 blockers (Pepcid, Tagamet, Zantac) decrease acid production.
• Proton pump inhibitors (Prilosec, Prevacid, Protonix, Aciphex, Nexium) also reduce the amount of acid your stomach makes.
• Prokinetics (Reglan, Urecholine) can help strengthen the LES, empty your stomach faster, and reduce acid reflux.
• Don’t combine more than one type of antacid or other medications without your doctor’s guidance.

If medications don’t completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn’t effective.
The most recently approved procedure involves surgically placing a ring known as a LINX device around the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps reflux by preventing stomach content from backing up into the esophagus. In one study, patients were able to stop taking medicine or cut down the amount they took. You shouldn’t get the LINX device if you’re allergic to certain metals, and once you have a LINX device you shouldn’t get any type of MRI test.

Another surgical procedure called fundoplication can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open incision in the abdomen or chest or with a lighted tube inserted through a tiny incision in the abdomen.

These procedures are done only as a last resort for treating acid reflux disease after medical treatment has proven to be inadequate.