According to the American College of Gastroenterology, more than 60 million Americans experience heartburn at least once a month, and millions deal with the burning and discomfort every day. Studies also point to an increase in the prevalence of gastroesophageal reflux disease (GERD), a chronic disease too often undiagnosed. But what is GERD?
What is GERD?
Short for Gastroesophageal Reflux Disease, GERD is a digestive disorder that most commonly presents itself as heartburn, or acid indigestion. Throughout the course of a healthy digestive process, the lower esophageal sphincter (LES), a ring of muscle separating the lower esophagus from the stomach, will open only to allow swallowed food to pass from the esophagus into the stomach. It then closes afterward to prevent stomach acid from damaging the esophagus. When the LES is weakened or otherwise does not seal securely, these acidic stomach contents can flow up into the esophagus causing moderate to severe discomfort in the form of burning, pain and pressure.
Some may experience “silent reflux”, wherein acid reflux causes throat discomfort, but does not elevate to the point of heartburn.
Other possible symptoms less commonly reported include: recurrent pneumonias, voice changes, vocal cord polyps, recurrent ear infections, difficulty swallowing, halitosis (bad breath) and chronic cough.
If left untreated, GERD can also lead to a condition known as Barrett’s esophagus, which increases risk of esophageal cancer.
GERD is estimated to affect as much as 20% of the population, but is often alleviated through dietary adjustment and simple lifestyle changes. In persistent or severe cases, medication may be prescribed and surgical options are available.
Heartburn vs. GERD
Due to the sometimes subtle nature of the symptoms, GERD can be difficult to identify. And not all heartburn is GERD. But if you experience heartburn on a weekly basis, suffer worsening heartburn or it interferes with sleep, swallowing or daily activities, you should notify a doctor.
What Can You Do?
Talk with your doctor.
“Until a thorough evaluation has been performed, it is difficult to determine whether the symptoms are GERD-related or a harbinger of something else,” says surgeon Arundathi Rao, MD, medical director of Sarasota Memorial’s Bariatric Services. “And symptoms similar to reflux can signal multiple other serious medical conditions, so getting a work-up is essential.”
Unfortunately, due to the prevalence of heartburn in the population and palliative effect of over-the-counter antacids, heartburn often goes unmentioned at the annual check-up. “Many patients fail to even report they are taking anything for reflux, because they don’t feel it is something they need to discuss,” says Dr. Rao. But long-term use of over-the-counter antacids can have their own negative side effects, such as kidney failure and iron and calcium deficiencies, which can lead to anemia and osteoporosis, respectively. Moreover, antacids do not actually stop reflux, but merely make it less painful by tempering the acidity. Continued reflux can still impact pulmonary function, cause recurrent ear infections, and affect a patient’s vocal cords.
So even if you think the symptoms are under control with over-the-counter medications and a tough-it-out spirit, only a doctor will be able to make the final determination as to the cause of discomfort and the healthy path forward.
And as a rule of thumb for doctor visits, it’s better to overshare than undershare. Your physician will know what’s relevant.
How Is GERD Treated?
The good news is that the majority of patients presenting with GERD see drastic improvement with medication, lifestyle changes and diet adjustment. For severe cases that do not respond to such approaches, surgical options are available, and getting better and better.
Medication, Diet & Lifestyle Changes
“A combination of medications, dietary modifications and lifestyle changes can significantly impact the severity and, potentially, the progression of the disease,” says Dr. Rao. “All three must be addressed in order to have optimal treatment.”
In terms of medication, your physician may prescribe something to reduce acidity in the stomach, thus alleviating some of the pain and forestalling some of the damage GERD can cause. The most common types of medication prescribed for GERD are H2 Blockers, such as Pepcid and Zantac, and Proton Pump Inhibitors, such as Nexium and Prilosec. Both inhibit acid secretion in the stomach.
Dietary modifications typically entail avoiding those foods that may relax the LES, including chocolate, peppermint, and foods with high fat content, as well as drinks high in caffeine or alcohol. Other possible esophageal irritants, such as citrus juices and spicy peppers, may also be off the menu.
“Weight loss can have a significant impact on GERD as well,” says Dr. Rao. Eating smaller portions at meals and not eating in the last couple hours before bed can also help reduce reflux.
Smoking cigarettes also weakens the LES, and quitting can have a marked effect on GERD symptoms.
Surgical Solutions to GERD
If GERD persists despite medication and lifestyle changes, surgical options are available. Surgery may also be deemed necessary, if testing reports the presence of a hiatal hernia blocking the LES or if GERD-induced recurrent pneumonias compromise lung function. But these are rare cases.
Surgery is also available for those simply looking to put GERD behind them for good.
“Until recently, the pervasive thought amongst healthcare providers was that surgery was reserved for the most severe cases of GERD and patients who were unsuccessful in managing their reflux with medication, lifestyle changes and dietary modification,” says Dr. Rao. “Now, however, surgery is an option for any patient wanting to stop taking their GERD medications.”
At Sarasota Memorial, surgeons are trained in a variety of minimally invasive options, including fundoplication, in which surgeons use a portion of the patient’s stomach to shore up the LES, and LINX surgery. In a relatively new approach, the LINX device simulates the sphincter between the esophagus and the stomach with a ring of titanium magnets installed via robot-assisted surgery.
“One of the more innovative and promising options is the LINX device,” says Dr. Rao. “Long-term studies reveal symptoms are well controlled and patients have a significant improvement in the quality of their lives. Patient satisfaction scores were over 90% at six months.”
Reflux Clinic & GERD Management
Along with Sarasota Memorial’s Reflux Clinic team, Dr. Rao help patients living with GERD in an outpatient specialty clinic dedicated to diagnosing, managing and treating conditions related to acid reflux, including GERD, heartburn and other esophageal disorders.
At the Reflux Clinic, patients receive one-on-one attention and care, with physicians conducting individual evaluations and crafting custom treatment plans to meet each patient’s unique needs. In addition to a physical assessment and thorough review of patient history upon the initial visit, physicians at the Reflux Clinic have access to an entire array of testing procedures, including wireless esophageal pH monitoring, barium swallow, high-resolution manometry and more.
Learn More
For more information about the Reflux Clinic, click here or call 941-917-GERD (4373). For healthy eating tips, click here, and be sure to check out our library of Healthe-Recipes as well.
As a Sarasota Memorial copywriter, local journalist and in-house wordsmith Philip Lederer, MA, crafts a variety of external communications for the healthcare system. He earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, Ky.