Gastroesophageal reflux disease or GERD is a common problem. It is estimated that over 8 million adults in the United States have this disease. While almost everyone has occasional heartburn, GERD occurs when stomach acid backs up into the esophagus on a continual basis. The resulting symptoms are not only like those experienced with heartburn, the substernal burning, belching and a bloated feeling that go along with a highly spiced meal. Symptoms of GERD also include difficulty swallowing, sore throat, a change in the voice, wheezing, coughing and even difficulty breathing. Occasionally irritation of the esophagus is so severe, vomiting blood results. If GERD persists untreated, a condition called Barrett’s esophagitis can result, which can even lead to esophageal cancer.

Gastroesophageal reflux disease develops when stomach acid moves up into the esophagus frequently. Known as acid reflux, there are many causes of this condition. An over production of stomach acid is one of the causes which can happen in a condition such as Zollinger Ellison Syndrome. A structural abnormality such as a hiatal hernia, which allows the stomach to move up above the diaphragm, weakening the lower esophageal sphincter, is another cause. Obesity, an ever increasing problem, can also be a cause of acid reflux and thus GERD. The mechanism of GERD in obesity seems to be an increase in intraabdominal pressure forcing the acid stomach contents into the esophagus.

The treatment of GERD can be medical or surgical depending on the cause. In cases of over production of stomach acid, medications to neutralize the stomach acid or decrease the production of the acid work well. Medications to neutralize stomach acid are combinations of calcium carbonate, aluminum, and magnesium in slurries such as Maalox and Mylanta or tablets such as Tums or Rolaids. There are also over the counter products which are acid blockers or H2 inhibitors such as Pepcid, Zantac, and Tagamet. One over the counter medication is a proton pump inhibitor, Prilosec. Prilosec must be taken continuously for several days to achieve relief of the symptoms of heartburn and GERD.

If prolonged symptoms of GERD have irritated the esophagus, prescription medications may be required for relief. Usually if symptoms persist for longer than two weeks, becoming more severe, not aided by over the counter medications, then a physician will prescribe stronger medications for relief. There are prescription strength H2 inhibitors such as Pepcid, Zantac, and Tagamet. More effective alternatives which have gained popularity recently are the proton pump inhibitors Nexium, Protonics, Prevacid, and Prilosec Rx.

After a trial of medication, if the symptoms of GERD are not improved, surgery may be recommended. Several surgical options exist. One is a Nissen fundoplication where the upper part of the stomach is wrapped around the lower part of the esophagus. A major surgical procedure, with a large incision, the fundoplication might be avoided with newer procedures such as the EndoCinch, which places sutures around the top of the stomach to prevent acid from washing into the esophagus. Ongoing research seeks to identify the best candidates for this procedure.

While medication and surgery can alleviate symptoms, GERD is very difficult to cure. The best measures to reduce symptoms and keep the lining of the esophagus from eroding, with progression to Barrett’s esophagitis, are lifestyle changes. Since obesity seems to be a major factor, weight loss can prevent GERD or aid in the treatment. Cigarette smoking also increases the chance of developing GERD, so smoking should be eliminated. Avoiding late night eating, raising the head of the bed 6 to 9 inches and remaining upright for at least 3 hours after eating will also prevent GERD symptoms.

While many people experience occasional heartburn from acid refluxing into the esophagus from the stomach, experiencing this symptom more than twice per week or if it is are accompanied by nausea, hoarseness, cough, wheezing or difficulty breathing GERD is likely the cause. There are many treatments available. Early treatment and a healthy lifestyle result in the best chance of complete resolution of GERD symptoms.

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