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Talk Tuesday - Ep. 12: All About GERD

December 22, 2020
Dr.Howard

Question: Is acid reflux the same thing as GERD?

Answer: Sort of. Acid reflux is the same as gastroesophageal reflux which just means that the contents of the stomach are backing up into the esophagus &/or mouth. Occasional reflux is completely normal and can happen to anyone, though usually it is following a meal and there are no real long-term consequences or bothersome symptoms and the episodes of reflux are short-lived. GERD on the other hand is Gastroesophageal Reflux Disease…so that means someone that suffers from GERD has bothersome reflux symptoms that can result in damage to the esophagus and their symptoms are typically a daily or somewhat routine occurrence. These symptoms include things like heartburn, regurgitation of food, and sometimes there is difficulty swallowing. Some people may have a persistent cough and nothing else. 

Q: How does reflux or GERD happen?

Answer: It is actually a little complicated, but when you eat…food starts in your mouth where you chew it up and then when you swallow it goes into this long muscular tube which is your esophagus and that tube propels the food from your mouth to your stomach. At the end of the esophagus where it meets the stomach it has what we call the lower esophageal sphincter. It is essentially an area on the esophagus that compresses together and keeps stomach contents from coming back up into the esophagus and it has to relax and open up to let food into the stomach. This sphincter can weaken or not have as tight of a seal as normal and when that happens it does a really bad job at keeping things in the stomach…especially is you lay down right after you eat.

Q: What makes the sphincter weaker?

Answer: There are some foods that will trigger reflux symptoms in certain people and the more and more that happens the reflux will then progress to GERD. Some things related to increasing your risk of GERD include alcohol, smoking, caffeine, chocolate, certain medications, and so on. Being overweight is also a risk factor for the development of GERD. Studies have shown that losing weight improves reflux symptoms and frequency and can be a reason to undergo weight loss surgery if you are obese. Pregnancy increases your risk, but that usually resolves after delivery. And you can have something called a hiatal hernia which essentially means you have part of your stomach with or without the lower esophageal sphincter pushed up into your chest through your diaphragm which loosens sphincter tone. 

Q: How do I know if I have GERD?

Answer: Usually this can be diagnosed on history and symptoms alone if you have the usual symptoms of heartburn and regurgitation and that can usually be treated with a trial of PPIs or proton pump inhibitors which block the acid production in the stomach and see if that gives you relief of your symptoms. If you don’t have the usual symptoms or there is an indication that something more concerning may be occurring you will need some tests. These tests include an EGD (more on that next week…but it is a test where a doctor puts a camera on a long tube or scope into your mouth and looks at your esophagus and stomach), a 24 hours pH monitoring study where a little probe is placed in your esophagus so it can record how many times a day and at what time the pH in your esophagus changes due to the acid and what that number changes to, and also a manometry study which really just checks the pressure of your esophagus…like the whole thing…that helps make sure there is no problem with the way the esophagus moves food and it is in fact the lower sphincter pressure causing the problem.

Q: You said there may be damage to the esophagus…is that bad? What do I need to worry about?

Answer: It can be bad. Most people don’t have serious complications as long as they are treated. There are some serious complications that can happen if you have severe GERD and do not treat it. You can get a stricture in your esophagus which is scar tissue causing a narrowing or blockage. This can result in difficulty swallowing or food getting stuck in your esophagus. The process of ulcerations that heal over and over again causes this scar tissue and narrowing. You can have erosive esophagitis. This is when the acid causes ulceration in the esophagus and those ulcers can sometimes bleed. You may not vomit blood or see bleeding per se, but blood can be detected in your stool. You can also get Barrett’s esophagus which is where the cells in the lining of the esophagus change to a completely different type of cell from all the damage. The change in these cells can actually change further and develop into cancer. The acid can actually get into your lungs and cause asthma type symptoms or permanent lung damage and it can damage your teeth. Like I said, most people don’t have serious complications, but these complications are why it is so important to see your doctor and discuss your particular case with them and get treatment as soon as possible.

Q: What do I have to do to treat GERD?

Answer: First and foremost…talk to your doctor. Everyone is different and should be treated as such. Common things work and should be done, but talk to your doctor to make sure you are treating the correct problem before you start trying to self medicate. There are some lifestyle things that can help like avoiding foods that you notice trigger your reflux, don’t eat close to bedtime, and try not to lay down after eating…try to eat several hours before you plan to lay down. You can lift the head of your bed up, but it involves more than just piling up pillows behind you, so really just try to avoid eating before bed. If you are overweight, try to lose weight. Not only for your overall health but like I said earlier, a lot of people have relief from their symptoms after they lose weight. Surgery is an option, but treatment with medication is always tried first because it is the least invasive option. Surgery does not come without its own complications.  Talk to your doctor about taking a histamine blocker or PPI for any symptom relief before trying it on your own. Antacids like tums can help treat the minor symptoms, but if you find you’re using those a lot it’s time to see a doctor. If you feel like the reflux is getting worse or you start losing weight and you aren’t trying, or you feel like you’re choking you should also get to your doctor as soon as possible. If you’ve been treated and are still having symptoms then talk to your doctor about changing medication or what surgical options are available to you if you want to explore that option. 

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