Girding up to treat GERD
By Nancy Maes
You have a big steak and a glass or two of wine for dinner, and the next day you suffer from heartburn. So you take an antacid and you’re good to go. After you have a beer and a brat, you do the same thing. The story repeats itself many times over and while you think you’re handling the problem, you’re really ignoring it.
It turns out that you are far from alone in experiencing heartburn, also called acid reflux, caused when the sphincter that acts like a valve at the end of the esophagus doesn’t function properly and lets stomach acid back up into the esophagus.
When acid reflux symptoms occur frequently and persist over a long period of time, it develops into a chronic disorder known as gastroesophageal reflux disease (GERD), which occurs when the sphincter relaxes abnormally or becomes weak.
GERD affects about 20 percent of the U.S. population, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Hospitalizations with either a primary or secondary GERD diagnosis increased by 216 percent from 1998 to 2005.
“No one knows why it is so prevalent, but it is likely related, to an extent, to the increasing weight of the American public,” says Nathaniel Soper, MD, chair of the department of surgery at Northwestern University Feinberg School of Medicine. The added weight puts pressure on the upper abdomen and the stomach. If the esophageal sphincter is weak, the fluid tends to be pushed back up into the esophagus. Also fat in the American diet has increased, and it is one of the things that causes loosening of the sphincter and increases reflux.
“People will self-medicate for years when they have acid reflux,” Soper says. “It’s difficult to get them to go to see a doctor for a diagnosis until it gets to a point where they’re sitting up in bed in the middle of the night because they have horrible reflux or are having to curtail normal activities.”
GERD can cause a persistent sore throat, like the one experienced by President Obama before he was diagnosed with acid reflux. Other symptoms are an ongoing cough or hoarseness caused by acid irritating the vocal chords, belching, bloating or severe pain in the chest that mimics a heart attack.
Soper says a typical case of acid reflux can be treated with lifestyle changes such as avoiding alcohol, fatty foods, onions, garlic and peppermint, quitting smoking, losing weight and taking over-the-counter H2 blockers that reduce acid produced in the stomach.
Early treatment can prevent potential complications, as GERD can lead to serious problems such as inflammation of the lining of the esophagus, formation of scar tissue that narrows the lower esophagus or changes in the lining of the esophagus called Barrett’s esophagus, which can lead to a rare and often deadly cancer.
At that stage, GERD is treated with prescription H2 blockers and stronger Proton Pump Inhibitors (PPIs) to relieve symptoms and allow the lining of the esophagus to heal. If medications don’t control the symptoms, or if the patient wants to get off medication perhaps because of the side effects, surgery can be an option.
Before making a surgery decision, Soper says, a patient should have a 24-hour pH test to see whether reflux is actually occurring. “There are many people who have stress-related symptoms that may not have anything to do with acid reflux, so those are the last ones we want to do the operation on because it’s not going to make them better,” he says.
GERD is not only prevalent in grown-ups. “Almost 50 percent of infants will have some GERD, and that’s normal,” says Tiffany Patton, MD, pediatric gastroenterologist at the University of Chicago Medicine Comer Children’s Hospital. To reduce the symptoms, she recommends burping the baby often, holding the infant upright for 30 to 45 minutes after feeding and adding rice cereal to thicken the formula or breast milk after two to three months of age. “Children usually outgrow GERD by the age of 12 to 18 months as the esophagus elongates and becomes more mature.”
If infants and children with GERD are vomiting and aren’t gaining weight and growing normally, they may be given H2 blockers or PPIs initially for their symptoms. School-age children might be given a short-term course of PPIs that can have side effects such as headaches and worsening abdominal pain.
In some cases children’s GERD symptoms may be the result of food allergies if symptoms do not improve with medication. Teenagers doing core exercises to strengthen their abs might also experience GERD. “Crunches and weight-lifting increase pressure on the stomach, pushing its contents [toward] the esophagus,” Patton says. She advises all GERD patients to avoid foods that trigger acid reflux, such as caffeine and acidic foods and avoid lying down within 2 hours after eating.
While it may be hard for people with acid reflux to give up some of their favorite foods in order to be free of the problem, medical professionals agree that making lifestyle and dietary changes are important steps in order to prevent serious complications down the road.
Originally published in the Fall 2015 print edition.
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