Gastroesophageal Reflux Disease (GERD)

If you have the burning sensation that we often refer to as "heartburn," it has nothing to do with your heart but everything to do with your esophagus.

The esophagus is the tube that connects your throat with your stomach. It is not intended to be a place to store food. It is simply a "pipeline" from mouth to stomach.

Swallowed food travels down your esophagus until a valve called the Lower Esophageal Sphincter, at its bottom, relaxes and allows it to enter your stomach.

Normally, this valve only allows food to move downward. But sometimes the valve isn't working properly and the stomach contents, including the acid that is produced in your stomach, may back up into your esophagus. This "refluxed" material, which irritates the sensitive lining of your esophagus, can cause the pain of heartburn. The lining of your stomach, by nature, is tough and can tolerate irritants such as stomach acid, spicy food, alcohol and other harsh substances. Your esophagus, on the other hand, is lined by a more sensitive kind of tissue which is not as tolerant as your stomach. Simply stated, the stuff in your stomach was never intended to be back up in your esophagus.

Certain foods are known to weaken or relax the valve making reflux more likely to occur. Repeated exposure to stomach contents can inflame the lining of your esophagus, making it so sensitive that sometimes even swallowing is painful. The chronically irritated lining may start to bleed, or an ulcer may develop in the esophagus.

Even though you may experience significant symptom relief while using medications, it is important that you continue to follow recommended lifestyle/diet modifications!

Here are some tips that can help you to avoid "heartburn."

  • Eat small, more frequent meals rather than one or two large meals a day.
  • Avoid high-fat meals. Fat can slow/delay emptying of your stomach
  • Don't eat within 2 - 3 hours of going to bed
  • Avoid tight-fitting clothing, such as belts and jeans, especially after a meal.
  • Lose weight if you're overweight.
  • Don't exercise immediately after eating. You might find that you actually eat less if you do a moderate amount of exercise before eating.
  • Avoid late night snacks altogether (unless you're on a special diet that requires it) since laying down soon after eating will almost always worsen the problem.
  • Smoking and drinking alcohol can cause the LES muscle to relax, worsening reflux and heartburn.
  • To reduce nighttime episodes of heartburn, elevate the head of your bed 4 - 6 inches. You can use books or bed blocks placed under the legs at the head of your bed. If you use a water-bed, elevating the head isn't going to do a bit of good. You might try getting a foam wedge that goes on your mattress and keeps your head and shoulders higher than your waist.
  • Some medications can cause heartburn. If you're not sure ask your health care provider or pharmacist. Always check with your clinician before stopping the use of prescribed medication.
  • Always remember to tell us if you're using any over-the-counter (store-bought) medications or nutritional supplements.

    Some of these foods can also contribute to heartburn:

  • Chocolate
  • Fatty Foods
  • Coffee
  • Tea
  • Colas
  • Alcohol
  • Peppermint
  • Spearmint
  • Onions
  • Tomato-based foods
  • Pepper
  • Citrus juices
  • Milk may be a problem for some people since it is a potent stimulator of acid production.

    If you've been using over-the-counter products and don't get adequate relief, you should talk with your health care provider about it. Remember, there can be other things going on which might need further assessment and management.

    Sometimes, over-the-counter products just don't do the job and I have to prescribe other drugs which cannot be bought in the store. Sometimes ,too, I have to do specialized testing to determine the precise cause of their heartburn or to identify other problems.

    Some things that can complicate reflux are ulcers, strictures or even tumors.

    Never ignore symptoms of food getting stuck in your throat. If you have trouble swallowing, such as having to drink liquids after every bite to "wash down" the food, you could have more trouble than reflux/heartburn.

    If you have a persistent "sore throat," let your health care provider evaluate you. That's a fairly common symptom of reflux.

    There are many other conditions for which you might need professional evaluation. Always check with your doctor, PA or nurse practitioner if symptoms become persistent.

    Disclaimer:
    The information in the foregoing discussion is for educational purposes only. I use them as adjuncts to counseling in the office. The information and advice given in this discussion is not intended to take the place of a clinical evaluation by a health care professional. Never take any medication without first checking with your health care professional if you have any drug allergies, G6PD deficiency or are already taking medication. If you have any condition for which you are under care, always discuss over-the-counter medications and nutritional supplements before using them.

    Thanks to JANSSEN Pharmaceuticals and Merck & Co., Inc.for the graphics and some of the text in this handout.

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