Gastroesophageal Reflux Disease

Heartburn is an extremely common symptom which occurs in one-third of Americans on a monthly basis. Heartburn is a feeling of burning pain in the chest, which can travel from top of the abdomen to the neck. Sometimes it feels like acid sizzling in the throat, causing burning pain. Most people call this “indigestion” or “acid regurgitation.” Heartburn usually gets worse after eating a meal or in laying down position, like going to bed with a full stomach after eating dinner.

gerd1Heartburn is precipitated by foods that lower the esophageal sphincter pressure or maneuvers that increase the pressure inside the abdomen like bending, wearing tight belts, or lifting. Cigarette smoking, alcohol, fatty meals, large meals, chocolate, peppermint, and finally caffeine also lower the esophageal sphincter pressure, resulting in heartburn.

Sometimes a number of other symptoms can occur alone or in conjunction with heartburn, which includes belly pain, bloating, nausea, and difficult/painful swallowing.

The anatomy of the esophagus is extremely interesting. After you swallow food, the food travels through the tubular esophagus down into the stomach by muscle contractions induced by the esophagus, called peristalsis. This action continuously moves every bolus into the stomach so you can continue to eat. After the bolus clears the esophagus and moves into the stomach, and you are finished eating, the lower esophageal sphincter helps the food and acid material stay in the stomach and not travel up into the esophagus. In GERD, there is a pathological opening and relaxation of the sphincter which allows the stomach content such as food, acid, and bile travel up into the esophagus and the throat, causing discomfort and pain.

gerd2There is a condition called a hiatal hernia, where a small portion of the stomach herniates inside the esophagus. Most people with a hiatal hernia have a bit worse heartburn due to weakening of the lower esophageal sphincter.

Heartburn can also manifest itself as severe chest pain/pressure with radiation into the neck and the arm, mimicking a heart attack. Always consult with a physician if you have these symptoms, because heart problems need to be evaluated and ruled out, before you can be diagnosed with GERD. Sometimes people tend to ignore their symptoms of chest pain and attribute all of it to heartburn, leading to consequences such as a heart attack.

The treatment of GERD includes life-style modifications as well as medication therapy if life-style modifications alone are not helpful. So, first try to avoid a diet that may cause heartburn. Avoid greasy/fatty meals, caffeine, chocolate, peppermint, alcohol, cigarettes, large meals, and eating right before sleep. Also avoid wearing tight belts, bending over, and straining to have a bowel movement. Obesity or having a large abdominal girth has also been associated with GERD, therefore weight management should also be considered.

If that fails, medications called proton pump inhibitors or (PPI’s) can help. A few examples include Lansoprazole, Omeprazole, Pantoprazole, and Esomeprazole. Another type of medication called H2-Blockers can also help. These are over the counter and called Ranitidine, and famotidine.

Although using over the counter medications can help, you should consult a physician if you continue to have symptoms, because your doctor may decide to perform an upper endoscopy to rule out more serious problems such as esophageal inflammation or esophagitis, Barrett’s esophagus, or rarely cancer of the stomach/esophagus.

If you are experiencing “red flag signs” such as weight loss, severe pain, difficulty swallowing, chest pain, I recommend consulting your primary care physician immediately.