Heartburn (GastroEsophageal Reflux Disease – GERD)
It is that burning sensation felt behind the breastbone and sometimes in the neck and throat. Heartburn is caused by stomach acid refluxing or splashing up into the esophagus — the muscular tube that connects the throat to the stomach. Serious heartburn is known as gastroesophageal reflux disease or GERD.
Anatomy & Pathophysiology
The esophagus carries food and liquid into the stomach. At the lower end of the esophagus where it enters the stomach, there is a strong muscular ring called the lower esophageal sphincter (LES). The LES should remain tightly closed, except to allow food and liquid to pass into the stomach. Reflux occurs when the LES is not working properly. It may relax for periods of time throughout the day and night, or it may be constantly too
weak to function effectively. This allows the stomach’s acid juices to flow into the esophagus. How severe the
disease becomes depends on how weakened the LES is, and the amount and duration of acid refluxed into the esophagus.
Symptoms of GERD Complications
- Frequent heartburn is the most common symptom. However, patients may also experience some of the following:
- Sour or bitter taste
- Bitter stomach fluid coming into the mouth, especially during sleep
- Worsening of symptoms after eating, or when bending over or lying down
- Short term
Constant irritation of the esophagus by stomach acid can lead to inflammation, ulcers, and bleeding. Over time, scarring and narrowing of the esophagus can also develop, making it difficult to swallow foods and liquids. It may lead to esophageal cancer.
Diagnosis of GERD
The diagnosis can usually be suspected by the physician, simply by taking the medical history. Beyond that, the physician may order an x-ray examination of the esophagus and stomach. For this x-ray, the patient swallows a liquid containing barium. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible tube called an endoscope. There are other tests that are helpful. A pressure recording of the esophagus is called esophageal manometry. It measures the pressure in the LES and any abnormal muscle contractions in the main part of the esophagus. Finally, a 12 to 24 hour recording of the acidity in the esophagus is often helpful.
What is the treatment?
Patients with GERD should follow these recommendations:
- Avoid eating anything within three hours before bedtime.
- Stop smoking. Nicotine in the blood weakens the LES.
- Avoid fatty foods, milk, chocolate, spearmint, peppermint, caffeine, citrus fruits and juices, tomato products, pepper seasoning, and alcohol — especially red wine.
- Decrease portions of food at mealtime, and avoid tight clothing or bending over after eating.
- Review all medications with the physician. Certain drugs can weaken the LES, allowing acid irritation of the esophagus.
- Elevate the head of the bed or mattress 6 to 8 inches. This helps to keep acid in the stomach by gravity when sleeping. Extra pillows by themselves are not very helpful.
- Lose weight if overweight. This may relieve upward pressure on the stomach and LES.
When symptoms are bad or GERD is moderate to severe, the physician will prescribe medications. Some that reduce stomach acid include proton pump inhibitors. Other medications, such as metoclopramide tighten the LES. These may be especially useful at night when reflux often occurs.
A number of patients with GERD may need surgery to strengthen the LES. This procedure is called fundoplication.
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