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It's not unusual to occasionally experience reflux after eating a large meal. When you start to feel that uncomfortable, burning feeling a few times per week or with more concerning symptoms, there’s a more serious suspect: GERD.
GERD, or gastroesophageal reflux disease, affects an estimated 20% of the U.S. population. “GERD is common, and many patients understandably brush it off as simple heartburn, but it can cause troublesome symptoms, even complications, down the road if not treated,” says AdventHealth board-certified gastroenterologist Ashil Gosalia, MD.
People at any age, even children, can experience GERD. However, obesity, smoking, hiatal hernia, anxiety and even depression can increase your risk.
GERD occurs when your stomach’s contents back up into the esophagus, the muscular tube that carries food from your mouth to your stomach. When the lower esophageal sphincter — the muscular ring that separates the esophagus from your stomach — becomes weak and relaxes when it shouldn’t, symptoms of GERD may surface.
While this may happen occasionally for some, for others, GERD is a chronic condition that requires consistent lifestyle modifications and medication.
Symptoms of GERD
Common symptoms of GERD include heartburn (burning sensation behind the breastbone), regurgitation (where acid and or food comes up from the stomach into the mouth) and epigastric pain. Other not so common symptoms are chest pain, nausea, difficulty swallowing, painful swallowing.
These symptoms are common so don't be alarmed if you have one or two of these on occasion. But if you are experiencing these symptoms two or more times a week (especially difficulty or painful swallowing, bleeding or significant weight loss) and/or you’re over age 50 it’s important to let your doctor know right away.
GERD should be treated because too much stomach acid in the esophagus can result in inflammation, acid scarring and strictures that can cause the lower end of your esophagus to narrow, making it difficult to swallow. It also may lead to a condition called Barrett’s esophagus, where the cells of the tissue lining the esophagus change abnormally and can lead to cancer.
Diagnosing and Treating GERD
“If a patient comes in who is 50 years or older and is experiencing symptoms like difficulty swallowing, pain when swallowing, weight loss, vomiting of blood or blood in the stool, we will do more testing such as an upper endoscopy to ensure the symptoms are not related to something more serious, like an ulcer or malignancy,” explains Dr. Gosalia. However, most patients can begin lifestyle modifications and medications to treat GERD right away.
Lifestyle, especially your diet and body weight, can make a big impact in improving your GERD symptoms. If a patient does not have alarming symptoms and their symptoms are not so troublesome, it's often preferred to try lifestyle modifications first, before medications.
Some lifestyle modifications that can help reduce the symptoms of GERD include weight loss, elevating your head while sleeping, avoiding heavy meals two to three hours before bedtime, and avoiding high-fat foods, chocolate, peppermint, carbonated drinks and caffeine. If you have GERD, making these changes for life go a long way to help manage symptoms and improve quality of life.
When it comes to medical management of GERD, there are very effective, well-studied medications available.
Medications in GERD Treatment
The first line of medical treatment for GERD are proton pump inhibitors, or PPIs.
PPIs treat the symptoms of heartburn caused by gastroesophageal reflux disease (GERD) by blocking the stomach’s ability to produce too much acid. And these medications are often quite successful. Between 40 to 90% of patients with GERD respond to PPI treatment; this is a very high response rate and we see many patients improve with these medications taken appropriately.
This includes taking the PPI consistently every morning 30 minutes before eating anything.
Your doctor can help determine the best treatment plan for you, incorporating lifestyle modifications with PPI treatment and evaluating the results down the road.
Dispelling PPI Medication Myths
It’s important to understand that many of the studies that have tried to correlate PPI use with serious adverse effects like Alzheimer’s disease or heart attack were observational studies and not randomized controlled studies that provide the most accurate data.
However, chronic use of medication can expose some level of risk, from minor side effects to potentially less common serious problems. With PPIs, some of these associated risks include vitamin absorption or bone fractures.
“At every clinic visit, I always encourage my patients with uncomplicated GERD to pursue aggressive lifestyle modifications as well as attempt a trial off medications if possible or to use the most minimal amount needed to control symptoms,” says Dr. Gosalia. It might be possible to stop the medication with lifestyle changes alone.
Surgical GERD Treatment
For some, surgical treatment for GERD might be indicated over chronic medications.
As GERD can be a lifelong problem, those who qualify for surgery may find it as an alternative to medical therapy. Many procedures are performed laparoscopically, which is a minimally invasive option that reduces pain and scarring while improving recovery time.
Learn more about our approach and get the help you need to treat GERD here.