Dousing the fire of GERD

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Dousing the fire of GERD

If you have an esophagus, you’ve almost certainly experienced the occasional bout of heartburn — that painful sensation that occurs when highly acidic stomach juices splash up into the tube that connects your mouth and stomach. It’s no fun, but the discomfort quickly passes.

But if you have frequent heartburn — called gastroesophageal reflux disease, or GERD — you know it can be a life-altering misery. People with GERD can experience such sharp pain it’s like they’re being stabbed, says Juan Carlos Bucobo, MD, vice president of gastroenterology at Northwell Health. They may wake in the middle of the night feeling like they’re drowning, or have coughing fits because of the reflux at the back of their throat. They can even wind up in the emergency department, with such intense chest pain — for some, this can feel like pain under the left rib cage — that doctors must rule out a heart attack.

“GERD can really make it impossible for someone to enjoy their life,” Dr. Bucobo says.

The National Institutes of Health estimates that one in five Americans suffer from GERD — some for years on end. But the misery is unnecessary, says Dr. Bucobo, because there are a variety of solutions that can tame the problem.

Lower esophageal sphincter dysfunction: havoc in the digestive tract

GERD is a disease affecting the esophagus, the tube that transfers food from the mouth to the stomach. The condition occurs when the lower esophageal sphincter (LES), the muscle that acts like a valve at the entrance to the stomach, becomes weak or dysfunctional. This can allow reflux to occur — which is a polite way of saying that the contents of the stomach back up into the esophagus and possibly even the throat. When stomach acid hits these sensitive tissues, you’ll feel burning and irritation.

“The lower esophageal sphincter is there for a reason,” says Dr. Bucobo. “The throat isn’t designed to handle the corrosive digestive fluids produced by the stomach. When these fluids sneak into the esophagus, they can wreak havoc.”

GERD can cause a range of symptoms. Common ones include burning in the throat and upper stomach; sufferers can also experience a nagging cough, a sore throat, and the feeling that food is stuck in the throat. Indeed, every part of the digestive tract above the LES is vulnerable to acid exposure. It can cause inflammation of the vocal cords, leading to a hoarse voice; repeated episodes of reflux may also erode tooth enamel and lead to decay. Digestive juices can be inhaled into the lungs and cause asthma-like symptoms. And nighttime reflux can impact sleep quality and lead to insomnia.

And then there are the psychological effects of persistent misery. “People sometimes become fearful to even go out to dinner or to see their friends, because they know they’re going to end up in terrible pain,” Dr. Bucobo says.

Prolonged inflammation caused by GERD can also lead to more serious conditions, such as Barrett’s esophagus. The continued exposure to acid reflux gradually eats away at the esophageal lining, damaging it and making it thicken — changes that increase the risk of esophageal cancer.

“When we talk about GERD, we don’t mean the patient who takes antacids once or twice a month to spot-treat heartburn,” Dr. Bucobo explains. “But when there’s a chronic pattern of reflux which has a sustained, adverse effect on quality of life, it warrants investigation and treatment.”

Is GERD curable?

The first step in treating GERD is figuring out what’s behind it. Habits that strain or damage the LES can trigger flare-ups — so adjusting those habits often brings relief.

Numerous lifestyle changes can help reduce the frequency of acid reflux, including:

• Maintaining a healthy weight
• Following a diet that emphasizes whole grains, fruits, and vegetables, and de-emphasizes saturated fats
• Getting regular exercise
• Quitting smoking
• Abstaining from heavy drinking (eight or more drinks a week for women and 15 or more a week for men, according to the Centers for Disease Control and Prevention)

“Most GERD triggers are things you shouldn’t be doing in excess anyway,” Dr. Bucobo points out. “It’s why GERD often occurs along with other diseases like hypertension and diabetes.”

Sometimes, the culprit can be a specific food item. For some people, lemonade or tomato sauce — notoriously acidic foods — can cause problems. Others sadly find that chocolate routinely leads to distress; it contains a chemical that can make the LES relax. Coffee, mint, and carbonated drinks can also be hard to tolerate. Sensitivities vary, which is why Dr. Bucobo suggests patients keep a dietary log and work with their doctor to identify potential causes.

A GERD sufferer may be entirely unaware that a behavior is contributing to their problem, he says. One patient of his — an otherwise healthy young man — had a particularly troublesome case of GERD. Dr. Bucobo instructed the man to keep a dietary log for a couple of weeks. When they went over the diary, the doctor found the offender: “Two to three 32-ounce bottles of iced tea, every day,” he says. “I told him to ease off. He did, and his GERD went away, just like that.”

When lifestyle changes aren’t enough

Of course, resolving GERD isn’t always as easy as ditching iced tea. If you make changes but still suffer symptoms, you may need to consider medication.

There are several over-the-counter options. People often start with an antacid, like Tums, Mylanta, or Rolaids. These help by neutralizing stomach acid; they’re fast-acting, but the relief they provide is short-lived, as they treat the symptoms of stomach acid production rather than the cause. Heavier-duty remedies include proton pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs), which are available over the counter or as a higher-strength prescription version. Both reduce the amount of digestive acid the stomach produces, which cuts down the volume of reflux. (PPIs include omeprazole, also sold as Prilosec; H2RAs include famotidine, also sold as Pepcid.) Of the two options, PPIs are generally considered the more potent, but both can ease symptoms.

“PPIs and H2RAs have long been known for their effectiveness at treating reflux,” says Dr. Bucobo. “So long as you take them in tandem with regular clinical consultation to make sure nothing more serious is going on, you can remain on medications long-term if necessary.”

GERD surgery

Maybe you’ve tried medication and it hasn’t worked for you. Or perhaps you don’t like the idea of staying on medication for the rest of your life. There’s a more permanent fix for GERD, and it involves minimally invasive surgery.

The most common surgical approach for GERD is called fundoplication. “What we do is we take the fundus — or the upper part of the stomach into which the esophagus opens — and wrap it around the lower esophageal sphincter,” says Dr. Bucobo. In effect, the procedure is like putting a girdle on your esophagus, he says. It adds an extra layer of tissue around the muscles of the lower esophageal sphincter muscles to reinforce them, helping to prevent leakage.

Types of fundoplication surgery

• Nissen fundoplication: The fundus is wrapped completely around the lower esophageal sphincter.
• Toupet fundoplication: The fundus is wrapped only partly around the lower esophageal sphincter, usually about two-thirds of the way, starting from the back.
• Dor fundoplication: The fundus is wrapped partly around the lower esophageal sphincter, but unlike the Toupet fundoplication, the wrapping begins from the front.

Most types of fundoplication are commonly performed laparoscopically. “A surgeon will go in through a tiny incision in the belly, do what they have to do and get out,” he explains. “In most cases, if you’re not home the same day, you’re home the next.” Sometimes, GERD can even be managed endoscopically: Instruments are inserted through the mouth, and no external incisions are required.

Best of all, the relief from GERD is practically immediate, Dr. Bucobo says. “People can expect to feel better within days.”

The most important message for people with GERD is that they don’t need to resign themselves to heartburn and indigestion, says Dr. Bucobo. “There are many causes of GERD, but there are just as many ways to keep it away,” he says. “We have more tools in our medical toolkit than ever.”

GERD VA rating

Veterans with GERD or symptoms of GERD may be eligible for monetary compensation and/or disability programs courtesy of the U.S. Department of Veterans Affairs (VA). The claims affected veterans file are reviewed by the VA and assigned a disability rating: a number from 0 to 100 corresponding to the severity of the condition, such that a case with a 60% rating, for example, is more debilitating than another with a 30% rating.

The VA evaluates individual cases of GERD according to its rating system for hiatal hernia, because hiatal hernia can cause GERD, and the conditions present similarly.

This story was produced by Northwell Health and reviewed and distributed by Stacker.