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Heartburn and GERD

 

What is GERD?

Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphinc­ter (LES) opens spontaneously, for varying 
periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. 
The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sen­sation in the chest or throat called heart­burn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is consid­ered GERD, and it can eventually lead to more serious health problems.  People of all ages can have GERD.

What are the symptoms of GERD?

The main symptom of GERD in adults is frequent heartburn, also called acid indi­gestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most 
children under 12 years with GERD, and some adults, have GERD without heart­burn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing. 

What causes GERD?

The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal 
hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a nor­mal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms. 

How is GERD treated? 

See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery. 

Lifestyle Changes 
If you smoke, stop. 
Avoid foods and beverages that worsen symptoms.
Lose weight if needed. 
Eat small, frequent meals. 
Wear loose-fitting clothes. 
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts.  Just using 
 extra pillows will not help.

Medications 
Your health care provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication. 
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symp­toms. Many brands on the market use 
different combinations of three basic salts— magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach.  Antacids, how­ever, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and 
magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supple­mental source of calcium. They can cause constipation as well. 
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. 
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are avail­able in prescription strength and over-the­counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms. 
Proton pump inhibitors include omepra­zole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescrip­tion. Prilosec is also available in over-the­counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD. 
Prokinetics help strengthen the LES and make the stomach empty faster.  This group includes bethanechol (Urecholine) and metoclopramide (Reglan).  Metoclo­pramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement. Because drugs work in different ways, com­
binations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neu­tralize the acid in the stomach, and then 
the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid produc­tion. Your health care provider is the best source of information about how to use 
medications for GERD. 
 

 

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