Gastroesophageal Reflux Disease (GERD)

"They had me on the operating table all day. They looked into my stomach, my gall bladder, they examined everything inside of me. Know what they decided? I need glasses."-Joe E. Lewis

I am amazed at the number of people I know (including a baby) who take Nexium or Prilosec for Gastroesophageal Reflux Disease (GERD). I have the misfortune of inheriting this from my mother and the past few days have been really bad.

What is GERD? When you eat, millions of tiny pumps in your stomach produce the acid that helps you digest food. The stomach walls are protected against this acid but for some people the acid leaks upwards into esophagus because the valve (the lower esophageal sphincter, or LES) does not close as tightly as it should. This Acid reflux damages the delicate lining of esophagus (food tube) esophagus, causing heartburn, a burning pain in the center of the chest.

Now heartburn in itself is not uncommon or a cause for worry. But for people with Acid reflux disease or GERD, the reflux is frequent; 2 or more days every week despite popping antacid pills and Pepto-Bismol. Over time acid reflux can scar the esophagus and may cause throat cancer. Only a doctor can see if you have damage in your esophagus. You can’t tell solely by how you feel.

The most common symptoms of GERD are heartburn, a sour or bitter taste, and difficulty swallowing. Other symptoms include persistent cough, hoarseness, burning in the throat, upset stomach, regurgitation of foods, and waking up from heartburn attacks.

An estimated 5 to 7 percent of the population experience heartburn daily due to GERD and an estimated 19.8 percent of the population experience heartburn or acid regurgitation weekly due to GERD, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD). In 2004 more than 60 million prescriptions for GERD were filled at retail pharmacies, representing 48 percent of all prescriptions for digestive system disorders.

Why is GERD so common? Perhaps it is the food we eat.

• Fatty foods and Fried foods: High-fat foods tend to relax the LES muscle allowing acid to escape the stomach. Fatty foods also digest more slowly; leaving food and acid in the stomach much longer. Chocolate is high in fat and is trigger for some people.


• Acidic Foods: these increase the acid level of the stomach
  Tomato-based foods (eg, pizza, pasta sauce, salsa)
  Citrus fruits and juices
  Onions: these foods increase the acidity of the stomach


• Irritants: these irritate the stomach walls
  Mint & Peppermint: long thought to aid in digestion, but bad for GERD
  Spicy foods
  Garlic
  Caffeine in coffees, teas, sodas, and even hot chocolate. Even decaffeinated coffee can aggravate heartburn with some people.


• Alcoholic drinks: is a triple danger. It can irritate the stomach lining, increase acid production AND relax the LES muscle.


• Certain medications – such as sedatives, tranquilizers and calcium channel blockers (medication to treat high blood pressure) – may contribute to reflux. Recent research also indicates that taking a certain type of sleeping pills may also increase the risk of developing nighttime heartburn.

There are lifestyle factors other than food that can make acid reflux worse, including

• Being overweight


• Smoking


• Stress


• Overeating (eating too much at one time)


• Wearing tight clothing that puts pressure on your stomach

Bottom Line. Living with GERD:

• Antacids work by neutralizing stomach acid. They can provide fast short-term relief from occasional heartburn.


• H2 blockers reduce acid production in the stomach by blocking a signal that leads to acid secretion.


• Proton pump inhibitors (PPIs) turn off some of the "acid pumps" in the stomach's acid-producing cells. Nexium is prescription only but its predecessor, Prilosec and generics of Prilosec can now purchased at drug stores.
  
• Identify your trigger foods. Try eating them in isolation – tomatoes or OJ but not both in the same meal.


• Eat your last evening meal or snack at least 3 hours before bedtime. Most of the food in your stomach is digested within 3 hours. Once food is digested, it cannot back up into your esophagus when you lie down


• Have smaller meals. Eating large meals creates pressure in your stomach. This pressure can force acid from the stomach into your esophagus, causing heartburn or other acid reflux disease symptoms


• Breathe better. Concentrate on breathing deeply from your abdomen, not your chest


• Stretch and relax. Stand up and stretch each of your muscle groups. Focus on releasing the tension in every part of your body


• Exercise and enjoy. Staying active can help you feel much better


• Have fun. Try to do things that make you smile and laugh. This can relieve stress


• Elevate the head of your bed. Nighttime heartburn is largely a gravity problem; when you lie down, acid can move up into the esophagus more easily. Try elevating the head of your bed 4 to 6 inches by placing wooden blocks under the bed's legs. Or you could place a foam wedge under the mattress to lift your head about 6 to 10 inches. Note: Piling up pillows behind your head doesn't help prevent reflux.

Resources

Nexium Resources

YourTotalHealth

National Health Institute paper on GERD