Understanding GERD

Dr. David Gremse, professor and chair of pediatrics at the University of South Alabama College of Medicine and a pediatric gastroenterologist with USA Physicians Group, said gastroesophageal reflux disease, or GERD, is a condition in which the stomach contents leak backwards from the stomach into the esophagus.

This action can irritate the esophagus, causing heartburn and other symptoms.

When you swallow, Dr. Gremse said, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. At the end of swallowing it will tighten up to hold the acid and food in the stomach where it belongs.

In people with GERD, the valve opens more frequently. When this valve opens, the contents of the stomach are more likely to come up into the chest portion of the esophagus, giving pain under or just below the breast bone.

Unlike the stomach, the lining of the esophagus cannot protect itself from acids. Thus, GERD can lead to esophageal erosions from acid damage. If untreated, it can lead to the formation of scar tissue, causing an esophageal stricture that can result in difficulty swallowing normal bites of food.

According to Dr. Gremse, the prevalence of gastroesophageal reflux disease is increasing. One factor that likely contributes to this increase is the obesity epidemic.

Implementing appropriate lifestyle modifications and using acid-suppressing medications, such as proton pump inhibitors (PPIs), can improve GERD symptoms in both children and adults.

In addition to heartburn, stomach aches, and upper digestive symptoms, there are also extraesophageal symptoms of acid reflux that can occur in children and adults. Acid reflux has been associated with asthma, sleep apnea, sinusitis, chronic bronchitis, non-cardiac chest pain, atypical loss of dental enamel, hoarseness, chronic cough, and chronic laryngitis.

Dr. Gremse said nighttime awakening is also a common symptom of acid reflux. “When you’re up and around during the day, the acid has the chance to drain off the stomach,” he said. “But when you’re lying flat in bed at night you can get a buildup of acid in the stomach.” Patients with extraesophageal symptoms of GERD may need higher doses of PPIs and a longer duration of therapy.

Dr. Gremse said those suffering from acid reflux should consider the following lifestyle modifications along with acid suppression therapy:

• Avoid large meals, especially prior to exercising
• Do not eat or drink two hours prior to bedtime
• If obese, consider a weight loss program to maintain a healthy weight
• Limit foods and drinks that provoke GERD symptoms (caffeine, chocolate, spicy foods, fatty foods, acidic foods, citrus juices, carbonated beverages)
• Avoid cigarette smoke exposure and alcohol use