Acid Reflux - Gastroesophageal Reflux (GERD)

Gastroesophageal Reflux Disease (GERD) occurs when the lower esophageal sphincter (LES) fails to remain closed. There are several theories on why this happens. It is most commonly believed that the tissue structure of the LES is compromised by one or more of these factors:

- Overeating
- Eating foods which contain high acid content
- Delayed digestion of stomach content
- Diminished salivation
- Relaxation of the LES (transient)
- Decreased LES resting status
- Ineffective esophageal clearance
- The inability of the esophagus to resist injury and repair itself

GERD episodes occur frequently during the day, quite often following the consumption of too much food or foods high in fat content. However there are also many reported cases of this happening at night, while one is in a horizontal sleeping position.

In the course of this research, I discovered that most physicians recommend that patients avoid alcohol, caffeine and chocolate, as these items seem to be the biggest "offenders" in one's battle against this affliction. It should also be noted that smoking, tight clothing, drugs, hormones, obesity, pregnancy, and even body position have been cited as triggering factors in the onset of this disease.

GERD is often accompanied by a hiatal hernia. This is a protrusion of part of the stomach through the esophageal hiatus, an opening in the diaphragm, which leads into the chest. When this type of hernia is present it may contribute to transient LES relaxation and delay clearance, due to impaired esophageal evacuation. This means that hiatal hernias may allow prolonged acid exposure after reflux occurs, thus creating GERD symptoms and esophageal damage.

Common symptoms of GERD involving the LES are:

- Heartburn - burning in the chest behind the sternum
- Regurgitation - not to be confused with vomiting, which employs the gastrointestinal and abdominal muscles to force stomach contents up the esophagus, this is a bitter or acid taste in the mouth caused by the gastric contents reaching it during reflux
- Dysfunctional swallowing (Dysphagia) - this is the sensation of food "hanging up", "getting stuck" or "slowing down" between the pharynx and the stomach
- Pain when swallowing (Odynophagia) - a sharp pain beneath the sternum that occurs when swallowing. This pain is caused by erosive esophagitis (when the lining of one's esophagus has been "eaten" by stomach acid and gastric enzymes)
- Chest Pain - when caused by reflux, this may be sharp or dull and may radiate into the neck, arms, or back. This is very often mistaken as a heart attack. Don't take any chances. Seek immediate medical attention in the event that this occurs so that your physician or health care provider may rule out heart problems and help you treat the cause.

Common tests used to diagnose and evaluate GERD are:

- Upper gastrointestinal endoscopy and possibly a biopsy of the esophagus
- pH testing of the LES - a sensor is put into place for 24 hours to determine whether or not the reflux is occurring, and to assess the level of the acid being refluxed.

Depending on your physician's evaluation, GERD may be controlled in the early stages with diet and an over-the-counter antacid. It is not recommended that one employ this method of treatment without first consulting one's physician. More severe diagnoses may require more in-depth treatment, possibly including surgery.

Your physician may recommend one, or a combination, of the following:

Lifestyle changes: - Elevate the head of one's bed 4 to 6 inches (5 to 8 centimeters)
- Antacids to neutralize excess stomach acid
- Avoid overeating
- Avoid alcohol, chocolate, and caffeine
- No food two to three hours before going to bed
- Lose weight
- Avoid fatty and/or greasy foods
- Drink eight 8 ounce glasses (about two liters) of water daily

Medical treatments:

- Prescription medications to reduce acid production in the stomach
- Endoscopic suturing - this is a minimally invasive procedure and can create a barrier to minimize reflux in those with mild to moderate GERD. It cannot be done, however, if one has a large hiatal hernia.
- Surgery on the LES - The most common is the Nissen fundoplication. But, there is a less invasive form of surgery using laparoscopy. Your physician will determine which better suits the necessity.

Please remember that left untreated, GERD can lead to many more serious complications, so don't ignore that frequent "heartburn". Get checked out now!

Michael Russell
Your Independent guide to Acid Reflux