Saanichton, BC

Dr. Miguel A. Lipka

Gastroesophageal Reflux Disease

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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.

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.

Other factors that may contribute to GERD include:

  • Obesity
  • Pregnancy
  • Smoking

The main symptom of GERD in adults is frequent heartburn. 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.

Common foods that can worsen reflux symptoms include:

  • Citrus fruits
  • Chocolate
  • Drinks with caffeine or alcohol
  • Fatty and fried foods
  • Garlic and onions
  • Mint flavorings
  • Spicy foods
  • Tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.

Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

  • 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.

Over-the-counter antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.

H2 blockers decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms. 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.

Because drugs work in different ways, combinations 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.

Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

GERD and Children

Distinguishing between normal, physiologic reflux and GERD in children is important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD.

Talk with your child’s health care provider if reflux-related symptoms occur regularly and cause your child discomfort. Simple strategies for avoiding reflux may be recommended, such as burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, your health care provider may recommend that your child eat small, frequent meals and avoid foods that cause symptoms.

Avoiding food 2 to 3 hours before bed and try raising the head of your child’s bed with wood blocks secured under the bedposts. Just using extra pillows will not help. If these changes do not work, your health care provider may prescribe medicine for your child. In rare cases, a child may need surgery.