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Overview

Gastroesophageal reflux disease often known more simply as GERD is a common condition in which stomach acid and enzymes flow backward from the stomach into the esophagus causing inflammation and pain. It is estimated that about one third of the population suffers from GERD. While the symptoms are similar to heartburn GERD is more serious and if not treated can lead to serious health problems.

Our bodies are designed to trap digestive acid in our stomachs. When we swallow a ring of muscle in the esophagus (the tube that connects the mouth to the stomach) serves as a valve. It opens to allow food to pass into the stomach and then quickly closes to keep the acids in. But sometimes the valve relaxes or weakens allowing stomach acid to regurgitate (reflux) back into the esophagus creating that burning sensation that we know as heartburn. Heartburn can last as long as 2 hours and is often worse after eating and when lying down. The pain is caused by stomach acid in the esophagus which unlike the stomach can't protect itself from acid.

There are a variety things that influence how often we get heartburn and how severe it is including the ability of that ·valve' to open and close properly the type and amount of stomach juices that back up into the esophagus the ability of the stomach to empty properly the clearing action of the esophagus and the acid-neutralizing effect of saliva. Researchers believe that a genetic link predisposes some people to acid reflux disease. If your parents or siblings have or had GERD you may be at greater risk of developing the condition.

In most cases your doctor can accurately diagnose GERD just using your description of symptoms (dominant symptoms of heartburn or acid regurgitation). However testing may be required to make the diagnosis (including ruling out other possible causes of your symptoms) or to determine the degree of damage. Tests may include the following:

Upper GI series: After swallowing a special liquid to coat the esophagus stomach and upper part of the small intestine x-rays are taken. This may be performed during the early stages of testing and the main value is to rule out other diagnoses such as ulcers.

Upper GI endoscopy: After patient sedation a long flexible tube with a tiny video camera on the end (endoscope) is passed through the mouth and down the esophagus so the doctor can visually examine the lining of the esophagus for inflammation or irritation. If necessary a biopsy (removing a small sample of tissue) can be taken for further testing. Not all people with GERD have visible inflammation in the esophagus - most do not. Endoscopy is an important procedure when GERD has been present for a long time.

24-hour pH monitoring: A very thin tube is passed to the bottom of the esophagus to monitor the acidity level over 24 hours while the patient goes about normal activities. The test is used to assess the episodes of reflux compared with symptoms and the type of activity associated with symptoms. This test is usually used in patients for whom a diagnosis is difficult.

If not treated GERD can lead to serious health problems. For instance esophagitis may cause bleeding or ulcers in the esophagus. Some people also develop a condition called Barrett's esophagus which is severe damage to the lining of the esophagus. Doctors believe this condition may be a precursor to esophageal cancer.

If you have acid reflux there is relief available. About 80 percent of patients who experience acid reflux are treated effectively with dietary changes and commonly prescribed drugs. However no medication will entirely prevent acid reflux. Instead medication helps reduce acid secretion · which means there's less acid to reflux. But you must still do your part by making lifestyle changes.

Tips to Control Heartburn

• Avoid lying down right after eating and within two to three hours of bedtime
• Elevate the head of the bed four to six inches
• Lose weight if overweight
• Stop smoking
• Avoid eating large meals. Instead eat smaller more frequent meals

Avoid:

• Chocolate
• Coffee and alcohol
• Fried and fatty foods
• Mint products (i.e. peppermint spearmint)
• Carbonated beverages and citrus fruits or juices
• Tomato sauce ketchup mustard and vinegar
• Aspirin and most pain medicines (other than acetaminophen)

Canadian Digestive Health Foundation

YourDigestiveHealth.ca