What You Should Know About GERD

Burp. We all do it, no matter our age. Sometimes our mouths have an acidic taste afterward, or we feel a burning sensation in our chest. In many cases, gastroesophageal reflux is sending acidic stomach juices, food, or fluids up from your stomach into your esophagus, and then to your throat and mouth, giving you a sour taste. When this happens repeatedly, over a long period of time, it’s called chronic acid reflux, gastroesophageal reflux disease or simply GERD which, left untreated, can pose a host of potential problems.

What causes GERD?

Although many things can trigger GERD, the underlying cause is usually a malfunction of the valve at the base of the esophagus called the lower esophageal sphincter, says Amir E. Soumekh, M.D.,  assistant professor of clinical medicine within the Jay Monahan Center for Gastrointestinal Health.  “This valve stays closed to prevent stomach contents from moving backwards into the esophagus and opens only briefly when we swallow to allow food to enter the stomach,” Dr. Soumekh explains. “In patients with GERD, this sphincter either opens too often--even when the patient is not swallowing--or is loose and does not remain tightly closed.”

GERD is common in the United States, affecting up to 20% of the population, according to Dr. Soumekh.  Anyone of any age can develop it, but some people are more at risk than others. For example, the chances of experiencing mild or severe GERD increase after age 40. “As patients become older, the likelihood of reflux appears to rise,” Dr. Soumekh says. Being overweight or obese also increase the risk. “Patients often improve their GERD symptoms--or even cure their GERD--by losing weight,” he says. “Exercise and staying physically active overall appears to be protective and lack of exercise appears to increase the likelihood of reflux,” he adds.

Smoking or regular exposure to second-hand smoke also increase the risk for GERD, as well GERD-related complications, such as esophageal cancer. Certain medications, such as non-steroid anti-inflammatory pain relievers (e.g., ibuprofen or aspirin), opiate pain medications, blood pressure medications, osteoporosis medications, and several others can trigger GERD, too. Certain foods, especially those containing peppermint, chocolate, coffee or caffeine, alcohol, as well as acidic or spicy foods, can cause GERD symptoms, Dr. Soumekh says. Finally, pregnancy or having a hiatal hernia, which causes the upper part of the stomach to bulge into the diaphragm, thereby loosening the esophageal valve, can also bring on GERD.

Symptoms of GERD

Although symptoms of GERD vary, heartburn (a burning sensation in the chest) and regurgitation (the painless sensation of food or fluid moving up into the esophagus or even all the way up into the mouth) are the two most common ones, Dr. Soumekh says. Other symptoms may include difficulty or pain with swallowing, non-burning chest pain, increased salivation, feeling a ‘lump’ in your throat, chronic cough, hoarse voice, ‘sour’ stomach, upper abdominal pain, or nausea.  “Many of these symptoms can be caused by diseases other than GERD, such as heart disease, so all patients with these symptoms should be fully evaluated and not simply presumed to have GERD,” he advises.

Although GERD isn’t life-threatening in itself, its symptoms, left untreated, can injure the lining of the throat, airways, and lungs, making breathing difficult and causing a persistent cough. Plus, chronic inflammation of the esophagus can lead to more serious problems. “GERD is a risk factor for precancerous esophageal changes, called ‘Barrett's esophagus,’ and for esophageal cancer,” Dr. Soumekh says.

Moreover, because other diseases can mimic GERD-type symptoms, it’s important to get a medical evaluation to confirm the diagnosis. “All patients with chronic reflux symptoms should be evaluated by a gastroenterologist specialized in this disease,” Dr. Soumekh says. A gastroenterologist’s evaluation can also help determine the ideal management strategy for GERD, which may include diet and lifestyle modifications, prescription medication, or more invasive treatments.

Get a medical evaluation

Sometimes an evaluation is as simple as a physical exam. Other times it requires in-depth diagnostic techniques, such as radiology exams (a barium esophagram), an upper endoscopy, formal reflux measurement, or esophageal motility testing. 

Treating GERD typically entails a variety of approaches, particularly diet and lifestyle changes.  “All WCM gastroenterology patients have access to a nutritionist specialized in gastrointestinal diseases to help them make these changes,” Dr. Soumekh says.  In addition to losing weight, such changes may include:

• Eating small, frequent meals rather than large amounts a few times a day
• Eating meals 2 to 3 hours before you lie down
• Avoiding foods and drinks that aggravate symptoms
• Reducing dietary fat (butter, oils, salad dressings, gravy, fatty meats and full-fat dairy products, like sour cream, cheese and whole milk)
• Sitting upright while eating and staying upright (sitting or standing) for 45 to 60 minutes afterward
• Avoiding clothes that are tight around the belly
• Stopping smoking

If changes in diet and lifestyle do not control your symptoms, then you may need medication. Anti-reflux procedures and surgery are also options. If you have acid reflux or heartburn more than twice a week for several weeks, rely on heartburn medicines or antacids, and still have symptoms, speak with your physician to determine which treatments are best for you.