GERD, short for gastro-esophageal reflux disease, is caused by acid or stomach contents coming back up or refluxing into the esophagus. The esophagus is the tube that goes from the mouth to the stomach. Stomach contents in the esophagus often cause heartburn.
What are the symptoms of GERD? Some of the more common are: burning sensations at the top of the abdomen, burning in the chest, waking up coughing (especially after eating in the late evening hours), and, in severe cases, GERD can cause irritation and bleeding in the esophagus that will lead to severe pain and, at times, vomiting blood. Reflux often causes the same symptoms as heart disease. Some people who think they have GERD may actually have heart disease. This is why it is important to go to your doctor if you have symptoms that aren’t clearly helped by changing your diet, modifying your habits and taking anti-acid medications.
Reflux is often made worse by hiatal hernias. Hiatal hernias are where part of the stomach is in the chest, allowing more reflux. Normally, there is a valve of sorts between the stomach and esophagus. In people who have a hiatal hernia, this “valve” is essentially non-existent, allowing acid to travel freely from the stomach to the esophagus.
If you think you have GERD, what can you do? Reflux is often made better by not eating at night for the four to six hours before you go to bed. You should avoid foods that you know will make you feel bad. Common culprits are chocolate, coffee, spicy foods, etc. Elevating the head of your bed by putting a 2x6 piece of lumber under the feet at the head may help with night-time reflux and heart-burn symptoms. Taking acid-reducing medications from the store may help reflux symptoms. Occasional use of such medications is OK. However, if you find yourself taking them regularly, it is best to get direction from your physician.
When should you go the doctor? If you have changed what you eat, have modified your habits or find yourself taking anti-acids regularly, it is time to enlist the help of your physician.
What will your physician be likely to do when you come to them with what you think is GERD? First, they will make sure there isn’t something else going on like heart or gallbladder disease. Then they will likely review your habits and place you on prescription medications to reduce acid. At times, they will refer you to a surgeon or gastroenterologist (“GI”) for an esophagogastroduodenoscopy (“EGD”).
What is an EGD? An EGD is a painless and safe test that is performed by a surgeon or GI physician. It is done while you are sedated. It allows the specialist physician to look directly at your esophagus, stomach and the first part of your small bowel (or duodenum) with a video scope. It helps diagnose reflux, hiatal hernias, cancer (reflux can cause cancer), bacterial infections, ulcers, polyps, celiac disease and many other things. It may give valuable information that is used to develop a better plan for the care of reflux and other diseases.
Is actual surgery ever required to treat reflux? Occasionally, If medications, dietary changes and changes in your habits don’t help your reflux and studies arranged by your physician suggest that surgery could be the answer to your problems, you may be referred to a surgeon trained to perform “anti-reflux” procedures. The most common “anti-reflux” procedure is the “Nissan Fundoplication.” This is a procedure where the stomach is surgically wrapped around itself to recreate a valve that keeps acid out of your esophagus thus reducing GERD. Surgery should be a last resort.
In summary, many people can stop the symptoms of reflux by modifying what and when they eat. There are many useful medications that may help reflux. If you use these more than occasionally, they should be prescribed by a physician. Your physician may and often will direct you to a specialist for an EGD. EGDs are painless and often give a great deal of useful information. Occasionally, if you have severe reflux that isn’t controlled with medications, surgery may be recommended.
Treat your stomach right, and it will likely treat you right!4
Jeffrey A. Larsen MD is a board certified general surgeon who practices in The Specialty Clinic at The Providence Medical Center in Kodiak