Digestive Distress? Easing the Symptoms of GERD

Digestive issues can be highly disruptive. One condition that affects approximately 20% of American adults is gastroesophageal reflux disease, commonly known as GERD. Here, Dr. Rameez Alasadi, gastroenterologist with Silver Cross Hospital, offers helpful information surrounding the condition—including symptoms and treatment options.

What Is GERD?

GERD is a chronic condition where stomach acid or contents flow back into the esophagus, irritating its lining. This happens due to an ineffective or incompetent valve (lower esophageal sphincter) at the bottom of the esophagus, which normally allows food to pass into the stomach and then tightens to prevent backflow.

While the valve can open to allow belching or vomiting, persistent relaxation or dysfunction leads to reflux and related symptoms. GERD results from this mechanical problem at the esophagus-stomach junction.

Common Symptoms of GERD

Dr. Alasadi explains that while small amounts of acid in the esophagus can be tolerated, excessive acid causes irritation, leading to a burning sensation behind the chest. “The lining of the esophagus is not made to handle acid for a long period of time. We produce acid in our stomach, but we don't feel it. The lining of the stomach is more acid resistant and can handle acid for a long period of time. The esophageal lining is completely different.”

Alarming signs of GERD include difficulty swallowing, anemia, vomiting blood, black tarry stools, and unintentional weight loss. These symptoms require immediate medical evaluation by a physician or gastroenterologist.

Additionally, long-term GERD sufferers, even those with controlled symptoms, should consult a doctor about treatment options, potential side effects, and screening for conditions like Barrett's esophagus—a precancerous condition that can develop from prolonged reflux.

GERD Risk Factors, Diagnosis Protocol

Anyone can develop GERD, but there are some individuals who are at a higher risk of having the condition. “We all have some reflux that we clear up right after we eat, but that's not GERD. The chronic condition that we refer to as GERD is seen more with increased weight because abdominal fat can push on the stomach,” notes Dr. Alasadi. “So, people who are overweight or obese are at higher risk for developing the condition. During pregnancy, patients might experience reflux as well.”

Diagnosing GERD typically begins with assessing the patient's symptoms, such as heartburn or regurgitation. Initial treatment often involves a trial of acid-suppressing medication.

Further diagnostic methods include:

• Endoscopy: A flexible tube with a camera is passed through the mouth into the esophagus under sedation. This allows visualization of esophageal damage, such as esophagitis or Barrett's esophagus.
• Acid Monitoring: Sensors or probes are placed in the esophagus to measure acid levels over several days. These devices wirelessly transmit data as patients go about their normal activities.
• pH Testing: A catheter is inserted through the nose into the esophagus to monitor acidity and correlate symptoms with acid reflux events.

How GERD Is Treated

GERD treatment involves various approaches tailored to the patient's needs, including medications, lifestyle changes, and mechanical interventions to address the root cause of reflux. Dr. Alasadi outlines the following options.

Medications

• Antacids (e.g., Tums, Maalox): Provide quick, short-term symptom relief
• H2 Blockers (e.g., Pepcid, Zantac): Reduce acid production in the stomach
• Proton Pump Inhibitors (e.g., omeprazole): Strongly block acid pumps, effectively control symptoms, and heal esophageal inflammation

Lifestyle Modifications

• Weight loss
• Avoiding late meals (no food or drink 3-4 hours before bed) to reduce reflux when lying down
• Minimizing triggers such as caffeine, smoking, alcohol, citrus, tomato-based foods, and peppermint
• Elevating the head of the bed to reduce acid backflow during sleep

Mechanical Treatments

• Surgical Options: Minimally invasive techniques (robotic or laparoscopic surgery) to repair the valve and fix issues like hiatal hernias, leading to quicker recovery
• Endoscopic Procedures such as TIF (Transoral Incisionless Fundoplication): A non-surgical approach using a flexible tube to wrap the upper stomach around the lower esophagus, creating a high-pressure zone and reconstructing the valve

“Clearly, there are different ways of treating reflux and it's not a one-size-fits-all approach. We have to look at what patients want and what procedure is suitable for them,” shares Dr. Alasadi. “Some patients don't want to take medication for a long period of time. Some patients have side effects from the medicine. Remember, medication will address the acid level, but not the mechanical component of reflux, which is the root of the problem.”

Ultimately, what’s most important is to address GERD before it leads to more problematic and potentially dangerous issues.