Severe Heartburn? It May Be GERD

Heartburn may seem like an irritation, but it can lead to serious health complications -- if left untreated.

From the WebMD Archives

You thought you have a simple case of heartburn, but lately, after adding a few inches to your waistline, it's more than that: a frequent feeling of pain under your breastbone; the faint taste of acid on the back of your tongue; trouble sleeping a few times a week; and problems swallowing.

It happens when you eat too much, when you doze on the couch after dinner, and when you have too many drinks during cocktail hour. Chowing down a few slices of pepperoni pizza doesn't seem to be a problem, but tacos almost guarantee a night of chest pain and tossing and turning. For other people, the reverse could be true, or the problem could come from other foods.

What's going on? Your occasional bout of heartburn has now become one part of a larger problem -- GERD, or gastroesophageal reflux disease.

"Everybody has a little bit of heartburn," says Joel Richter, MD, a gastroenterologist and chairman of medicine at Temple University. "But GERD is when it becomes chronic, occurring two or three times a week or more; when it's interfering with your lifestyle so that you're avoiding eating various foods; when you're not exercising because you get heartburn; and when it's interfering with sleep and when swallowing."

Heartburn: A Symptom of GERD

More than 15 million Americans, usually adults but also children, have GERD. Many of these people deal with heartburn, its most common symptom, two or more times a week. The root cause of the disease is a faulty valve between the esophagus and the stomach, called the lower esophageal sphincter, that relaxes more often than it should. The result is that juice from the stomach -- made up of acid, digestive enzymes, and other unpleasant substances -- sneaks back up into the esophagus and damages its lining.

Why this happens isn't always clear, but doctors do know that the valve may stop working properly if a person:

  • Is overweight. Extra weight puts pressure on the valve, causing it to relax.
  • Is pregnant. Hormones play a role in relaxing the valve, and the growing fetus puts pressure on the stomach.
  • Has a hiatal hernia. This prevents the muscle wall between the chest and the stomach from supporting the valve as it should.

GERD can be just heartburn or heartburn plus other symptoms, including excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, and burning pain in the chest. Untreated, GERD can lead to serious health problems, so it needs to be taken seriously and managed with both medication and smart lifestyle choices, starting with maintaining a healthy weight.

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Lifestyle Choices

Dropping some pounds, taking a look at your diet, and making some adjustments to your bed -- all can help you deal with GERD.

"Losing weight is perhaps one of the most important lifestyle choices when it comes to GERD," says Richter. "It's been shown that people who are obese have more heartburn, more irritation of the esophagus, and more complications from their disease."

In addition to maintaining a healthy weight, it's best to avoid overeating. "More often, it's not as much the types of food we eat as it is the volume of food," Richter tells WebMD. "That's why reflux commonly occurs after dinner, because in our society it's the largest meal of the day. With big meals, the stomach slows down, so there's more stomach contents to go back into the esophagus."

You should also learn which foods spell trouble for you individually. While you might be living by the credo that pepperoni pizza causes the symptoms of GERD to flare without fail, that's not necessarily so.

"At this point, I no longer recommend that people completely avoid spicy foods, fried foods on occasion, and chocolate and coffee and tea, other than to say if it hurts to eat it, then don't," says Patricia Raymond, MD, a fellow with the American College of Gastroenterology and host of National Public Radio's House Calls program. "And be aware that some people can eat some foods, while others can't. Each case of GERD varies."

Even though the effects of meals differ from person to person, foods that most commonly cause GERD symptoms include fatty items (such as french fries and cheeseburgers), chocolate, peppermint, colas, and orange juice.

And anyone with GERD should avoid alcohol, which has a relaxing effect on the esophageal sphincter, explains Raymond. This opens the door for acid to reflux from the stomach into the esophagus and makes the symptoms of GERD worse.

Finally, it sounds simple, but it's true: When and how you sleep has a big impact on GERD symptoms. For example, lying down or going to bed an hour after having a three-course dinner means that the food in your stomach, along with damaging acids, can make its way up your esophagus. Wait at least two or three hours after eating before you lie down, Raymond advises, and follow the "head of the bed" rule.

"Put bricks or blocks under the front legs [those at the head] of the bed to incline your head six to eight inches," Raymond tells WebMD. "Or get a foam wedge that goes from under your hips all the way to the head of the bed. This helps keep stomach contents where they belong -- in the stomach."

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Medications for GERD

If lifestyle changes alone aren't enough to keep the disease in check, you may need a prescription medication. In fact, if you're popping antacids more than once a week for heartburn, that's also a sign you may need more aggressive treatment. Relying on antacids alone can be dangerous, since they don't prevent long-term damage to the esophagus.

Two categories of drugs on the market today help treat GERD: H2 blockers and proton-pump inhibitors. Though you can buy some over-the-counter versions of the drugs, see your doctor first to have your symptoms evaluated and determine which treatment is best.

H2 blockers, which have been around for more than 30 years, are generally regarded as a good short-term option for people with mild forms of GERD that flares up often, but not every day. H2 blockers work by decreasing the flow of stomach acid, which helps heal minor irritation of the esophagus and prevents further damage.

Proton pump inhibitors are required when GERD symptoms are frequent or the severity of the disease has progressed significantly. These drugs are more effective than H2 blockers at reducing acid flow and healing the esophageal lining even when it has been badly damaged. They are also better at managing symptoms for longer periods of time and preventing relapse.

Long-term treatment for GERD may be necessary, since symptoms often flare up again when treatment is stopped -- unless lifestyle changes are able to get it under control.

As a last resort, and when GERD symptoms have caused significant damage to the esophagus, surgery is an option. The procedure repairs the valve between the stomach and the esophagus, preventing acid reflux from occurring and giving the esophagus an opportunity to heal.

GERD isn't curable, but it is treatable with medication and healthy living -- which means there's no reason to suffer through sleepless nights or an uncomfortable feeling after a meal.

"Many people try to live with GERD, but there's no need to do that," says Raymond. "It has such a severe impact on quality of life when left untreated. The good news is that it's manageable. See your doctor, discuss your treatment options, and get on with your life."

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GERD: A Symptom Checklist

"When you see your doctor, talking through your symptoms is nearly as accurate in diagnosing GERD as the tests we have," Richter says. "Are the classic symptoms there? If the answer to that question is yes, it's probably GERD."

What are those classic symptoms? Here's a checklist that will help you gauge your reflux troubles:

  • Do you suffer from heartburn symptoms more than two or three times a week?
  • Do the symptoms feel like a burning under your breastbone?
  • Do your symptoms often get worse after eating?
  • Are you taking antacids after every meal to minimize symptoms? Do they help?
  • Do you feel a burning chest pain when exercising?
  • Are your symptoms worse when you lie down?
  • Do you often taste a faint sense of acid in your mouth?
  • Do you have trouble sleeping at night?
  • Do you have asthma that is made worse when you're having heartburn?
  • Does your voice get scratchy when you have heartburn?
  • Is heartburn interfering with your quality of life?

Answering yes to one or more of these questions might mean you have GERD. Make an appointment to see your doctor.

Why You Should Never Ignore GERD

After several years, untreated GERD erodes the lining of the esophagus, and as a protective mechanism, the esophagus starts to create a new lining with cells that resemble the makeup of the intestine. At this stage, GERD has progressed into a precancerous condition known as Barrett's esophagus, bringing with it a 30-fold increased risk of eventually developing esophageal cancer.

Esophageal cancer is deadly -- only about 15% of people are still alive five years after being diagnosed, according to the American Cancer Society. And it's more common among individuals who have long suffered from GERD that is not properly treated.

According to a study published in TheNew England Journal of Medicine, cancer of the esophagus was nearly eight times as likely among people who suffered from heartburn at least once a week, and almost 44 times as likely in those who had severe, frequent heartburn for more than 20 years. Almost all of these people had only sporadic treatment for GERD, not long-term treatment.

If you have GERD, and you are having any of these symptoms, tell your doctor right away:

  • If difficulty swallowing or a feeling like food is trapped behind the breastbone becomes a new symptom of your GERD.
  • If you vomit blood or have black, tarry bowel movements.
  • If you have the sensation of acid reflux into the windpipe causing shortness of breath, coughing, or hoarseness.
  • If you lose weight unexpectedly or without trying.
WebMD Magazine - Feature Reviewed by Michael W. Smith, MD on February 09, 2007

Sources

Published March 1, 2007.

SOURCES: Patricia Raymond, MD, fellow, American College of Gastroenterology; host, National Public Radio's House Calls program, Chesapeake, Va. Joel Richter, MD, chairman of medicine, Temple University, Philadelphia. American College of Gastroenterology web site: "The Word on GERD." American Cancer Society web site: "Esophageal Cancer." Lagergren, J. TheNew EnglandJournal of Medicine, March 18, 1999; vol 340: pp 825-831. National Institute of Diabetes & Digestive & Kidney Diseases web site: "Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)."

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