Health&Nutrition 8th Year _ issue 72-73 _ August/September 200656

MedicineMedicine

Gastroesophageal RefluxDisease (GERD)

Gastroesophageal reflux disease (GERD) is acondition in which food or liquid travels fromthe stomach back up into the esophagus (thetube from the mouth to the stomach). This par-tially digested material is usually acidic, andcan irritate the esophagus, often causingheartburn and other symptoms. GERD usuallyoccurs because the lower esophageal sphinc-ter (LES) - the muscular valve where the esoph-agus joins the stomach - does not close prop-erly. Someone who experiences recurring, sig-nificant heartburn two or more times a weekmay have GERD

CausesIt may include:- alcohol use - pregnancy - obesity - smoking

Also, certain foods sometimes are linked toacid reflux, including:- citrus fruits - mint flavorings - chocolate - spicy foods - drinks with caffeine - fatty and fried foods - garlic and onions - tomato-based foods, like spaghetti sauce,

chili, and pizza

Symptoms - Heartburn

➧ Involves a burning pain in the chest (underthe breastbone) ➧ Increased by bending, stooping, lyingdown, or eating ➧ Relieved by antacids ➧ More frequent or worse at night

- Belching - Regurgitation of food - Nausea and vomiting - Vomiting blood - Hoarseness or change in voice - Sore throat - Difficulty swallowing - Cough or wheezing

DiagnosisAn upper endoscopy is one of the best waysto look for inflammation and damage to theesophagus and stomach. For this test, the doc-tor first gives you medicine to make you feelsleepy and less anxious, then sprays yourthroat to numb it and slides a thin, flexibleplastic tube called an endoscope down intothe esophagus and the stomach. A tiny cam-era in the endoscope lets the doctor look forabnormalities on the surface of the esophagusand stomach lining. During the endoscopy,the doctor also may use small tweezers (for-ceps) to remove a piece of tissue for biopsy.A biopsy can reveal damage caused by acidreflux or infection and help rule out otherproblems.In another kind of test, called an ambulatorypH monitoring exam, the doctor puts a tinytube into the esophagus that will stay therefor 24 hours. While you go about your nor-mal activities, it measures when acid comesup into your esophagus and how much acidrefluxes. This test is useful in teens with GERDsymptoms but no esophageal damage. It alsocan detect whether the reflux triggers respi-ratory symptoms, such as wheezing andcoughing

TreatmentYour doctor can tell you about diet changesand medicines to help with GERD.

General measures include:- Weight reduction - Avoiding lying down after meals - Sleeping with the head of the bed elevated - Taking medication with plenty of water - Avoiding dietary fat, chocolate, caffeine,

peppermint (they may cause loweresophageal pressure)

- Avoiding alcohol and tobacco

A doctor may give you a prescription for other

Health&Nutrition8th Year _ issue 72-73 _ August/September 2006 57

medicine. A group of medicines called H2blockers works to lower stomach acid. Somemedicines can help make thesphincter muscle stronger andhelp the stomach empty morequickly. If nothing else works,a person may need surgery totreat GERD, but this isn't done very often

The majority of people respond to nonsurgicalmeasures with behavioral modification andmedications

Preventive measures- Avoid foods that can cause problems for

you. - Eat smaller, more frequent meals throughout

the day. - Don't eat right before you go to bed. Wait

2 to 3 hours between eating and lyingdown or sleeping.

- Try sleeping on a special wedge-shaped pil-low. Elevate the head of your bed on 6-inchblocks.

- Don't wear tight clothing -like snug jeans or a tight belt- around your middle. - Follow your doctor's adviceabout your weight. In somecases, losing weight canhelp GERD. But never start adiet without consulting withyour doctor.

- Keep a diary of GERDsymptoms. Record yoursymptoms and see if there'sa pattern. Do the symptomshappen after eating certainfoods or doing certain activi-ties? If so, you'll know whichfoods or activities are OKand which ones to avoid.Soon, you can be on yourway to being GERD-free!

The key to living with GERDis to not ignore it. Early diagnosis and treat-ment can help reduce or even eliminate

uncomfortable symp-toms. Left untreated,however, GERD cancause permanent dam-age to the esophagus

You'll probably find that one of the simplestways to make living with gastroesophagealreflux disease easier is to avoid the things thattrigger your symptoms. By taking these stepsand working with your doctor, you'll soon dis-cover that GERD doesn't have to limit whatyou can do.

Citations: - Gastroesophageal Reflux Disease (GERD)

Reviewed by: Mitchell Cohen, MD, TheNemours Foundation

- Gastroesophageal reflux disease Updated by:Christian Stone, M.D., Division ofGastroenterology, Washington University in St.Louis School of Medicine, St. Louis, MO.Review provided by VeriMed HealthcareNetwork.

Persistent heartburn is one of the signs ofgastroesophageal reflux disease, morecommonly known as GERD or acid reflux