Many of us have been burned by acid reflux after a night of hearty eating or drinking -- unpleasant and annoying, but perfectly common. But if you experience these symptoms a few times a week, you might have GERD.
Even the sound of the acronym is unappealing. GERD stands for gastroesophageal reflux disease. Gastroenterologist Dr. Sarah Kahn, of Stamford, explains it as a chronic condition that occurs when the sphincter muscle at the lower end of the esophagus relaxes, allowing stomach acid to back up into the esophagus. (Normally, this muscle closes tightly so nothing comes back up.) This is acid reflux, and the most common result is heartburn -- that burning sensation that starts in the esophagus, slowly creeping up the throat. Swallowing only makes the burning sensation worse. An antacid can bring relief, but that's often temporary.
Marisa Amorando began having regular heartburn a few years ago. At the time she smoked, was overweight, ate lots of chocolate, as well as fried and acidic foods, and drank a good amount of caffeine. She was also missing work because she felt sick all the time. Amorando was diagnosed with GERD and a hiatal hernia, often a result of GERD.
Today, Amorando is 60 pounds lighter, drinks no caffeine, gave up smoking and eats chocolate occasionally, because, she laughs, "women need it," in addition to tomato sauce, because she's Italian. "Truthfully, being diagnosed with GERD was the best thing to happen to me," she says. "It was a wakeup call for me to make some serious changes."
Symptoms of GERD
Amorando's symptoms were acid reflux, heartburn, a sour taste in her mouth, and chest pain, caused by the hiatal
hernia. Kahn says GERD can present in other ways, including difficulty swallowing, dry cough, hoarseness or sore throat, and the sensation of a lump in the throat.
In rare cases, GERD can lead to Barrett's esophagus -- a change in the lining of the esophagus -- which can eventually progress to esophageal cancer. Kahn says since this is so rare, it is not a concern for most GERD sufferers. But because it exists, it is one reason to seek medical help if your acid reflux is becoming problematic.
Many women experience reflux during pregnancy, which Kahn says usually disappears once the baby is born. That's when Stephanie Lahey of Easton first experienced heartburn, but, for her, it never went away. She says her mom and grandmother had chronic heartburn, so she grew up seeing them pop their antacids daily. Now, six years after the birth of her son, Lahey keeps her GERD in control with medication and tweaks in her diet because she knows spicy food and pizza will keep her up all night. "But sometimes it is just so hard not to eat the foods I love," she admits.
Kahn says for many patients a GERD diagnosis is the start of a new way of living. "Just losing 10 pounds, especially around the belly, is all that some people need to bring relief," Kahn says. She also suggests:
-- Elevating the head of the bed about six inches
-- Eating smaller meals, scattered throughout the day
-- Eating nothing for the three hours before bedtime
-- Not smoking
-- Avoiding tight clothing
-- Avoiding chocolate, red wine, mints, carbonated beverages, and acidic foods such as tomatoes and citrus
Gastroenterologist Dr. Jacqueline L. Wolf, author of A Woman's Guide to a Healthy Stomach, says three types of medications are used to treat heartburn: antacids, H2 (histamine type 2) blockers and proton pump inhibitors (PPIs), the medicine both Amorando and Lahey take daily.
Antacids work quickly to bring relief, but unfortunately do not last long and often need to be taken frequently. Antacids contain combinations of aluminum, magnesium, sodium bicarbonate and calcium, and Wolf says it's important to find the one that works best for you. She notes that those high in magnesium can cause loose stools, while those high in calcium and aluminum can be constipating.
H2 blockers decrease the amount of acid produced in the stomach. The most common H2 blockers are Zantac, Pepcid and Tagamet. PPIs such as Prilosec, Nexium, Prevacid, Aciphex and Protonix are used if the H2 blockers fail. They are more powerful acid suppressants.
East meets West
And then there's stress, which both Lahey and Amorando credit with making their GERD worse, even with medication. Lahey's problems became worse following the death of a loved one. For Amorando, it's her job as a victim's advocate at The Center for Women and Families of Eastern Fairfield County. Both Wolf and Kahn encourage their patients to develop relaxation techniques to handle GERD.
Amorando admits she has always been a fast eater, and has begun to practice mindful eating techniques. "I am learning to slow down when I eat," she says. "I am learning to ask myself why I am eating what I am eating, so I really think about the food. I really believe that the mind-body connection exists, and when I slow down, I digest my food better. When I think about the food I am eating I make better food choices."
Kahn says some people find it easier to pop a pill than change a behavior, but for many conditions affecting your gut, it's the behavior that needs to change in order to feel better.
"People are wound up and eating under stress," she says. "We are a nation that is gulping down our food, and that is causing a lot of reflux." Kahn keeps a book on her desk, Yoga as Medicine, which she uses to introduce her patients to the concept of combining Eastern philosophy with Western medicine. "If we would all just slow down and take a deep breath, we could be healthier," she says.
Wolf agrees. "We would all be better off if we learned to meditate, even only 15 minutes each day," she says. "Or, learn deep breathing techniques, which actually become a way to meditate. When you feel stress coming on, stop and start deep breathing."
In addition, finding time to exercise daily, even just walking up and down the stairs a few times if you are out of shape, can work off stress. "The past two years have been a learning experience for me," Amorando says. "I still have weight to lose, and my job is stressful, but I am learning to deal with my emotional issues and I feel so much better. I go to the gym. And now, when I am sick, I am sick. It's not GERD that is making me sick. I don't know if it will ever go away totally, but I am living life, learning how to cope with GERD, and I feel so much better."
Gastroenterologist Dr. Sarah Kahn, of Stamford, says if you have bouts of acid reflux or heartburn more than twice a week, it's best to see a doctor. According to the Mayo Clinic, the following tests are often used to diagnose GERD:
An X-ray of your upper digestive system: The patient drinks a chalky liquid that coats and fills the inside lining of the digestive tract. An X-ray of the upper digestive tract is taken, and the liquid shows a silhouette of the shape and condition of the esophagus, stomach and upper intestine.
Endoscopy: a flexible tube equipped with a light and camera is inserted down your throat so the doctor can examine the stomach and esophagus. Sometimes, tissue samples are collected.
Ambulatory acid (pH) probe tests: The acid monitor is a thin, flexible tube that's treaded through your nose into your esophagus. Or, it can be a clip that's placed in your esophagus during endoscopy. It identifies when, and for how long, stomach acid regurgitates into your esophagus.
Esophageal motility testing: Measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.