GERD (Gastroesophageal Reflux Disease)

GERD (gastroesophageal reflux disease) is a chronic condition where stomach acid frequently flows back into the esophagus, the tube connecting your mouth and stomach. This backwash (acid reflux) can irritate the lining of your esophagus, causing symptoms and potential complications.

While occasional acid reflux is common and normal, GERD is diagnosed when reflux occurs frequently (two or more times per week) or causes complications. GERD is very common and can usually be managed with lifestyle changes and medications.

GERD symptoms may include:

Common Symptoms:

• Heartburn: Burning sensation in chest, often after eating
• Regurgitation: Sour or bitter-tasting acid backing up into throat or mouth
• Chest pain: May feel like heart attack (seek care if unsure)
• Difficulty swallowing: Sensation of food stuck in throat
• Feeling of lump in throat: Globus sensation
• Chronic cough: Especially at night
• Hoarseness: Voice changes
• Sore throat: Persistent throat irritation

Symptoms often worse:

• After eating
• When lying down
• When bending over
• At night

Call Emergency Services (112 in Sweden) if:

• Chest pain (could be heart attack)
• Severe difficulty swallowing
• Vomiting blood
• Black, tarry stools
• Severe abdominal pain

Managing GERD involves:

1. Lifestyle Changes (most important):

   • Elevate head of bed: 6-8 inches
   • Don't lie down after eating: Wait 2-3 hours
   • Eat smaller meals: More frequent, smaller portions
   • Avoid trigger foods:
     • Spicy foods
     • Fatty foods
     • Chocolate
     • Caffeine
     • Alcohol
     • Citrus
     • Tomatoes
     • Onions
   • Lose weight: If overweight
   • Don't smoke: Smoking worsens GERD
   • Wear loose clothing: Avoid tight waistbands

2. Over-the-Counter Medications:

   • Antacids: Quick relief (Tums, Rolaids)
   • H2 blockers: Reduce acid production (ranitidine, famotidine)
   • Proton pump inhibitors: Stronger acid reduction (omeprazole, lansoprazole)
   • Follow instructions
   • Don't use long-term without doctor approval

3. Take Medications as Prescribed (if prescribed):

   • Don't skip doses
   • Take as directed
   • May take time to work
   • Don't stop without doctor approval

4. Manage Stress:

   • Stress can worsen symptoms
   • Practice relaxation techniques
   • Get adequate sleep

• Chest pain (could be heart attack)
• Severe difficulty swallowing
• Vomiting blood
• Black, tarry stools
• Severe symptoms

• Frequent heartburn (2+ times per week)
• Symptoms not improving with lifestyle changes
• Symptoms not responding to OTC medications
• Difficulty swallowing
• Persistent symptoms
• Questions about treatment
• Need for prescription medications

• Occasional mild heartburn
• Responds to lifestyle changes
• Responds to OTC medications
• No concerning symptoms

Diagnosing GERD may involve:

1. Medical History and Physical Exam:

   • Symptom assessment
   • Medical history
   • Physical examination

2. Trial of Treatment:

   • Often diagnosed by response to treatment
   • If symptoms improve with medications, likely GERD

3. Upper Endoscopy (if needed):

   • Scope into esophagus and stomach
   • Check for damage
   • Look for complications
   • May take biopsies

4. pH Monitoring (if needed):

   • Measures acid in esophagus
   • 24-hour test
   • Determines acid exposure

5. Other Tests (if needed):

   • Esophageal manometry (measures muscle function)
   • Barium swallow (X-ray test)

Treatment aims to reduce symptoms and prevent complications:

1. Lifestyle Modifications: First-line treatment

   • Dietary changes
   • Weight loss if needed
   • Elevate head of bed
   • Avoid triggers
   • Don't lie down after eating

2. Medications:

   • Antacids: Quick relief
   • H2 blockers: Reduce acid (OTC or prescription)
   • Proton pump inhibitors (PPIs): Strong acid reduction
   • Prokinetics: Help stomach empty faster (less common)
   • Usually long-term for chronic GERD

3. Surgery (in severe cases):

   • Fundoplication: Wraps stomach around esophagus
   • LINX device: Magnetic device to strengthen valve
   • Usually only if medications don't work or can't take them

4. Treat Complications (if present):

   • Esophagitis (inflammation)
   • Barrett's esophagus (precancerous changes)
   • Strictures (narrowing)
   • Other complications

Prevent GERD by:

• Maintain Healthy Weight: Excess weight increases pressure
• Eat Smaller Meals: Don't overeat
• Avoid Trigger Foods: Identify and avoid yours
• Don't Lie Down After Eating: Wait 2-3 hours
• Elevate Head of Bed: If nighttime symptoms
• Don't Smoke: Smoking weakens valve
• Limit Alcohol: Can worsen symptoms
• Manage Stress: Stress can trigger symptoms

In GERD:

1. Lower Esophageal Sphincter Weakens: Valve between esophagus and stomach
2. Stomach Acid Flows Back: Into esophagus
3. Esophagus Irritated: Acid damages lining
4. Symptoms Develop: Heartburn, regurgitation, etc.
5. Complications Possible: If untreated long-term

Causes:

• Hiatal hernia: Stomach bulges into chest
• Weak lower esophageal sphincter: Valve doesn't close properly
• Delayed stomach emptying: Food stays in stomach longer
• Pregnancy: Hormones and pressure
• Obesity: Increases abdominal pressure
• Smoking: Weakens valve
• Certain medications: Can worsen GERD

• More common with age
• May have other health conditions
• May need different medications
• Higher risk of complications

• Common during pregnancy
• Hormones and pressure contribute
• Usually resolves after delivery
• Safe treatments available

• Excess weight is major risk factor
• Weight loss can significantly improve
• Should be primary focus
• Combined with other treatments

If Untreated, GERD Can Lead To:

• Esophagitis: Inflammation of esophagus
• Esophageal stricture: Narrowing of esophagus
• Barrett's esophagus: Precancerous changes
• Esophageal cancer: Rare but serious
• Respiratory problems: Chronic cough, asthma

Heartburn is a symptom of GERD. GERD is the condition where acid reflux occurs frequently. Occasional heartburn is normal, but frequent heartburn may indicate GERD.

Many people with GERD need long-term treatment. However, lifestyle changes can reduce the need for medications. Some people may be able to reduce or stop medications with significant lifestyle changes.

GERD is usually a chronic condition that can be managed but not necessarily "cured." However, with proper treatment, most people can control symptoms effectively.

For mild cases, dietary and lifestyle changes may be sufficient. For more severe cases, medications are usually needed in addition to lifestyle changes.

While GERD itself is usually not life-threatening, it can significantly affect quality of life. If untreated, it can lead to serious complications. Proper treatment is important.