When GERD strikes

November 29, 2013

Turkey, stuffing, mashed potatoes, gravy and pumpkin pie. Right now, people all over are feeling the uncomfortable sensation of heartburn (acid reflux) thanks to a big, rich Thanksgiving feast.

But when heartburn is more than an occasional nuisance after an indulgent meal, it may mean that you have gastroesophageal reflux disease (GERD).

Chronic heartburn is one of the most common symptoms of GERD, but other signs can include:

  • Sour stomach
  • Nausea
  • Soreness or a lump in the throat
  • Food regurgitation
  • Bad breath

Acid reflux occurs when the esophageal sphincter — a band of muscle connecting the esophagus to the stomach — weakens or inappropriately relaxes. This allows stomach acid to flow back into the esophagus, causing pain and irritation.

GERD is more than a nuisance, though. When the esophagus is chronically irritated, other more serious conditions can develop.

One such condition is Barrett’s esophagus, which puts sufferers at increased risk for a type of cancer called esophageal adenocarcinoma. Between 5 percent and 10 percent of GERD sufferers can develop pre-cancerous Barrett’s esophagus.

This makes management of the disease especially important.

What causes GERD?

It’s not fully understood why some people get GERD and others don’t, says UCI Health gastroenterologist Dr. Kenneth Chang.

In some cases, genetics may play a role. “I’ve seen families with GERD generation after generation,” says Chang, director of the UCI Health H.H. Chao Comprehensive Digestive Disease Center (CDDC).

There’s also a theory that GERD begets GERD, Chang says. That is, the more a person experiences reflux, the worse the reflux gets.

Certain conditions can also play a role. Hiatal hernia, obesity, pregnancy, smoking, delayed stomach emptying and asthma are conditions that may increase the risk of having GERD.

Easing the discomfort

When is acid reflux cause for concern?

“If you’re experiencing heartburn more than three times a week for a period of five years, you should be checked by your doctor,” Chang suggests.

This is especially true, he says, for white males over 50 with an increased body mass index (BMI) and intra-abdominal distribution of body fat.

At the CDDC, Chang’s team focuses on controlling or eliminating symptoms and, ultimately, cancer prevention.

Your physician may first recommend over-the-counter antacid medications to relieve symptoms, as well as dietary and lifestyle changes, such as:

  • Losing weight, if necessary
  • Eating smaller meals
  • Avoiding food and drinks that worsen symptoms – fried or fatty foods, alcohol, chocolate, mint, garlic, onions and caffeine
  • Eating at least three hours before going to bed
  • Quitting smoking

When conservative treatments for GERD don’t relieve symptoms, stronger medication and even surgery may be considered.

Fortunately, Chang says, most patients (75 percent to 80 percent) respond to medications and lifestyle changes. However, with recent data showing more potential side effects of antacid medications (including bone fractures among post-menopausal women), patients are seeking alternatives.

Those who do need further interventions beyond long-term medication have several options to choose from, including:

  • Laparoscopic Nissen Fundoplication, also known as “the wrap,” which involves wrapping the upper part of the stomach around the esophageal sphincter to prevent acid from coming back up.
  • LINX®, a magnetic bracelet that is surgically placed around the esophageal sphincter that lets food into the stomach but blocks acid reflux.
  • Incision-less procedures that put a barrier between the esophagus and stomach (TIF® with EsophyX®) or create scar tissue in the esophageal sphincter to strengthen it (Stretta®). Both are incision-less procedures performed through the mouth.

There is hope for GERD sufferers, and the specialists at the CDDC do all they can to help patients get control of their symptoms.

In addition to offering several innovative procedures to help GERD sufferers, Chang notes that his team does it all. “We have everything here. We do physiological testing to find out what type of reflux you have, we look at your whole anatomy and individualize the treatment to your specific situation.

“If we discover Barrett’s or early cancer, we can take care of that as well. A one-stop-shop — we are at your service.”