For many people, all it takes is eating that one extra doughnut or going to bed on a very full stomach. An uncomfortable burning sensation creeps into the throat or chest, and it doesn't go away until you take some antacid. Almost everyone experiences occasional heartburn or acid reflux (regurgitation of stomach fluid). In fact, 60 million Americans report getting heartburn at least once a month. Occasional heartburn or reflux is not something to worry about.
But if you have two or more heartburn or acid reflux episodes every week, or if the attacks interfere with your life and keep you awake at night, you should see your doctor. You may have gastroesophageal reflux disease (GERD) -- and it's not something you should ignore: In rare cases, GERD can be a precursor to esophageal cancer.
What is GERD?
GERD is a condition in which acid that belongs in your stomach backs up into your food pipe, or esophagus. It happens when a sphincter muscle at the base of the esophagus relaxes at the wrong time. Normally, this muscle releases when you swallow to let food and liquid enter your stomach and then closes again. In people who have GERD, the muscle is weakened and it stays open when it should close. Stomach acid flows backwards into the esophagus. The stomach lining is designed to handle this acid, but the esophagus is not: The acid irritates and inflames the lining of the esophagus, causing a burning sensation.
The chronic inflammation of the esophagus caused by GERD not only creates discomfort, it can also lead to several complications. Scar tissue that forms when acid damages cells in the esophageal lining can narrow the food pipe, making it hard to swallow. The acid can also cause painful, bleeding sores or ulcers to form on the esophagus that also make it difficult to swallow.
A third complication caused by GERD comes from microscopic changes that make the lining of the esophagus more like the lining of the intestine. These changes, known as Barrett's esophagus, are associated with an increased risk of esophageal cancer. While esophageal cancer is relatively rare -- about 1 percent of cancers diagnosed -- people who have Barrett's esophagus have as much as eight times the risk of getting this cancer.
If you think you may have GERD, it's important to get a diagnosis from your doctor, since the disease can be confused with other conditions. In addition to heartburn and acid reflux, symptoms of GERD include a sour taste in your mouth, a dry cough or hoarseness, a sore throat, and chest pain. If you experience chest pain, seek medical attention immediately, since it may be the symptom of a heart attack.
Preventing and treating GERD
Changes in diet and lifestyle can help reduce or eliminate symptoms of GERD and also lower your risk of developing the disease in the first place.
• Watch your weight: If your weight is within the normal range, you are less likely to develop GERD, so stay vigilant about keeping extra pounds from creeping on. If you are overweight, lose the extra pounds. Obesity is linked to a 1.5- to 2-fold increase in GERD symptoms and a 2- to 2.5-fold increase in the risk of esophageal cancer. Being overweight puts pressure on your abdomen, which pushes up your stomach, which in turn causes acid to back up. (Pregnancy has a similar effect, which is why many pregnant women complain of heartburn.)
Talk to your doctor about a gradual weight loss plan that includes fresh fruits and vegetables, lean protein, whole grains and regular exercise. Aim for a body mass index of less than 25 if you are female and less than 26 if you are male, and you'll lower your chances of getting GERD. No matter what your weight, avoid wearing clothes that are tight around the waist, since that also puts pressure on your abdomen.
• Avoid trigger foods: Certain foods weaken the sphincter muscle at the base of the esophagus and also irritate the lining of the esophagus. If you have GERD, notice which foods trigger your symptoms and stay away from them. Common trigger foods include tomatoes and citrus fruits, fatty or fried foods, tea, coffee and other caffeinated beverages, chocolate, alcohol, mint, garlic, onions and spicy foods.
• Go easy at mealtime: Don't stuff yourself. Eat smaller meals so your stomach isn't filled to the brim. And wait at least three hours before lying down after a meal. Stomach acid can flow into the esophagus more easily when you lie down. For the same reason, sleeping with the head end of your bed elevated can help relieve nighttime symptoms. Use blocks to raise the head of the bed or put a wedge under your mattress. Using pillows to elevate your head is not considered to be effective.
• Quit smoking: If you smoke, stop. Smoking can impair the functioning of the esophagus's sphincter muscle and increase your risk of GERD.
• Medication and other remedies: While lifestyle changes can help alleviate symptoms of GERD, many people find they need to combine changes in diet with medication to relieve the symptoms of GERD. Over-the-counter antacids can provide temporary relief of heartburn by buffering the effects of the acid, but overuse can cause side effects. Another type of medication called H-2 receptors (Pepcid AC is an example), gives longer relief. A third medication, called protein pump inhibitors (PPI), actually blocks acid production, giving the inflamed esophagus a chance to heal.
A long-term side effect of PPIs is Vitamin B12 deficiency. This is because the parietal cells in the stomach that produce stomach acid also produce a protein called intrinsic factor (IF), a glycoprotein necessary for the absorption of Vitamin B12. However, recent studies suggest that while this may be a problem for elderly patients (where B12 deficiency is a common disorder), most patients consuming a normal diet will not experience clinically significant B12 deficiency, taking into account that the usual human diet contains far more B12 than required. Long-term use of PPIs at high doses may also increase the risk of hip fracture in people over 50, possibly by reducing calcium absorption, according to a 2006 study. Your doctor can help you decide which, if any, of these medications make sense for you to use and whether you should take calcium supplements with PPI medication.
In rare cases where medication combined with lifestyle changes doesn't relieve GERD, surgery is sometimes used to treat GERD. One procedure, known as Nissen fundoplication, involves reinforcing the lower esophageal muscle by wrapping the stomach muscle around it. Another involves stitching closed part of the stomach to prevent acid from washing back into the esophagus (EndoCinch endoluminal gastroplication). And another type of surgery uses heat to form scar tissue as a way of strengthening the lower esophageal muscle (Stretta procedure). According to a 2006 review, however, more research is needed to determine how effective these surgical approaches are at actually reducing acid reflux and inflammation of the esophagus. That's why your best bet is to make healthy lifestyle choices that will help you avoid getting GERD and get the symptoms under control early on.
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