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Living with GERD

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August 8th, 2016
Image of living with GERD

Image of living with GERD

Heartburn. Acid indigestion. Acid reflux. These terms get tossed around whenever people have that uncomfortable burning behind the breastbone. According to the New England Journal of Medicine (NEJM), 60% of Americans experience heartburn at least once a year, and up to 10% experience it daily. 

NEJM also reports that heartburn is the most common symptom of the fourth most prevalent gastrointestinal disease in the United States—gastroesophageal reflux disease (GERD). 

Both men and women are affected by this disease, but research shows that mild forms of GERD are slightly more prevalent in women. “The structures that keep stomach contents from backing up into the esophagus are more elastic,” says Dimitri Cefalu, M.D., medical director at Seabrook, an Erickson Living community in Tinton Falls, N.J. “This usually occurs because of previous pregnancy.”

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), practically anyone can develop GERD, even people without common risk factors such as obesity, smoking, asthma, and diabetes. A condition called hiatal hernia has been associated with GERD, although research shows that one condition does not necessarily cause the other. “Hiatal hernia is a condition in which part of the stomach slides up above the diaphragm,” Cefalu explains. 

Symptoms could mean damage 

You could have GERD without ever experiencing heartburn. “You might have regurgitation after a meal and a sour taste in the back of the throat when you wake up in the morning,” says Swathi Gopalakrishnan, M.D., gastroenterologist from the Department of Medicine at Montefiore Medical Center in Bronx, N.Y. “Less commonly, people might experience a cough, hoarse voice, or chest pain that is unrelated to the heart or lungs.”

There are some symptoms that signal serious complications. “Trouble swallowing could indicate esophagitis, which is swelling of the esophagus,” Cefalu says. “This condition is caused by the acidity of stomach contents. Untreated esophagitis can also cause esophageal narrowing or stricture.” 

Long-term complications

Esophagitis over many years can lead to precancerous changes in the cells of the esophagitis. In addition, stomach acid breathed into the lungs can cause wheezing and pneumonia. 

According to NIDDK, about 7% of people with chronic GERD develop Barrett’s esophagus. “With this condition, tissue similar to the lining of your intestine replaces tissue lining your esophagus,” Cefalu says. “Barrett’s esophagus is twice as common in men than in women.”

A small number of people with Barrett’s esophagus develop esophageal cancer. 

Medicines for GERD

Depending on the severity of your symptoms, you might need medication. A study published in NEJM found that about 40% of Americans use over-the-counter (OTC) or prescription drugs twice a week to treat GERD symptoms.

OTC options used to include primarily antacids, but in the past couple of decades, medicines that were only by prescription became available on store shelves. These include histamine receptor (H2) blockers such as cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac). “These medications work for many people and have little in the way of side effects,” Gopalakrishnan says. “They may, however, lose their effect if taken long term.” 

Proton pump inhibitors (PPIs) are newer options and include esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec). “PPIs have many short and long-term effects,” Gopalakrishnan says. “In the short term, they can increase the risk of pneumonia, particularly in seniors. They can also increase the incidence of a particular diarrheal infection called Clostridium difficile. Although it is rare, electrolyte imbalances may occur in some people.”

Just because some of these drugs are available OTC doesn’t mean they are safe. “Always ask your doctor before trying any drug, even antacids,” Cefalu says. “They can block effects of other medications you might be taking.”

According to Consumer Reports, PPIs are one of the highest-selling classes of medications in the United States. Scientific evidence is emerging, however, that shows long-term use is associated with serious complications. “Some studies have associated PPI use with increased fracture rates and dementia in the elderly, but more information is needed in these realms,” Gopalakrishnan says. 

Do-it-yourself treatments

Whether you’ve been living with GERD for a short or long time, you can control some symptoms. Start by examining your diet. “People with GERD should avoid caffeine, alcohol, chocolate, fried foods, and highly acidic foods such as tomatoes and tomato products,” Cefalu says. “Peppermint also causes problems for some people.”

“Triggers differ from person to person, so it is important to know what yours are,” Gopalakrishnan adds. 

When and how much you eat also matters. “Your last meal of the day should be three hours before your bedtime,” Gopalakrishnan says. “Instead of three big meals, try eating smaller meals more often,” Cefalu says. 

Losing a few pounds can make a big difference. “Extra weight puts pressure on your abdomen,” Cefalu says. “Similarly, tight-fitting clothing can squeeze your abdomen and increase the risk for reflux.”

Experts also recommend quitting smoking, avoiding secondhand smoke, and sleeping with the head of your bed slightly elevated. Don’t use pillows because studies show it may in fact worsen symptoms.

Last but not least, keep your doctor updated on all medications you take. “Several classes of medications can interact with GERD medications or worsen GERD symptoms,” Cefalu says. “These include bisphosphonates [Fosamax, Boniva]; pain relievers such as ibuprofen and aspirin; certain antidepressants; heart medications such as calcium channel blockers and nitrates; and sedatives.”

Very serious GERD that doesn’t respond to medication or lifestyle changes may necessitate surgery. “The good news,” Cefalu says, “is that the majority of people with GERD respond well to lifestyle changes and medications.”


Red flags 

The following are symptoms that warrant emergency medical treatment: 

• Vomiting large amounts

• Regular projectile (forceful) vomiting

• Vomit containing blood or what looks like coffee grounds

• Problems breathing after vomiting

• Significant problems swallowing or painful swallowing

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