You just got home from having dinner at your favorite restaurant and wow, did you enjoy yourself! Appetizers, salad, main course, dessert and coffee–you were on top of the world. But now, you’re not feeling too great. You have a little heartburn, maybe a bellyache, can’t stop burping, and maybe a little reflux. You’ve heard about GERD (gastroesophageal reflux disease) and you wonder, “Do I have this?” Should you go see a doctor?
The answer is maybe, but it is more likely that you just overdid it, and you’ll feel better tomorrow. The symptoms you are feeling are not unusual after a large meal; however, they should be short-lived and should not happen very often. GERD is diagnosed when symptoms create regular and significant discomfort or when it causes injury to your esophagus (food pipe). Let’s take a look at what GERD actually is, what causes the symptoms, and what you can do to treat or prevent it.
What Is GERD?
When you swallow food, it goes from your mouth to your stomach through a long tube called the esophagus. The muscles of your esophagus contract and relax in a wave-like motion, gently massaging the food downward toward your stomach. At the bottom of the esophagus, where it attaches to the stomach, there is a strong muscular ring called the lower esophageal sphincter (LES), which relaxes when it senses that food is on the way. After food enters the stomach, the LES tightens so that there is no backwash of stomach contents into the esophagus.
The stomach tissue is suited to contain acids that digest food, but these acids can be corrosive to the tissue of the esophagus. When the LES becomes weakened, or relaxes when it shouldn’t, or if the pressure in the stomach is increased such as after a large meal, it is not unusual for reflux to occur. It’s a problem when this becomes a frequent occurrence. If you are experiencing mild symptoms two to three times per week or moderate to severe symptoms once weekly, it is time to consult your doctor.
The diagnosis of GERD is based on the report of persistent symptoms. It does not necessarily mean that you have damage to your esophagus, although some people with GERD develop inflammation. This, in turn, can lead to small ulcerations of the esophagus or narrowing of the esophagus in the area where the inflammation is occurring. Eventually, this may lead to difficulties swallowing. Additionally, chronic inflammation can result in Barrett’s esophagus, which means there have been tissue changes that may be the precursors for esophageal cancer. Given that 10 to 20% of the western world is estimated to have some degree of GERD, it is important to recognize its symptoms and seek medical advice when needed.
What Are the Symptoms and When Should You Be Concerned?
The most common symptoms of GERD are heartburn, regurgitation, and trouble swallowing. Other symptoms that you may experience include increased salivation, a sour taste in your mouth (especially in the morning), belching, stomach pain, a sore throat, a taste of acid in the throat, worsening dental or gum disease, worsening sinus problems, coughing, hoarseness or a feeling that you have mucus or something else in your throat, wheezing (especially at night), or frequent lung infections. All of these symptoms can be caused by the constant irritation created by stomach acids backing up into the esophagus and throat.
All of this being said, worse symptoms do not necessarily mean worse disease. Some people who have mild symptoms may have severe inflammation, while some with severe symptoms may have mild disease. And some people may have no symptoms at all.
If you are experiencing chest pain, you should be evaluated right away to make sure it is not your heart. If you are vomiting blood, you should also seek emergency treatment. If you feel as though you have something stuck in your throat, are choking frequently, or it is painful to swallow, it is important to see your doctor right away. Also see your doctor if you have black stools because it could be a sign that you are bleeding. And if you have unexplained weight loss, you should be evaluated to find the cause.
What Is the Treatment of GERD?
When you see your doctor, the diagnosis of GERD is often made by the symptoms you are experiencing. In some instances, you may need a test to monitor the amount of acid in your esophagus. If symptoms persist or are severe, the best way to find out the extent of the problem is with a test called an endoscopy. During this procedure, the doctor uses a flexible tube with a light and camera to look at the tissue inside of your esophagus and to take samples for testing.
Once diagnosed, the first treatment—especially for mild cases—is lifestyle changes. For example, avoid large meals and instead eat small, frequent meals. You should also not lie down for at least three hours after you eat. It may help to raise the head of your bed six to eight inches with boards or foam under the mattress so you don’t lie flat. If you are overweight, lose weight to decrease the amount of pressure on your stomach. Don’t wear tight clothing. If you smoke, you should quit. You should also avoid foods that increase reflux symptoms, such as caffeine, chocolate, alcohol, peppermint, and fatty foods. Sometimes chewing gum or using hard candies will increase saliva production and help clear acids out of the esophagus.
You may use antacids such as Tums for periodic and brief relief of symptoms but these medications only help for a short amount of time. Over-the-counter medication, such as famotidine (Pepcid) or ranitidine (Zantac), may also decrease the acid in your stomach and improve symptoms, although these are not meant to be long-term medications.
If lifestyle changes and over-the-counter medications do not help, or if your disease is more severe, your doctor may have you take proton pump inhibitors (PPI), which are more effective in decreasing the acid in your stomach. Some frequently used PPIs are omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium). The recommended treatment is usually eight weeks. Taking PPIs for longer periods of time can increase the risk of gastrointestinal infections and decrease the absorption of minerals from your diet. However, some people may need to take them indefinitely for chronic reflux and inflammation. It is best to discuss your symptoms and options with your doctor, who may also recommend further testing if your symptoms are not improving.
If you are concerned about the symptoms you are experiencing, have more questions about GERD, or have any other health concerns, call Rockville Concierge Doctors at (301) 545-1811 to request an appointment, or request an appointment online. We look forward to helping you with all of your healthcare needs.