Gastroesophageal Reflux Disease (GERD)By Annelie Meador

HLTH 1020-003

Annelie MeadorHLTH 1020-00321 July 2013

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Gastroesophageal Reflux Disease (GERD)

What is GERD? Gastroesophageal Reflux Disease (GERD), or reflux disease, is a very

common disease of the digestive system. GERD is caused by a weak lower esophageal sphincter

or LES. The LES is a ring of muscle that connects the esophagus to the stomach. As pictured

below:

The LES acts like a gatekeeper; opening to allow food to pass into the stomach, and then

closing to prevent the contents of the stomach (food, acid, and other secretions) from

backflowing, (or refluxing) into the esophagus. Because the lining of the esophagus is easily

irritated by the contents of the stomach, reflux causes heartburn and other symptoms of GERD.”

Stomach acid helps break down food. While the stomach is naturally protected from acidic

juices, the esophagus doesn’t have the same protection” (Maves, et al, 2008).

According to the Ohio State University Wexner Medical Center (n.d.) there are several

different ways to go about diagnose GERD:

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● Barium swallow radiograph With the help of X-rays the doctors are looking for “spot

abnormalities such as a hiatal hernia and other structural or anatomical problems, of the

esophagus” (Wexner Medical Center. n.d.). To do this test one must drink a solution and

then the X-rays are taken.

● Upper endoscopy An endoscopy is more accurate than a barium swallow radiograph and

can be performed either in a hospital or in a doctor’s office. The doctor will spray the

throat with a numbing spray and then slide a thin, flexible plastic tube with a light and

lens on the end called an endoscope down the throat. This will help the doctor to see the

surface of the esophagus and look for abnormalities.

● pH monitoring examination Either a small tube is inserted into the esophagus or a tiny

device is attached to the esophagus that will stay there for 24 to 48 hours, to monitor how

much acid comes up into the esophagus. This test can be useful in combination with a

food diary in which the doctor can draw conclusions between symptoms and reflux

episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms,

including wheezing and coughing, are triggered by reflux.

● Manometry Determines how well the esophagus contracts and if it can move food in

the right direction. Muscles that do not work well in the esophagus can cause

heartburn-like symptoms and may also affect the type of treatment that will work best

(Wexner Medical Center. n.d.).

● Gastric Emptying Study This test is to determine how well the stomach empties. If

food and acid stay in the stomach for too long, the stomach contents can reflux back

into the esophagus and cause problems. This test is performed in the radiology

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department where patients are given food and then imaging is performed over the next

few hours.

Although these tests can help diagnose GERD or other digestive system diseases, there is

not a complete accurate diagnostic test for GERD.

What does heartburn or GERD feel like? Heartburn is so common that mostly everyone

has experienced it. That burning sensation in the chest and the feeling of fullness that often

results when a person eats too much. “Heartburn is usually a pain behind your breastbone; you’ll

feel GERD at the back of your throat and may cough and feel pain in your neck or face” (Stork,

et al, 2010). Heartburn is the most common symptom of the more serious condition: GERD.

Some people with GERD also experience regurgitation, difficulty swallowing, persistent cough,

and hoarseness. The symptoms can make it difficult to eat, sleep, work, or make for a difficult

day in general.

The answer to the question on who is most affected had me flabbergasted! Everyone can

suffer from GERD. Baby, child or adult - GERD does not discriminate. Millions of people suffer

from reflux. “In fact, it is estimated that one in three Americans, suffer from the pain and

discomfort of reflux disease on a regular basis. Reflux disease has an enormous impact on the

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overall quality of life of the people who suffer from it. GERD is considered a lifetime disease”

(Cox, 2012). Once a person is diagnosed with GERD, the disease will need to be managed for a

lifetime and can get worse over time. GERD can have serious consequences and should not be

ignored. It is important for sufferers of GERD to select the best treatment options for them. This

can mean making lifestyle changes, change of medications or even surgery.

Reflux can happen for a variety of reasons: too much food in the stomach, too much

pressure on the stomach, or chemicals in certain foods that cause the LES to relax

inappropriately. Over time, the more you reflux, the weaker the LES becomes. GERD develops

when the LES can no longer do its job effectively. Pregnant women are common sufferers of

heartburn as their internal organs gets squashed due to a growing baby.

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GERD can cause other, more serious problems. Hiatal hernias is one of the complications

that can be caused by GERD. Some people with hiatal hernia have no symptoms while others

suffers from frequent heartburn related to gastroesophageal reflux disease. “Hiatal hernia occurs

when a portion of the stomach gets pushed through the diaphragm and into the thoracic cavity

where it doesn't belong” (Lipski, 2012). Even tho there appears to be a link between these

conditions, one does not seem to cause the other. Many people have a hiatal hernia without

having GERD, and others have GERD without having a hiatal hernia.

Acid reflux can also cause Barrett’s esophagus if untreated. This can be treaturous as

GERD symptoms might decrease as Barrett’s surfaces. Barrett's esophagus is a condition in

which the cells of the lower esophagus become injured that is most often due to repeatedly

exposure to stomach acid. The injuries cause changes to the color of the esophagus cells.

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Barrett's esophagus is most often diagnosed in people who have long-term

gastroesophageal reflux disease (GERD). Thankfully only a small percentage of people with

GERD will develop Barrett's esophagus.”It is an extremely rare condition in children” (James,

2010). However sufferers of Barrett’s are at a higher risk of developing esophageal cancer.

As just explained, if GERD or Barrett’s is left untreated, there is a risk for the

development of esophageal cancer. Esophageal adenocarcinoma is a type of cancer affecting the

esophagus that is directly linked to reflux disease. In fact, reflux disease is the only cause for this

type of cancer. “The number of esophageal cancer cases has grown over 600% since 1975

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making this deadly disease the fastest growing type of cancer in the United States” (Cox, 2012).

Esophageal cancer is in a force of its own. Esophageal adenocarcinoma is one of the most

deadliest kinds of cancer a person can have. “The overall likelihood of surviving five years is

only 10-15%. This year alone approximately 20,000 deaths will result from reflux-induced

esophageal cancer” (Cox, 2012).

There are also many drugs that can cause GERD or increase the symptoms of GERD,

such as “NSAIDs, aspirin, steroids, birth control pills, diazepam, nicotine, nitroglycerin,

progesterone, provera, and theophylline” (Lipski, 2012).

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Nutrition plays a big part in the health of the digestive system and in the prevention of

GERD. There are many foods that can cause heartburn or reflux. Every person has their own

*triggers* and avoiding those foods can help prevent heartburn or reflux. “Common culprits

include fizzy sodas, high-fat foods like pizza, acidic or spicy foods, coffee, and peppermint, as

well as alcohol, nicotine, and caffeine. Studies show that different foods and beverages ignite

heartburn pain for different people” (Stork, et al, 2010). Even though heartburn triggers can vary

from person to person, certain foods and drinks are more inclined to cause acid in the stomach to

splash up into the esophagus. Here are a few examples:

“Meats. Ground beef, marbled sirloin, chicken nugget-style, and chicken/buffalo wings.

Fats, Oils & Sweets. Chocolate, regular corn and potato chips, high-fat butter cookies, brownies,

doughnuts, creamy and oily salad dressings, fried or fatty food in general.

Fruits, Vegetables & Juice. Orange juice, lemon, lemonade, grapefruit juice, cranberry juice,

tomato, mashed potatoes, French fries, raw onion, potato salad.

Grains. Macaroni and cheese, spaghetti with marinara sauce.

Dairy. Sour cream, milk shake, ice cream, regular cottage cheese” (Magee, n.d.).

When it comes to treatment of GERD, there are many options to choose from. Most of

the time when a person experience the symptoms of reflux, a proton pump inhibitor, or PPI, such

as Prilosec, Prevacid, or Nexium is prescribed by a doctor. Many people however do not go to

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the doctor and prefer to take over the counter type of drugs like Tums. The prescription drugs

relieve the symptoms of reflux by reducing the amount of acid produced by the stomach. This

helps with the heartburn and allows inflammations that can occur on the esophageal lining to

heal. If the person's symptoms are relieved, no additional treatment is done. But symptom control

does not mean that the reflux is cured. A person can still reflux while taking PPIs, they just do

not feel it.

There are many options for treating or reducing the symptoms of GERD, as introduced

above, with lifestyle changes. Here I will explore this further. Excess weight and obesity can

contribute to GERD symptoms. Therefore it is in the best interest to try to lose the extra weight,

“being overweight or obese has been clearly identified as a major cause of GERD” (James,

2010). Elevation is also key when it comes to sleep. Fluffing or adding another pillow will not be

enough and will only contribute to back and neck pain. Therefore it is suggested to”raise the

head of your bed somewhere between 6 and 9 inches” (James, 2010) this will help reduce GERD

symptoms greatly at night. Avoid alcoholic beverages and avoid stress as much as possible, as

these can increase the GERD symptoms.

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One can never know if GERD will affect a person in the future. However, knowledge is

power. Eliminating and avoiding known risk factors, such as obesity, poor diet, smoking, and

excess alcohol consumption, can greatly reduce the chances of GERD. Stay healthy, stay strong

and stay informed.

References

Cox, L. (2012, 3 Oct.) What is acid reflux? Getting real about reflux disease. Retrieved from

http://www.refluxmd.com.

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James, D.G. Scott, L. M.D. (2010) The complete idiot’s guide to digestive health. Smart

strategies

that will definitely agree with you.

Lipski, E.Ph.D. CCN. CHN. (2012). Digestive Wellness - 4th Edition - Strengthen the immune

system and prevent disease through healthy digestion.

Magee, E. MPH. RD. Hoffman, M. M.D. (n.d.) Heartburn: Foods to avoid. WebMD. Retrieved

from

http://www.webmd.com/heartburn.

Maves, M. M.D., M.B.A. Hengesbaugh, B. Musacchio, R. Ph.D. White, M. Lloyd-Jones, D.

M.D.,

Sc.M. McKibbin, K.M.D. Et al. (2008). Complete Guide to Prevention and Wellness.

What

you need to know about preventing illness, staying healthy, and living longer. American

Medical Association.

Ohio State University - Wexner Medical Center.(n.d.). Diagnosing GERD. Retrieved from

http://medicalcenter.osu.edu/patientcare.

Stork, T. OBGYN. Masterson, L. M.D. Ordon, A. Sears, J. M.D. (2010). The Doctors - The

Prescription for a Lifetime of Great Health. RX 5 minutes Health Fixes.

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