For most of us, heartburn is the occasional back-up of stomach acid in the throat, leaving an icky, sour taste that thankfully goes away in just a few minutes. But 20% of Americans suffer from the more serious and long-lasting GERD (Gastroesophageal reflux disease) in which chronic acid reflux plays havoc with their digestive system and quality of life.
So, what exactly is GERD and how does it develop? Drew Calcutt, MD, of Lowcountry Surgical Services breaks down the whats, whys and hows of acid reflux and GERD.
Normally when we eat or drink, we swallow and a band of muscles at the bottom of our esophagus (lower esophagus sphincter) (LES) opens up to let the food or liquid into the stomach. The muscle closes once it’s passed through," Calcutt explains. "Acid reflux happens when that muscle doesn’t close or tighten back up as it should."
When that happens, stomach acid then backs up into the esophagus leaving us with that sour taste at the back of our throat – something most of us have experienced as a minor case of heartburn fixable with an antacid or two. "GERD happens when that acid reflux happens so often or severely that it irritates the lining of your throat (esophagus)," Calcutt says. "Generally, your physician will diagnose GERD when reflux happens more than twice a week or if there’s clear inflammation in the esophagus. It can be mild or moderate, depending on its frequency and how it impacts a person’s quality of life."
What does your gut tell you?
GERD symptoms can pose a head-scratcher for us because they can mimic lots of other conditions:
- Trouble swallowing, or the feeling of a lump in your throat
- Burping back up food or a sour tasting liquid
- Sore throat that feels “raw” or inflamed
- Chest pain or a burning in your chest, which usually happens after eating or at night when you lay down (If you are having chest pain that persists, seek emergency care immediately, especially if you have arm or jaw pain as these can indicate a heart attack.)
- Frequent dry coughing
"Because these symptoms can indicate a number of conditions, always check with your doctor if you are experiencing them," advises Calcutt. "Start with your primary care physician who can refer you to a specialist if needed. As a rule, if you are having symptoms frequently or feel like you’re taking over-the-counter heartburn medicines more than a couple of times a week, you should be seen."
Causing a gut reaction – triggers and risk factors
When diagnosing GERD, your doctor will take a look at your lifestyle and overall physical health and characteristics. Some things that can make us more prone to heartburn, or trigger or worsen our symptoms:
- Being overweight or obese
- Being pregnant
- Drinking alcohol or coffee
- A hiatal hernia (a bulging at the top of the stomach)
- Eating certain kinds of food such as fried or fatty
- Certain medicines that can weaken the lower esophagus muscle including some pain relievers, antidepressants, antihistamines and others.
Lifestyle and Diet
For some, avoiding certain food and drinks can help minimize symptoms:
- Fatty and fried food
- Carbonated drinks
If the thought of giving those things up causes you, well, heartburn, talk with your doctor about possibly eating that fried catfish earlier in the day, rather than for dinner. Sometimes changing when you eat something can help minimize the symptoms. Elevating the head of the bed when sleeping can also help minimize the symptoms. Those who are overweight may also find symptom relief by losing weight.
Medications (over the counter and prescription) focus on treating the acid part of acid reflux by either neutralizing acid in the stomach (antacids) or lessening the amount of acid from being produced (H2 blockers and proton pump inhibitors).
Up to 40% of patients may continue to have symptoms despite being on medication. For those patients, there are new, advanced options for care:
Minimally invasive implant procedure: With this procedure, an implant is placed around the LES muscle to help it stay closed unless food is passing through it into the stomach. The implant itself is about the size of a quarter and looks a bit like a beaded ring. Except instead of beads, there are small magnets. The ring is placed around the LES muscle and the magnets close tight to prevent anything flowing out of the stomach and into the esophagus. The procedure takes about an hour and patients are usually able to go home within a day and resume a normal diet.
Traditional fundoplication: This procedure, performed through open surgery or laparoscopy has been used to effectively treat patients with GERD for more than 50 years. Basically, the procedure strengthens or reinforces the lower esophageal sphincter to prevent the acid from backing up into the esophagus. 3. Transoral incisionless fundoplication (TIF): This new minimally invasive, outpatient procedure differs from a traditional fundoplication procedure because it is performed through the mouth rather than through laparoscopy or open abdominal incisions. In essence, it provides GERD sufferers the same relief as traditional fundoplication with the additional advantages of an incisionless approach – no scars, faster recovery and fewer potential complications and side effects.
Transoral incisionless fundoplication (TIF): This new minimally invasive, outpatient procedure differs from a traditional fundoplication procedure because it is performed through the mouth rather than through laparoscopy or open abdominal incisions. In essence, it provides GERD sufferers the same relief as traditional fundoplication with the additional advantages of an incisionless approach – no scars, faster recovery and fewer potential complications and side effects.
"Your doctor can help you determine the best course of treatment," Calcutt says. "If someone has GERD, it is important to get it taken care of as untreated it can lead to complications such as scarring or narrowing in the esophagus and esophageal cancer."