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Posted: December 31, 2008

GERD -- Little Word for a Big Pain

More Than Heartburn, Less Than Heart Attack

Dr. Michael Rushnak knows what he’s talking about when it comes to GERD, an acronym for a highly discomforting stomach disorder called gastroesophageal reflux disease that’s often harder to identify and more serious among seniors.

That’s because Rushnak, a gastroenterologist from Jackson, New Jersey, has seen GERD from both sides of the fence. In his 20 years of internal medicine practice, he has treated thousands of patients for GERD – and he has developed and had to deal with GERD himself.

“I’d go to bed and wake up an hour later with a sour taste in my mouth coming up my food pipe, burning like classical heartburn,” he says of his own experience. A lot of people liken GERD to a horrible case of heartburn, and that can be a problem when it comes to receiving proper treatment.

More than 60 million Americans experience heartburn monthly. Fifteen million suffer from the condition daily. But when heartburn occurs two or more times a week, it could be GERD. And if it’s left untreated, GERD can lead to serious consequences.

While heartburn is the most recognized GERD symptom, there are other signs to watch for. They Include:

Causes of GERD

When stomach acid backs up into the esophagus, GERD occurs. The esophagus is made up of tissue and muscle layers that expand and contract to move food to the stomach. At the lower end of the esophagus, where it joins the stomach, there’s a group of muscles that comprise the lower esophageal sphincter (LES). After swallowing, the LES relaxes to allow food to enter the stomach and then contracts to prevent the backup of food and acid into the esophagus.

Sometimes, however, the LES improperly relaxes, allowing stomach acid to wash back into the esophagus. This is called reflux, and reflux becomes GERD when it causes injury to the esophagus or when it results in troublesome symptoms.

Fatty and spicy foods, mints, chocolate, and caffeine cause the LES to relax more frequently. Caffeine, alcohol, nicotine, citrus- or tomato-based foods, and some drugs also cause it to improperly relax.

Heavy meals, especially when served within three hours of going to bed, can also cause GERD. Rushnak says, “As a physician, I was working hard. My hours were chaotic, and I was not eating on a schedule. Often I’d come back from the hospital late at night not having had dinner. I’d eat and go to bed right afterwards. I gained weight. Excess weight, especially in the stomach area, can push up the stomach on the esophagus. That’s called a hiatus hernia and it can lead to reflux.”

Dr. Amit Bhan, a gastroenterologist at Henry Ford Hospital in Detroit, says, “Additional factors may increase reflux, such as wearing tight fitting clothes that can increase pressure on the stomach.”

GERD Complications

“Left untreated, GERD can cause inflammation leading to narrowing and scarring of the esophagus,” Bhan says. “As a result, food can get stuck in the esophagus.”

Rushnak adds, “Over a long period, chronic inflammation of the esophagus lining can result in Barrette’s esophagus. While rare, this can be a precursor to esophageal cancer.”

According to the American College of Emergency Physicians, GERD accounts for up to 60% of patients yearly visits to the emergency room with chest pains not related to the heart. Marcia King, a registered nurse in Campbellsport, Wisconsin, has seen this in the hospital emergency room where she works. “We treat a lot of people with chest pain who think they’re having a heart attack,” she says. “If they have a known history of GERD, the doctor frequently gives them something for pain relief like an antacid. At the same time, he’ll run tests to make sure it isn’t their heart.”

The confusion over heart attack vs. GERD can be dangerous for the patient. “Don’t assume any chest pain you or your loved experience is GERD,” Rushnak notes. “It could be a heart attack. Only a physician can decide. All pain should be looked at immediately.”

Other more troublesome signs of GERD requiring immediate medical intervention include unexplained weight loss, new-onset asthma or asthma occurring only at night, choking, bleeding (vomiting blood or dark-colored stools), and pulmonary fibrosis.

Diagnosis and Treatment

If you or your loved one develops a sour taste in the mouth (called water brash) without also having pain or complications, it’s probably GERD. A physician can provide a correct diagnosis and offer an appropriate treatment plan. In less than a perfect approach, GERD is usually diagnosed based upon symptoms and the sufferers’ response to treatment.

Most people don’t develop serious complications, especially when it’s being adequately monitored and treated. Testing may not be necessary for people with reflux symptoms but none of the troublesome complications. Lifestyle changes and possibly non-prescription medications (antacids or histamine type 2 receptor antagonists) may be all that is needed. However, if the diagnosis is unclear or more troublesome signs of GERD are present, testing that evaluates the esophagus and the frequency of reflux may be required.

Effective GERD treatment should ideally result in a lifestyle change and have the patient take the lowest possible dose of medication to control symptoms and prevent complications. Most health care providers first recommend an occasional over-the-counter antacid or other medication that stops acid production and helps the muscles empty the stomach. For best results, they should be taken an hour after eating and at bedtime. “However,” warns Rushnak, “see your physician before starting or adding any medication on your own.”

Rushnak says he cured his own GERD by losing weight and eating lighter meals earlier in the evening. If you are caring for someone with GERD, he advises, “Be supportive and encouraging. Avoid serving trigger foods. Don’t fix heavy meals especially within three hours of your loved one going to bed. Gravity helps prevent reflux. Raise his headboard six to eight inches (additional pillows don’t work). Keep alcohol out of your home. Check out nearby smoke cessation and weight loss programs he might be interested in.”

If these strategies don’t work for you or your loved one, stronger medications may be needed. Because these stronger prescribed drugs work in different ways, a combination may be needed.

“If the patient still has symptoms after all these treatments have been tried and lifestyle changes have been incorporated, in rare cases, surgery may be needed,” says Rushnak.

Overall, the future looks bright for people with GERD, according to Bhan. “They need to remember that GERD is very common,” he says. “With lifestyle changes, drug therapy, medical intervention, and surgery (as a last resort), this problem can be appropriately managed for most individuals.”

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Rachel Davidson is a freelance writer focusing on elderly care. She published a quarterly magazine for nursing home administrators for 15 years, as well as a caregiver newsletter for five years. Rachel lives in Baraboo, Wisconsin and can be reached at families@centurytel.net.

RESOURCES

National Digestive Diseases Information Clearinghouse (800-891-5389) has additional information and a listing of current clinical trials.

Up-to-Date (800-998-6374) has current information on GERD, under New Search.

American College of Gastroenterology (301-263-9000) offers free pamphlets, a video and other information on its site.

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