Gastroesophageal Reflux Disease (GERD) is the back flow of the stomach contents into the esophagus (the tube that connects the mouth to the stomach) with or without esophageal inflammation. Heartburn is the most common symptom of GERD. Sixtyfive percent of Americans suffer from this condition which occurs at all ages. Infants and children may experience persistent vomiting, coughing, or other respiratory symptoms. What causes GERD? A number of factors can contribute to GERD and some people may have a combination of them. They include: A poorly functioning lower esophageal sphincter (LES) caused by: - Medications, such as nitrates, bisphosphonates, estrogen, oral contraceptives, progesterone, alpha adrenergic agents, theophylline, calcium channel blockers, benzodiazepines, anticholinergics, and tricyclic antidepressants can weaken IheLES. - Smoking, eating just before bedtime, and drinking alcohol. These can all decrease the muscle's effectiveness. - Foods such as chocolate, caffeinaled beverages, peppermint, spearmint, greasy or spicy foods, onions, garlic, tomato products, and citrus juices. Slow stomach emptying (eg, in diabetes mellitus) Poor removal of acid from the esophagus Too much acid in the stomach Fragile, tender esophageal lining Hiatal hernia (see panel) - causes include coughing, vomiting, straining, sudden physical exertion that increases abdominal pressure, obesity, or pregnancy Increased abdominal pressure during pregnancy Recognizing the symptoms Heartburn - A burning sensation, or pain in the middle of the chest, moving to the neck and throat. This may worsen when lying down or bending over. The burning/pain can begin within an hour of eating and can last as long as 2 hours Acid or bitter taste in the mouth A feeling that food is coming back into the mouth Difficulty swallowing Asthma-like symptoms - coughing and wheezing. Hoarseness, laryngitis, earache Tooth decay, bad breath, gum problems such as gingivitis (inflammation of the gums) The symptoms of GERD may include: In some cases a reflux attack may be so severe that it can mimic the chest pain experienced during a Heart Attack. Individuals with GERD may also have an increased risk of Barret fs esophagus and esophageal cancer. Esophagus Saliva (the liquid In the stomach, the produced in the food mixes with acid mouth) provides a and other digestive protective mechanism enzymes. for the esophagus The LES prevents because it has a digested food, neutralizing effect on stomach acid, and acid. other digestive Chewed enzymes from food mass (bolus) moving back into the esophagus. After being chewed If the LES is weakened, and swallowed, food or relaxes at the wrong travels down the time, tthe contents of esophagus. the stomach can go backwards (called The muscular action ""flux) into the of the esophagus esophagus. (called peristalsis) The stomach acid and propels the food enzymes can be very towards the stomach. irritating and even damaging to the lining of the esophagus. The lower esophageal The esophagus can sphincter (LES) initially protect itself relaxes to allow the from damage by its food to move down into own muscular action the stomach where it is (peristalsis). This further digested. would normally propel the partially digested food and fluids back into the stomach again. A common test used is a Barium Meal (also called a Barium Swallow Test). This involves digesting a special liquid which shows up on an x-ray and helps to indicate activity in the stomach. In more complex cases, an Endoscopy might be required. An endoscopy is a procedure where a thin, flexible tube, containing a miniature camera, is placed into the patient's mouth and down into the esophagus to look at the lining for damage. This also helps to rule out other, more serious conditions.ln another procedure, a monitor ma be laced in the esophagus Endoscope to test the acid content r-------~----I (Esophageal pH Monitoring). This can help to record acid reflux in the esophagus. If symptoms show a history of uncomplicated GERD, then a period of drug treatment - together with dietary and/or lifestyle changes - may be all that is required to resolve the condition. Your healthcare provider should review your current medications to see if any aggravate your GERD. In rare, severe, cases surgery may be required . .udrugs con be grouped together by how they wOO<(ie. tbeir sptdfic mode 01_). The list below iDcIudes allbe dilIamt types 01drugs .,..,.".... for use in Ibe _ 01Ibis condition at Ibe lime of puIoIiQlion. (Updat.td information is also avUb.bIe online ~ www din.ltl .,..,.,. era ) Drug Type AhoII,o _looIIIIIIc8oft ~ if_ haw _~ --- --. about Ibe medlcalioa _ -= Efled Prokinetic Agents Enhance stomach muscle action Increase gastric emptying into the small intestine. (in alphabetical order) Antacids Cholinergic Agents Histamine H2 Antagonists , Proton Pump Inhibitors Help neutralize acid in the esophagus and stomach. Help to reduce or stop heartburn. Stimulate muscle contractions in the gastrointestinal tract, causing increased movement in the esophagus and stomach. Reduce stomach acid. Effective in reducing symptoms and damage to the esophageal lining. If taking on an "as needed" basis, take before a meal, especially one that might cause reflux. Reduce stomach acid. Very effective in reducing symptoms and damage to the esophageal lining. OTHER TREATMENTS Surgery Surgical corrections for GERD are only used in patients who have failed a combination of aggressive nonmedical and medical therapies, or who have had additional complications from GERD itself. A Hiatal Hernia is a condition in which a portion of the stomach protrudes into the chest cavity through the sphincter diaphragm. Part of the stomach protruding through the diaphragm Surgical Repair In some cases, surgery may be required (known as a fundoplication) in order to relocate the esophageal sphincter. void large, fatty meals. Decrease meal portions. Avoid foods that you suspect may contribute to the symptoms. Discontinue, or strictly limit, the use of all caffeinecontaining beverages. Try to allow time for your food to digest at each meal. Exercise regularly to improve your general well-being. Avoid tobacco and alcohol. Try to lose weight if you are overweight. Avoid wearing tight clothing. Avoid eating 2-3 hours before sleep. Elevate the head of the bed by 6 inches to reli e some of the symptoms and provide restful sleep.