Stop Acid Reflux Blog

GERD is a very simple disease to keep under control. If it is left untreated, however, complications may result

A late-night snack can sound appealing, but for the estimated 60 million Americans currently living with gastroesophageal reflux disease, or GERD, it could mean a restless night. Bedtime eating is among the culprits of occasional acid indigestion, also known as heartburn. While not uncommon or a major concern, heartburn becomes a problem when it occurs more than once a week.

A little ring of muscle located at the bottom of the esophagus, known as the lower esophageal sphincter (LES), separates the stomach from the esophagus. It opens and closes in response to food moving from the esophagus into the stomach. In normal function, the LES is supposed to remain closed while stomach acids help to promote digestion.

When this muscle is weakened, it cannot completely close off the stomach from the esophagus. This “leaky seal” allows the stomach acids to flow back up through the esophagus toward the mouth. This burning feeling in the esophagus — which is located behind the breastbone — is what we call heartburn or acid indigestion. It is the most common symptom of gastroesophageal reflux disease.

The weakening or relaxation of the muscle is what causes GERD. Not everyone who has GERD experiences heartburn, however, so it is important to be aware of the other symptoms of this disease. Wheezing or coughing, frequent burping, pain in the chest, difficulty swallowing, bad breath and hoarseness in the morning are all symptoms of the disease. Symptoms may also be worse after eating, bending over or lying down.

A hiatal hernia can form at the opening (hiatus) of the diaphragm where the esophagus joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of the stomach may bulge through the diaphragm into the chest cavity. The size of the hernia often correlates with the severity of GERD.

GERD is a very simple disease to keep under control. If it is left untreated, however, complications may result, such as a bleeding ulcer in the esophagus or the formation of scar tissue, called a stricture, which prevents swallowed food and liquids from moving through the esophagus.

Of even greater concern is a complication of chronic GERD — relatively unknown to the public — called Barrett’s Esophagus. The condition develops in 10 to 15 percent of patients with chronic GERD. A cellular change takes place in the esophagus known as metaplasia, which can predispose to dysplasia, which are precancerous cells. Occasionally, Barrett’s Esophagus can develop into a form of cancer known as esophageal adenocarcinoma.

The good news is that, in most cases, the incidence of acid reflux can be prevented or drastically reduced through lifestyle and diet changes. Avoiding spicy foods, chocolate, caffeine, tomato-based products, citrus fruits, garlic, and onions, as well as fried and fatty foods, can reduce symptoms significantly.

When considering mealtime, eat the last meal of the day three to four hours before bedtime and avoid bedtime snacks. Pay attention to portion sizes. Even overeating healthy food can have the same adverse effect as eating foods which precipitate GERD.

Just as diet changes can inhibit the occurrence of acid reflux, lifestyle adjustments can also eliminate GERD. Maintain a healthy weight, exercise (but not too soon after eating), quit or significantly reduce smoking, and elevate the head of the bed about six inches.

Making these changes early on can arrest the development of complications related to GERD.

If you are experiencing heartburn, indigestion or belching more than once a week, and/or regularly using over-the-counter antacids, visit a gastroenterologist to receive an EGD test. This test involves the passage of a lighted flexible tube through the mouth into the esophagus, stomach and upper intestines. The EGD is the single best test to evaluate the esophagus for damage from GERD. The gastroenterologist can take both pictures and tissue samples — a biopsy. Early detection of GERD may prevent the more complicated conditions of Barrett’s Esophagus and possible esophageal cancer.

For more information about GERD, Barrett’s Esophagus or endoscopy, contact the American College of Gastroenterology at (301) 263-9000 or visit www.acg.gi.org. To find a University Medical Center at Princeton gastroenterologist near you, call (888) 742-7496.

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(info by Glenn L. Osias, M.D. in collaboration with Gloria N. Beck from http://www.pacpub.com/site/news.cfm?BRD=1091&dept_id=535412&newsid=14865592&PAG=461&rfi=9)