This brochure was prepared by the partners of Gastroenterology Consultants of Augusta, P.C. This is intended to provide you with some information that will allow you to better manage some of your symptoms. Please understand that this is not a rule book but is merely a guide that may be used in conjunction with medical therapy to ease the reflux symptoms.
Gastroesophageal Reflux Disease (GERD) is a common problem and tends to increase with our hectic lifestyles and dietary patterns. Gastroesophageal reflux, in many instances may have few or no symptoms. It may be heralded by episodes of chest pain, hiccups, soreness, burning in the chest area, or difficulties swallowing. Long-term reflux can be associated with increasing risks for esophagus cancer. Chronic irritation of the esophagus with sores and ulcers may lead to scaring of the esophagus and narrowing of the normal esophagus diameter. These narrowing areas, also called strictures and rings, may actually catch pieces of food such as meats, breads, or pills. Certain types of symptoms are considered alarm symptoms because of the seriousness of the underlying problems that may cause them. Alarm symptoms include chest pains, difficulty swallowing, and weight loss.
What causes Gastroesophageal reflux?
Gastroesophageal reflux occurs normally, to a limited degree, in most persons. The lower end of the esophagus has a muscular function and a barrier-type function that generally prevents stomach contents from entering the esophagus. There are normal relaxations in the muscular barrier, which are associated with burping and occasional regurgitation of stomach contents into the esophagus. With increasing acid exposure, the esophagus may often become irritated or eroded. Several factors tend to increase esophagus acid exposure.
These factors include:
- Weakness of the barrier itself
- disruption of the normal anatomy such as a hiatal hernia
- dietary patterns
- the chemical action of medications, food substances, cigarette smoke, and alcohol on the barrier
- the effect of gravity on stomach contents
- increases in abdominal pressure during events such as coughing or sit-ups.
Several medications diminish acid production in the stomach. Reduced acid production in the stomach will reduce acid exposure in the esophagus. Medications are not a substitute for good dietary habits. Avoidance of such factors as smoking, eating late, or drinking alcohol will enhance the effect of medications to reduce acid production. In the long run, dietary habits and lifestyle will tend to overcome the ability of medications to reduce heartburn symptoms. We strongly encourage a combination of lifestyle modification and medical therapy to relieve the reflux problem.
Several classes of medication are available for the relief of heartburn and reflux. Antacids such as Tums or Mylanta are excellent medications for the instant relief of the burning sensation caused by acid in the esophagus. The relief may be brief because acid production is not affected. Antacids are the best choice for instant acid neutralization. Histamine blockers (H2 blockers) are medications that provide significant relief from reflux symptoms by diminishing acid production. These medications tend to have a relatively short onset of action and last for several hours. H2 blockers are readily available, over the counter, in doses equivalent to the prescription doses. Proton pump inhibitors (PPi’s) are potent inhibitors of stomach acid production. They tend to reach their full effect after a few days and tend to last at least 12 hours. These medications are better suited for the long-term management of heartburn and reflux. PPI’s are excellent inhibitors of acid production but are not well suited for the rapid relief of heartburn. Continuous dosing is most effective with this class of medications. Side effects from PPI’s may include cramps, diarrhea, and occasionally headaches.
Lifestyle modification is a very important part of any anti-reflux plan. Remember that acid production in the stomach is a normal process. When acid remains in the esophagus for extended periods of time this may lead to heartburn, chest pain, difficulty swallowing or voice problems. Different persons may experience different symptoms with the same level of acid exposure. Dietary habits that lead to weight gain tend to make heartburn symptoms worse. If you are overweight, a calorie reduction plan with portion reduction can help in reducing reflux symptoms. Obesity is not the only cause for reflux. Thin persons may have significant reflux. Some medications weaken the normal esophagus barrier while others slow stomach emptying. Please discuss your medical regimen with your doctor to identify medications that may contribute to the reflux problem. We strongly discourage stopping medications without discussing the potential hazards with your physician.
The effect of overeating or eating near bedtime is best understood by thinking of the stomach and esophagus as a long-necked bottle. When the stomach is filled with food, acid production begins and peaks in about three to four hours. If you lie down with a full stomach, the stomach contents and the produced acid will move into the esophagus by gravity. Since the stomach is a soft organ, any activity that compresses the stomach will forcibly move acid upwards into the esophagus. Coughing, sit-ups, or occasionally a tight belt may make this problem worse. We strongly encourage our patients to avoid eating or drinking within 2 ½ hours of the normal bedtime. This allows enough time for the majority of the stomach contents to move out of the stomach and thereby reduce acid exposure to the esophagus. Many people feel the need to drink milk or soda at bedtime. All of these items move into the esophagus with the help of gravity. Although milk may provide some temporary relief, it also stimulates acid production. If you need immediate relief of symptoms at night, we suggest reclining in an easy chair and using antacids. Taking your other heartburn medications on a regular basis will also prevent the intermittent breakthrough of reflux symptoms.
Foods with a high fat content actually slow stomach emptying. For example, turkey and gravy, mashed potatoes with sour cream, and the usual trimmings of a Thanksgiving dinner cause most people to reflux for several hours after the meal. The larger the meal, the longer the stomach acid production contains. Further, it takes much longer for the stomach to empty a large meal with a high fat content than a smaller, lower fat-content meal. We encourage our patients to make the evening meal smaller in portion size and lower in fat content, to ease symptoms. Many of us have evening obligations, such as business dinners, that require eating late. Many late meals include drinking coffee and wine. This is a perfect prescription for reflux. First, try to avoid the caffeine and alcohol in the evening. Second, recline in an easy chair for several hours before retiring to bed. This allows the stomach contents to rapidly return to the stomach when reflux occurs. For example, if your normal bedtime is 9 p.m., and you have arrived home from a wonderful meal at a local restaurant, we suggest reclining in the easy chair at 9 p.m. and then retiring to bed around 1:00 a.m. Elevating the head of the bed or sleeping on several pillow scan be helpful; however, our experience suggests that people slide off of pillows easily and six inches of elevation at the head of the bed may not be enough to overcome the effects of gravity. Remember that reflux begins about six inches above the naval, not at the level of your neck. Propping up your neck with pillows does not change reflux at the level of the esophagus.
Your doctor may suggest examination of the esophagus, to better evaluate your symptoms. Options for further testing and surgical therapy for reflux are available, and will be discussed as needed.
- Most any food is permissible.
- Many people find that red meats tend to make reflux worse. Fish and chicken are good alternatives.
- Try to reduce spices