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GERD (Gastroesophageal reflux disease) FAQ

1. What is GERD?

GERD is a disorder in which the lower oesophegal sphincter (LES) is affected. LES is the ring of muscle between the oesophagus and stomach. GERD typically occurs when the contents and acids of the stomach flow back into the oesophagus causing irritation in its inner lining. The full form of GERD is Gastroesophageal reflux disease. GERD may cause heartburn or acid indigestion in pregnant women. Change of diet and lifestyle helps to cure this condition; however in critical cases, patients need medication or even surgery.

2. What are the symptoms of GERD?

All the symptoms of GERD are more or less related to the digestive system.

The most common symptoms of GERD are heartburn, nausea and regurgitation.
Heartburn usually refers to a burning sensation that occurs in the chest, especially at the centre. The pain may shift towards the abdomen or the neck or back. Such a pain occurs mostly after meals.

There are other GERD symptoms as well.

  • The acid reflux often passes through the upper oesophageal sphincter and reaches the throat causing sore throat (pharyngitis).
  • GERD causes coughing.
  • Laryngitis is another common symptom of GERD.
  • GERD may worsen asthma by causing irritation in the airways.
  • There are some minor symptoms of GERD that include lump in the throat, sudden increase of saliva, pain in the ears, a constant feeling of discomfort in the chest, etc.
  • Among children, the symptoms of GERD show in the form of repeated vomiting, unexplained coughing, difficulty in breathing, etc.

3. Whom should I contact in case I have GERD symptoms?

If a person is suspected to have GERD he is generally referred to a gastroenterologist (a doctor who specializes in digestive diseases).

4. Medications I am currently taking are causing me GERD symptoms?

Gastroesophageal reflux disease is often aggravated by certain medications.

Medicines that are responsible for relaxing the LES, thereby inducing or increasing acid reflux are:

  • Anti cholinergic medications (taken for nausea) that include promethazine (Phenergan), prochlorperazine (Compazine) etc.
  • Antidepressants that include doxepin (Sinequan), imipramine (Tofranil) and amitriptyline (Elavil)
  • Medicines taken for asthma that include bronchodilators like theophylline (Uniphyl) or beta-adrenergic agonists
  • Sedatives or tranquilizer like temazepam (Restoril), diazepam (Valium) etc. and also medications that contain oestrogen.

Medicines that directly cause inflammation in the oesophagus are:

  • Osteoporosis medicines (Bisphosphonates) like alendronate (Fosamax)
  • Iron tablets
  • Potassium supplements
  • Quinidine, a medication prescribed for heart diseases
  • There are some other medications that may worsen GERD.
    Medications prescribed for blood pressure that include beta blockers or calcium channel blockers. Some of the examples are diltiazem (Cartia, Cardezem), verapamil (Calan, Isoptin), nadolol (Corgard), and nifedipine (Adalat, Procardia).
  • Narcotics like oxycontin and morphine
  • A three year study conducted on the role of non-steroidal anti-inflammatory (NSAID) drugs in aggravating GERD shows that people who take NSAIDs like aspirin and ibuprofen (Motrin, Advil) for months or years are more like to suffer from GERD symptoms than those who don’t take such medications.

5. If I have chest pain, how can I differentiate whether it’s GERD or a heart problem?

Heart burn has no connection with the heart directly or indirectly. The pain occurs in the middle of the chest because the heart and the oesophagus are located very close to each other. However, many people mistake heart burn for angina (a heart disorder that may lead to a heart attack) and sometimes vice versa.

An easy way to differentiate between the two is if the symptoms go away as a result of belching, it is heartburn. But if sweating or breathing difficulty occurs due to shortage of oxygen, the chest pain is likely to have arisen due to heart related problems. The most accurate way to determine is to consult a doctor because symptoms might differ from one individual to another.

6. Which foods or beverages I should avoid in case of GERD?

Mild and moderate cases of Gastroesophageal reflux disease get cured considerably just by changing diet and lifestyle. So getting a good diet should be a matter of prime importance for GERD patients. The doctor generally gives a proper diet chart to patients. The best way to follow a diet is to maintain a food journal. The main cause of GERD is malfunctioning of the LES. There are foods that intensify malfunctioning whereas some others minimize it.

According to experts, the foods that can directly or indirectly cause GERD symptoms are:

  • High-fat foods

French fries, onion rings, cream sauces, creamy salad, dairy products (butter, regular cheese, milk etc.), fats of lamb, pork, or beef, bacon, lard, ham and high calorie snacks and desserts (chips, ice cream etc.)

  • Tomatoes and tomato products like tomato sauce, salsa sauce etc.
  • Citrus fruits like lemons, oranges, lime and grapes
  • Chocolates (It contains methyxanthine, which relaxes LES muscles)
  • Garlic and raw onions
  • Coffee

There are no such foods that can prevent GERD from appearing but some foods can lessen the symptoms of GERD.

  • Probiotic Yogurt

Probiotic yogurt or other foods that contain probiotics help in digestion. Probiotics help in treating digestive problems like constipation, diarrhoea, abnormal bowel syndrome etc. The reason probiotics have this effect is undetermined but studies have shown these microorganisms to be beneficial in reducing the adverse effects of GERD.

  • Peanut Butter

Peanut Butter has lower fat protein and is helpful in reducing GERD symptoms. However, everyone doesn’t have equal tolerance to peanut consumption and some patients are allergic to it.

  • Fibre

According to a leading international journal in gastroenterology, “Gut”, people whose diet consists of more high fibre foods are 20 percent less likely to have GERD.

7. Are there any lifestyle changes that might help relieve my symptoms?

Lifestyle changes relieve GERD symptoms to a great extent. Eating healthy food is the primary thing that should be done to reduce GERD symptoms. Other lifestyle changes must include:

  • Limiting the intake of caffeine and alcohol
  • Quitting smoking
  • Exercising regularly (Weight gain aggravates GERD)
  • Practicing meditation, yoga or other stress reduction techniques
  • Losing extra weight

8. Should I take medication? If so, do I need a prescription?

If it is a moderate case of GERD medicines either prescribed or non-prescribed can prevent complications. However, it is wiser to visit a doctor and take medications prescribed by him/her.

The medications for GERD generally include:

Antacids–

  • H2 Blockers: There are prescribed as well as non-prescribed H2 blockers. If non-prescribed H2 blockers are unable to relieve pain, the ones with prescribed strength help. Common H2 blockers include famotidine (Pepcid), ranitidine and cimetidine (Tagamet). These help to decrease the acids in the stomach.
  • Proton pump inhibitors: These also help lessen the acids in the stomach. Some of the proton pump inhibitors can be available without a prescription. Some common proton pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid).

These medicines play a major role in decreasing the acid content of the stomach, but patients can still suffer from heartburn sometimes. Along with taking medicines, they should maintain proper food habits and a healthy lifestyle to get the best results.

9. What should I do if the medication doesn’t seem to help?

If medical treatment is not helping, the as a last resort the patient can undergo a surgery. Besides, there are other alternative processes of surgery that may be explored. These processes include magnet therapy, acupuncture etc.

Nissen fundoplication is the most common surgical procedure for GERD. The surgery is done to prevent stomach acids from entering the oesophagus. It is the most effective procedure till date but has some side effects as well that include trouble in swallowing, gas formation or bloating, flatulence (gas formation in alimentary canal) etc.

10. Will I need any tests or examinations?

If the symptoms of acid reflux disease are chronic heartburn or regurgitation, it is easier for the doctor to diagnose. However there are other symptoms which are less direct. These include anaemia, weight loss, difficulty in swallowing, etc. and in case of these symptoms, doctors usually prescribe the following tests:

  1. Barium Swallow Radiograph: It is a painless test in which the patient has to swallow a solution of barium, which enables the doctor to take an X-ray of his/her oesophagus to examine if there is any anatomical problem in the oesophagus. However, it is not the ultimate test to detect GERD. In fact the X-ray can detect oesophageal changes on only one out of three people with GERD.
  2. Endoscopy: An endoscope (a small tube with a fiberoptic camera) is inserted through the mouth into the oesophagus to check for irritation in the inner lining of the oesophagus. The patient is given local anesthaesia or a mild sedative before carrying out the test. It is a painless test that takes less than 20 minutes to detect GERD complications including Barrett’s oesophagus. However, not all GERD patients have irritation in the inner lining of the oesophagus.
  3. Biopsy: Often the doctor performs a biopsy test on patients who are suspected to have GERD. In this test a small lining of the oesophagus is extracted by a tiny surgical instrument. Then the tissue sample is sent to a pathological lab to analyze if there is any underlying disease like oesophegal cancer.

12. What complications could occur if my GERD doesn’t improve?

If the GERD is left untreated or if it doesn’t improve even after proper treatment, it may lead to serious consequences.

  • Esophagitis: If acid reflux occurs repeatedly it may cause oesophaegal injury, which may in turn cause erosions or ulcers.
  • Barrett’s oesophagus: It is a condition that develops in 10% of total patients suffering from long term GERD. Barrett’s oesophagus involves abnormal changes in the inner lining of the oesophagus. It may lead to oesophageal cancer as well.
  • Strictures: Sometimes the damaged lining of the oesophagus gets scarred, which results in the formation of strictures in the oesophagus. These strictures hinder food and liquid to reach the stomach, causing severe indigestion.
  • Oesophageal cancer: Oesophageal cancer cannot be detected in its early stages. The only symptom that might crop up is difficulty in swallowing.

There are two types of oesophageal cancer. These are:

  • Squamous cell carcinoma: The cancer is detected in the squamous cells (the cells are located on the lining of the oesophagus) and affects the upper and middle parts of the oesophagus.
  • Adenocarcinoma: Barrett’s oesophagus leads to this type of cancer, which affects the lower part of the oesophagus.

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