Condition Center: GERD
This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.
Gastroesophageal reflux disease, or GERD, is a condition experienced by approximately 20 percent of the US population. While it's easy to brush off the condition as "just" heartburn (one of its most common symptoms), it's important to get appropriate treatment, since over time GERD can lead to difficulty swallowing, asthma-like symptoms, chronic cough, and even changes in the lining of the esophagus that could then lead to esophageal cancer. Here, experts give advice on what signs to look for and when to see a doctor.
GERD is an intense form of acid reflux defined by a chronic backflow of stomach acid into the esophagus, resulting in frequent heartburn, according to Mayo Clinic. The most common symptoms of GERD are heartburn, regurgitation, difficulty swallowing, coughing, loss of appetite, nausea, and diarrhea.
But when do you know if it's more than just acid reflux? "I would recommend seeing a doctor if they are having GERD symptoms several times a week or if the symptoms remain despite dietary and lifestyle modifications," Jose A. Lopez, MD, board-certified general surgeon who specializes in GERD treatment at Austin Surgeons, says. "If someone is having to take over-the-counter antacids on a regular basis, I also recommend that they seek medical evaluation." Paulina Lee, MSHS, RD, LD, gut-health functional dietitian and founder of Savvy Stummy, adds, "If symptoms are causing increased nausea or vomiting or chest pain, disrupting your quality of life, decreasing your appetite, [causing] unexplained weight loss, or [showing] signs of blood in your stools (like black or tarry stool or coffee-ground vomit), then you should see a doctor."
Dietary modifications and medications are the first line of treatment. "However, if symptoms persist despite medication and/or somebody does not want to stay on medications for their entire life, surgery could be an option," Dr. Lopez adds.
Causes of GERD
When you swallow, there is a muscle in your lower esophagus that opens to allow food and liquid into the stomach and then closes again. If that muscle cannot close properly, stomach acid can flow back into your esophagus. The constant exposure to the acidity causes inflammation. "GERD could also be caused by an abnormality that prevents the esophagus from relaxing properly," Samir Patel, MD, FACS, FAS, MBS, APG, surgeon with AtlantiCare, says. This could include a hiatal hernia, or when the upper part of the stomach bulges into the diaphragm, preventing normal food intake. "Or it can come from diet, stress, obesity, and certain medications [like aspirin]." According to Mayo Clinic, other factors that can aggravate acid reflux include:
- Eating large meals
- Eating before bed
- Eating fatty or fried foods
- Drinking alcohol or coffee
Most Effective GERD Treatments
Just like most disease processes, GERD is a spectrum. "Thus, different individuals usually require different treatments in order to improve or eliminate their symptoms," Dr. Lopez says. Ahead are some of the treatment options.
- Dietary Modifications. "It is important to avoid very big meals late in the evening and late-night snacking, especially if these meals involve foods that trigger GERD symptoms." Acid-forming foods include onions, garlic, tomatoes, vinegar, and high-fat foods. "Dietary modifications are perhaps the most important modifications one can make if they suffer from GERD," Dr. Lopez says. Instead, try foods that are high in fiber (think: nuts and seeds, legumes, and starchy vegetables like potatoes and corn).
- Lifestyle Changes. Small changes like chewing your food really well and elevating the head of your bed while you sleep can make sure the acid is flowing the right direction. "They should also try to eat sitting up and remain in the seated position for a short while after a meal," Dr. Lopez says. "Smaller, more frequent meals are also thought to be of some benefit to patients who have GERD."
- Medication. Currently, the most common medication used to treat GERD is a proton pump inhibitor, also known as a PPI. "These medications help by reducing the acid secretion in the stomach," Dr. Lopez says. "There can be some long-term side effects, but for the most part, it is believed that these medications are safe." There are also other types of medications, including H2 blockers, which also work by reducing the amount of acid produced in the stomach. "Both these classes of medications tend to be used more to prevent symptoms as opposed to antacids, which are used after symptoms have started for quick, immediate relief."
If these don't control symptoms or if you do not wish to take medications for an extended period, surgery may be recommended. Surgery for GERD is known as a laparoscopic fundoplication. "During surgery, the valve between the esophagus and the stomach (the lower esophageal sphincter or LES) is reinforced, and if a hernia is present, it is repaired," Dr. Lopez explains. "Young, healthy individuals may benefit from surgery earlier."