Conditions

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) results from the reflux of stomach acid into the esophagus. A common and often chronic condition, GERD affects a large percentage of healthy individuals, many of whom have experienced symptoms for more than a decade. Lying down after eating often exacerbates heartburn (the primary symptom). Complications are more common with older patients.

GERD is generally not considered to be a disease unless the symptoms are severe and occur frequently or the esophageal mucosa is damaged. It is important to note that individual symptoms do not always reflect the severity of esophageal mucosal damage.

Signs and Symptoms:

• Heartburn
• Regurgitation
• Belching
• Burning sensation
• Chest pain (similar to angina)
• Bronchospasm (asthma)
• Laryngitis
• Chronic cough
• Recurrent aspiration
• Wheezing
• Hoarseness
• Sore throat
• Globus sensation in the neck
• Infants: apnea syndrome, failure to thrive, recurrent emesis

Diagnosis:

Other diagnostic procedures can be used to confirm GERD and to tell if GERD resulted from acid reflux. These procedures can also determine if mucosal inflammation or other damage has resulted, and ascertain the severity of the condition.

• Esophageal manometry: indicates abnormal peristalsis and poor LES tone; does not show reflux
• Prolonged esophageal pH monitoring: enables comparison of symptoms to actual acid levels
• Acid perfusion (Bernstein) test: indicated for patients with atypical symptoms or treatment complications
• Endoscopy with biopsy: most effective assessment of reflux-induced mucosal damage; recommended with complications (e.g., stricture or Barrett's epithelium)
• Gastric analysis

Treatment Options:

Treatment depends on the severity of the symptoms. In most cases, treatment of symptoms is sufficient. In some cases damage needs to be treated and complications need to be prevented.

Traditional Treatments:

• Antacids are the old standby of conventional treatment. This class of medication includes Tums, Rolaids, and Maalox, which buffer the acid in the stomach and tend to provide some relief.
• In addition to standard antacids, there are now a variety of acid-blocking agents available over the counter. These include nizatidine (Axid AR), famotidine (Pepcid AC), and cimetidine (Tagamet HB).
• Drugs to speed the movement of food through the digestive tract can sometimes afford relief of acid-reflux symptoms. Examples of drugs in this class include cisapride (Propulsid) and metoclopramide (Reglan). There are severe side effects with these drugs and they also can interact with other drugs, so discuss their use with your doctor before taking them.
• H2 antagonists effectively relieve symptoms and generally heal mild-to-moderate esophagitis; can prevent relapse with mild GERD.
• Cimetidine, famotidine, nizatidine or ranitidine, once or twice/day; some interactions.
• Proton-pump inhibitors (PPIs) - potent, long-acting acid secretion inhibitors; relieve severe symptoms and heal esophagitis; provide effective maintenance therapy; minimal short-term side effects, long-term side effects unknown. Omeprazole or lansoprazole.

Complementary and Alternative Therapies:

Dietary changes can be very important in decreasing the irritation of GERD. Herbs may be very effective at healing esophagitis. The correct homeopathic treatment may also be quite helpful.

Nutritional Supplementation:

• Pancreatin plus bromelain enzymes necessary for proper digestion. Follow label directions on both supplements.
• Papaya tablets can relieve symptoms.
• Vitamin B complex is needed for proper digestion. Use lozenge or sublingual forms that contain at least 50 mg of each major B vitamin. Take 3 doses daily.
• Extra vitamin B12 is also important to digestion. Take 1,000 ­ 2,000 mcg daily.

Alternative Therapies:

• Aloe vera juice aids healing of the intestinal tract.
• Catnip, fennel, ginger, marshmallow root, and papaya tea all aid in proper digestion and act as a buffer to stop heartburn.
• Drinking chamomile tea can relieve esophageal irritation.
• Deglycerrhizinated licorice (DGL) has effectively treated both heartburn and ulcers of the stomach and esophagus.
  Warning: Do not use licorice if you have high blood pressure.
• Slippery elm protects irritated tissues and promotes their healing.
• Valerian (Valeriana officinalis)-bitter, sedative, especially for anxiety or depression and poor digestion.
• Wild yam (Dioscorea villosa)-antispasmodic, anti-inflammatory, especially for fatigue from long-term stress or maldigestion.
• St. John's wort (Hypericum perforatum)-analgesic, antidepressant, historically used to treat adhesions and strictures, especially for anxiety or pain.
• Skullcap (Scutellaria lateriflora)-antispasmodic, sedative, nervine, especially for disturbed sleep.
• Linden flowers (Tilia cordata)-antispasmodic, mild diuretic, gentle bitter, especially for dyspepsia.

General Recommendations:

• At the first sign of heartburn, drink a large glass of water.
• Try raw potato juice. Do not peel the potato ­ just wash it and put it in the juicer. Mix the juice with an equal amount of water. Drink it immediately after preparation, three times a day.
• Change your eating habits.
• Eat more raw vegetables.
• Eat smaller, more frequent meals.
• Chew your food well.
• Eat slowly and enjoy your food.
• Do not eat for three hours before bedtime. Wait at least 3 hours before lying down.
• Do not consume carbonated beverages, fats, fried foods, processed foods, peppermint, spearmint, tobacco, tomatoes, onions, caffeine products, sugar, or spicy or highly seasoned foods. These seem to be the main cause of heartburn.
• There is some confusion about whether a mutli-enzyme complex containing HCI is good for, or harmful for, those with GERD. Talk with your doctor about this supplement.
• Maintain an exercise program that includes walking, biking, or low-impact aerobics. Avoid running and weight lifting as these activities put pressure on the stomach.
• Do not exercise after eating.
• Elevate the head of your bed.
• As much as possible, avoid stress and anger.
• Do not wear clothes that fit tightly around the waist.

Warnings:

• If heartburn lasts longer than two weeks, seek medical attention.
• The early symptoms of angina and heart attack sometimes mimic those of "acid stomach". If symptoms persist, if the pain begins to travel down into your left arm, or if the sensation is accompanied by a feeling of weakness, dizziness, or shortness of breath, seek emergency medical help at once.
• Do not use licorice if you have high blood pressure.