What is GERD?
by Alyn L. Adrain, MD
Gastroesophageal reflux disease (GERD) is by far the most common esophageal disease in the United States. 95 million Americans have reflux symptoms on a monthly basis, and this results in sales of about a billion dollars worth of non-prescription medications yearly. About 38% of people in this country have intermittent heartburn. 20% have heartburn at least once a week and 10% have daily heartburn.
Heartburn is typically described as a burning discomfort behind the breastbone, often following a meal or after lying down. It may be accompanied by the need to belch or by regurgitation. Less commonly, GERD may be manifested by the development of chest pain (which may feel like a heart attack), asthma, chronic cough, hoarseness, hiccups, sore throat, sinusitis, or even dental caries. The presence of a hiatal hernia may predispose to, but is not the same as, GERD.
While most people with GERD have mild intermittent heartburn-type symptoms, often readily controlled by over-the-counter medications, chronic reflux may cause more severe problems. Frequent and prolonged exposure of the lining of the esophagus to acid may cause the surface to be burned away, resulting in lesions called erosions. Years of recurrent burning of the lining of the esophagus may lead to scarring, which in turn may cause difficulty in swallowing. Occasionally food may lodge above one of these scarred areas requiring an emergency trip to the hospital. A very small percent of people with long-term reflux may develop a condition called Barrett’s esophagus. While this condition itself is benign, a small percent (probably less than 1% of people with Barrett’s) go on to develop cancer of the esophagus.
The first step in treating reflux is always to modify your lifestyle. Foods that may cause or aggravate reflux include fatty or fried foods, alcohol, peppermints, chocolates, citrus juices, carbonated beverages, and perhaps caffeine. Very large meals or late meals just prior to lying down are to be avoided. Weight loss may help to decrease the pressure on the stomach pushing food up the esophagus. Tobacco use should be avoided.
If these efforts are ineffective, mild, occasional reflux (fewer than three episodes weekly) is usually well treated with over the counter medications. Symptoms more frequent than this generally require the use of prescription medications, of which there are a growing number. Alternatively, there are surgical treatments that may give long-term relief without the need for long-term medications. The overwhelming majority of people can get excellent relief from the many treatments now available.
People who have had several years (more than 5 - 8) of heartburn should be evaluated for the development of Barrett’s esophagus, through a test called an upper endoscopy. Symptoms such as difficulty swallowing, unexplained weight loss, heartburn uncontrolled by medications, or bleeding (red, maroon or black stool) should prompt immediate medical attention.
In summary, GERD is a common disorder with symptoms ranging from occasional heartburn to life-threatening complications. There are many excellent treatments available so majority of symptoms can be well controlled.
Doctor Adrain is a graduate of Brown University Medical School. She completed her residency, where she was Chief Resident in Medicine, at Kaiser Permanente Medical Center, Oakland, CA; and a Gastroenterology and Advanced Endoscopy Fellowship at Temple University Hospital, Philadelphia, PA. Doctor Adrain is Board Certified in Internal Medicine and Gastroenterology.
Alyn L. Adrain, MD
Gastroenterology Associates
1 Randall Square
Providence, RI 02904
401-274-4800
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