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Your Burning Questions Answered

Understanding gastroesophageal reflux disease (GERD)

By Alice Rhein

Do you feel it? That burning sensation behind the breastbone that seems to be moving up from the stomach? If you do, you’re not alone. More than 60 million Americans experience heartburn at least once a month. That’s a lot of indigestion.

But what many may not know is that heart burn is actually a symptom of gastroesophageal reflux disease, or GERD. “GERD is the medical name for [heartburn],” says Mark DeVore, M.D., a gastroenterologist at Providence Hospital in Southfield. “Once heartburn is proven through one assessment or another, then it’s GERD.” Here are other important things to know about GERD:

How does GERD occur? The sphincter muscle at the base of the esophagus opens to let food pass into the stomach. When this ring-like muscle doesn’t work properly, acid from the stomach backs up into the esophagus causing symptoms that include heartburn.

What are the symptoms? The main symptoms are a burning feeling behind the breastbone, acidic or sour taste in the mouth, belching and the sensation of bloating or fullness in the stomach.

Who is most at risk for GERD? Recent studies indicate a correlation between obesity and acid reflux, according to William Chey, M.D., associate professor of internal - medicine at the University of Michigan, “A couple of well-done longitudinal studies clearly show that a greater BMI [body mass index] associates with greater reflux,” says Chey. What the studies haven’t shown yet is whether weight loss equals less reflux.

Other at-risk groups include pregnant women and smokers.

How is GERD diagnosed? Having recurring heartburn and other classic symptoms is one way. Other methods used to diagnose GERD include an X-ray study of the esophagus or an endoscopy, a procedure in which a tiny camera is passed through the mouth down the stomach so the lining can be viewed directly.

What are the current treatments? Reflux is a chronic, relapsing disease; however, longterm therapy may control the symptoms. This includes lifestyle changes such as diet modification, wearing loose clothing, not eating or drinking prior to bedtime, and avoiding alcohol.

Many over-thecounter remedies were available only by prescription a decade ago. These include a group called H2 receptor antagonists such as Pepcid or Zantac. The “big guns,” as DeVore notes, are proton pump inhibitors (PPIs) such as Prilosec, which heal erosive esophagitis and relieve symptoms.

While surgical measures are available, including a laparoscopy procedure that helps to strengthen the lower esophageal sphincter, the most common treatments for GERD are medicine and lifestyle modifications.

What are ways to prevent GERD? Lose weight, say both physicians. “We eat too much as a society and we eat at the wrong times, and when we do eat, we don’t have one serving, we eat a lot,” says DeVore. Chey recommends watching dietary intake and avoiding fatty, greasy foods.

Chey notes that in moderate to severe cases in which GERD interferes with day-to-day activities, diet modification may not be enough.

Can GERD be dangerous? Left untreated, GERD can lead to more serious problems such as Barrett’s esophagus, a pre-cancerous condition.

How do I find out more? For more information about GERD, visit www.acg.gi.org or call 800.478.2876 for a free brochure.

SOMETHING TO CHEW ON

If you suffer from gastroesophageal reflux disease (the No. 1 symptom is heartburn), here are some foods to avoid and a few safer alternatives.

Fruits and veggies
Avoid: citrus and acidic foods and juices such as orange juice, lemonade and tomato juice
Try instead: apples, bananas, peas, green beans, carrots or broccoli

At meals
Avoid: fatty foods such as french fries, chicken nuggets and spicy wings; ground beef; tomato-based sauces and raw onions
Try instead: egg whites, skinless chicken breast, fish, lean meats, fat-free cream cheese, goat cheese, soy cheese or bread

Snack time
Avoid: chocolate and greasy snacks such as potato chips
Try instead: jelly beans, fat-free cookies, red licorice, baked potato chips or pretzels

Beverages
Avoid: liquor, wine (especially red), coffee and tea (decaf and regular)
Try instead: mineral water or regular water