Heartburn and GERD

with Jeffrey Bahr, M.D., internal medicine specialist, Advanced Healthcare

Last Updated: June 1, 2003

GERD, the acronym for gastroesophageal reflux disease, is the term that is used for heartburn that occurs on a consistent basis, usually considered more than twice a week. “Duration and persistence mark the difference between heartburn and GERD. People with GERD have a physiological abnormality that should be treated,” said Dr. Jeffrey Bahr, an internal medicine specialist with Advanced Healthcare.

Heartburn is a problem that affects nearly everyone at some time. Set off by spicy foods or alcohol or a large meal, especially one eaten close to bedtime, heartburn causes what TV ad writers have termed “that burning sensation of acid indigestion.”

Fortunately, because heartburn is so common, there are many over-the-counter treatments to deal with it. These range from the old standbys such as TUMS to the newer drugs that were once available by prescription only. Usually, these are enough to alleviate heartburn symptoms.

“If heartburn does not respond to over-the-counter medications, if symptoms are persistent and the patient is doing his best to avoid foods known to cause his problems, it is time to see a physician. For anyone treating heartburn at home, I would give the problem two weeks. If it does not improve, see your physician,” Dr. Bahr said.

When to see the doctor
There are many reasons to see a doctor for GERD.

First, GERD is a progressive disease. In time the reflux into the esophagus will create changes in the tissue there, making the reflux more common and more painful. “The pain often becomes unbearable. We don’t want people walking around in pain all the time,” Dr. Bahr said.

Untreated reflux also can cause a condition called Barrett’s esophagus, associated with an increased risk of developing esophageal cancer.

Finally, the pain a sufferer assumes to be reflux might be something else. “We don’t want people assuming their symptoms are reflux when they are something more serious such as heart disease. It takes an evaluation by a physician to sort out what is actually causing the symptoms,” Dr. Bahr said.

Symptoms and causes of GERD
The most common symptom is pain behind the breastbone, and often an acidic taste in the mouth. “Other symptoms include wheezing due to stomach acid causing irritation in the larynx, particularly when a patient is lying down,” the doctor said.

Many different conditions can cause GERD or similar symptoms. Conditions that cause GERD include an abnormally relaxed esophageal sphincter and a hiatal hernia. Gastric ulcers often cause a similar pain as do some bacterial infections, notably H. pylori which is sometimes a cause of ulcers. Doctors also can take tissue samples to rule out Barrett’s esophagus or esophageal cancer.

Treatment will depend on the cause and may range from prescription medicines to surgery, to repair a hernia, for example. Most physicians will first suggest lifestyle changes.

Who is at risk
The main risk factors for GERD include being overweight or pregnant. In both of these cases, excess pressure on the stomach can cause recurrent reflux. Other common risk factors include alcohol use and smoking. “This is because both alcohol and nicotine lower the muscle tone of the lower esophageal sphincter, making reflux more likely to occur,” Dr. Bahr said.

Certain foods also can trigger GERD. Among the most common are chocolate and peppermint. “These relax the sphincter in much the same way alcohol and tobacco do,” the doctor said.

And other foods can make the problem worse by causing additional burning during reflux. Spicy foods, citrus, tomato-based products, coffee, onions and high-fat foods are the most common triggers, though some people may have a reaction to an entirely different type of food.

How patients can help themselves
The first thing those suffering from GERD can do is alleviate the main triggers: give up smoking, cut back or stop drinking, lose some weight. Keeping a diary of foods that seem to cause the problem is a good way for GERD sufferers to find a pattern between their eating habits and their symptoms.

“Also, try to leave the table a little big hungry. After eating, stay upright. Don’t wear tight or constrictive clothing, and if you need to, loosen that belt a notch or two,” Dr. Bahr concluded.

GERD can damage your esophagus. Read what Dr. Thomas Puetz advises about Barrett’s Esophagus.

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