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What Can be Done for GERD?
by our Health Guru

Question:
"After suffering from various digestive complaints, I did some reaserch online and think I may have GERD. If so, what can I do about it?"

our Health Guru's Answer:
GERD, which stands for Gastroesophageal Reflux Disease, is becoming increasingly common in the United States. GERD is also referred to simply as acid reflux and heartburn. People with GERD frequently experience the liquid contents of their stomach backing up (refluxing) into their esophagus. Usually, this regurgitated liquid contains acids, as well as bile and pepsin, an enzyme that digests protein. For the most part, it is the back up of acid into the esophagus that you need to be concerned about, since it can cause damage and inflammation along the lining of the esophagus.As a result, if GERD becomes chronic, as it often does, and is left untreated, it can result in a damaged esophagus and an exponential rise in the risk for esophageal cancer, among other conditions.

Everyone experiences the back up of stomach acids into the esophagus to some extent. In fact, some research indicates that healthy people experience reflux as frequently as people with GERD do. The chief difference with GERD suffers is that the liquids that back up tend to contain more acid, and that the acid usually remains in the esophagus for longer periods. In fact, GERD may actually be a problem of overall gastric motility, meaning the stomach contents remain within the stomach longer than is necessary for digestive purposes.Additionally, among healthy people, reflux tends to occur primarily when they are upright, causing the back upped liquids to flow back into the stomach due to gravity. People with GERD, on the other hand, often experience reflux when they are lying down and while they are asleep. The back up of liquids that occurs at night usually results in acids remaining in the esophagus longer, potentially causing greater harm to the esophagus.

GERD can be caused by a variety of factors. These include being overweight and subsequent abdominal obesity (a waist circumference greater than 36 inches), overeating and eating heavy meals, drinking carbonated beverages, overconsumption of caffeine drinks, and the standard American diet (SAD). Pregnancy can also result in GERD due to the increased pressure that is placed on the abdomen by the developing fetus. Connective tissue diseases, such as scleroderma, can also cause GERD, as these conditons tend to weaken the esophageal walls. Another common cause of GERD is what is known as a hiatal hernia, which is actually not a hernia at all in the strictest medical sense of the word. A hiatal hernia refers to a slight "slippage" of the stomach wall above the diaphragm where the esophagus passes from the chest cavity into the abdominal cavity. While the opening in the diaphragm is anatomically necessary it is often less than perfect and therefore allows the stomach wall to slide up into the chest cavity. While up to 80 percent of people may have a hiatal hernia, they result in less than 30-40 percent of reflux symptoms. Conversely, however, the majority of GERD patients also have hiatal hernias.

In addition to regurgitation, the primary symptoms of GERD are heartburn and, in some cases, nausea. However, sometimes GERD can lead to other complications, such as chronic coughing, esophageal ulcers, difficulting swallowing due to the formation of scar tissue in the esophagus that can cause strictures, inflammation and infection of the lungs, and the buildup of fluid in the sinuses and middle ears. GERD can also result in a condition known as Barrett's esophagus, a precancerous condition that can often lead to esophageal cancer. Approximately ten percent of all cases of GERD result in Barrett's esophagus.

There are a number of ways in which your doctor can determine whether or not you have GERD. These include a physical examination of your esophagus, throat and larynx (usually in consultation with an ear, nost, and throat, or ENT, specialist), as well as various tests, such as endoscopy, esophageal acid testing, and esophageal motility testing.

Endoscopy is a common method used to screen for GERD. In this procedure, a tube to which a small cameralike device is attached is passed from the throat down into the upper gastrointestinal tract (esophagus, stomach and duodenum). AEndoscopy is useful for detecting inflammation and ulceration of the esophagus, as well as strictures and signs of Barrett's esophagus. It can also be used to determine if problems in the stomach or duodenum are causing GERD-like symptoms.

Esophageal acid testing is used to determine how long the esophagus contains acid. In this procedure, a small tube containing a sensor that detects acid is placed inside the esophagus. The other end of the tube is attached to a recorder worn around the waist. For a period of 24 hours, the test monitors the the amount of acid that is recorded in the esophagus during that time. A newer variation of this test involves attaching a small, wireless capsule to the lower esophagus, which measures acid levels for a period of 48 hours, transmitting its information to a receiver that is worn on the wrist. This information is then analyzed by computer.

Esophageal motility tests are used to determine the efficiency of the esophageal muscles. In this procedure, a thin tube containing a sensor device is placed inside the esophagus. The sensor first monitors the esophagus muscles at rest. The patient then sips a glass of water to stimulate contraction of the esophageal muscles, enabling the sensor to determine the muscles' motility.

As the incidence of GERD has increased in America, so to has the use of drugs known as proton pump inhibitors (PPI) to treat it. Perhaps the most well known PPI is Prilosec. PPIs work by suppressing the body's production of stimach acid (hydrochloric acid, or HCl). While Prilosec and other PPIs are clearly able to suppress stomach, research has found that they also can cause deficiencies of vitamin B12, which is important for a variety of functions in the body, including energy. PPIs can also increase the risk of osteoporosis, as well as osteoporotic hip fractures. Additionally, patients who need to be hospitalized are at increased risk for infection when PPI are used since HCl is necessary to kill bacteria that find their way into the stomach via mechanical ventilator tubing.

Therefore, rather than PPIs, I ask my patients to implement to take a more conservative approach, starting with simple lifestyle changes. These include avoiding overeating and minimizing their intake intake of foods that can trigger GERD symptoms, such as spicy foods, fried foods, coffee, tea, carbonated drinks, citrus juices, alcohol, whipped cream, milk shakes, peppermint, green and red peppers, and onion. You should also avoid lying down or bending over after eating. Also, don't drink too much during and after meals. For best results, eat small meals throughout the day, rather than the typical three-meal plan.

The use of certain nutritional supplements can also be helpful, including taking digestive enzymes before each meal. Aloe vera juice can help to relieve symptoms of GERD, and a multivitamin/mineral formula containing vitamin B complex can also be useful.

Additionally, when you sleep, be sure that your upper body is in an elevated position so that your chest cavity is above your stomach. This can help prevent acid from backing up into your esophagus while you sleep.

Finally, I often recommend that my patients with GERD add cimetidine (Zantac) to help relieve their symptoms. Cimetidine may in fact have novel anti-cancer properties, an added bonus in this case.

Before you do anything else, though, it's important that you consult with your physician to determine what is causing your symptoms.

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