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Gastroesophageal reflux disease (GERD) is a condition in which contents of the stomach or small intestine repeatedly move back up into the esophagus (the tube connecting the throat to the stomach). This backwards movement is called reflux. Reflux causes heartburn. Although most people have heartburn at some point in their lives, persistent reflux and severe heartburn may mean you have GERD. GERD is one of the most common gastrointestinal disorders.
Signs and Symptoms
Heartburn -- a burning sensation under the sternum in the chest -- is the primary symptom of GERD. Heartburn often happens after a meal and gets worse at night, when you are lying down. It is more likely to happen after a heavy meal, or if you bend, lift, or lie down just after eating.
Other symptoms of GERD include:
GERD is common in infants and young children, but is usually mild. If an infant has the following symptoms, call a doctor as soon as possible:
Normally when you swallow, the muscles in the esophagus move in waves to push food down into your stomach. Just after the food enters the stomach, a band of muscle (the lower esophageal sphincter, or LES) closes off the esophagus. If the muscle doesn’t close tightly enough or gets weak over time, the stomach contents can back up into the esophagus, causing heartburn and other symptoms of GERD.
Substances in the digestive juices from the stomach (such as acid, pepsin, and bile) can damage the inner lining of the esophagus. That can lead to ulcers (open sores), and, possibly, precancerous changes to cells (called Barrett's esophagus).
Any of the following may weaken the LES:
Some medicines can also weaken the LES. Among them are:
Children with the following conditions are at particular risk for GERD:
GERD is usually not hard to diagnose. Your symptoms, what you eat and drink, medications you are taking, and your lifestyle are usually enough to make a clear diagnosis. If your doctor is not sure, one or more tests may be performed:
Treatment is intended to reduce the reflux, stop the harmful effect by reducing stomach acid, improve the way food gets through to the stomach, and protect the walls of the esophagus.
For mild cases, lifestyle changes (such as avoiding certain foods) and by taking over the counter medication may be enough to reduce symptoms. Health care professionals may recommend herbs such as DGL-licorice (Glycyrrhiza glabra) for their soothing properties. Prescription medicines may be recommended also.
For moderate to severe cases, prescription medication may be needed, and your doctor will monitor you closely. In some cases surgery may be needed.
Changing certain habits can go a long way to relieving or preventing symptoms of GERD:
If you have more symptoms at night, these steps may help:
The main aim of drug treatment is to reduce stomach acid. Both prescription and over the counter drugs that reduce stomach acid are available. Your doctor will determine which medicine is best for you.
There are several types of medications used for GERD, and each works in a different way.
Over the counter antacids -- neutralize stomach acids. They include:
Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. It is recommended to take antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information.
Histamine H2 blockers -- block the production of stomach acid. They include:
Proton pump inhibitors -- work by suppressing molecules responsible for the release of stomach acid. They include:
Sucralfate (Carafate) -- makes a coating over an ulcer, protecting it from further damage.
Metoclopramide (Reglan) -- promotes movement of stomach acids along the gastrointestinal tract, rather than backing up into the esophagus.
Surgery and Other Procedures
For a small number of people, diet, medication, and lifestyle changes are not enough to relieve symptoms of GERD. In such cases, a surgical procedure called fundoplication may be done to prevent reflux and repair a hiatal hernia. As many as 90% of people who have had this operation report no longer having heartburn.
Nutrition and Dietary Supplements
Following these nutritional tips may help reduce symptoms:
The following supplements may help with digestive health:
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of GERD symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type - your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
GERD is common during pregnancy, particularly in the third trimester. In fact, the incidence in pregnant women exceeds 80 percent.
Warnings and Precautions
Contact your health care provider if the medication recommended does not help or if you experience side effects, such as cramping or diarrhea.
Prognosis and Complications
The acidic contents of the stomach can damage the esophagus, causing narrowing, ulcers, erosion, and precancerous changes to cells known as Barrett's esophagus. GERD can also result in respiratory diseases, ear, nose, throat conditions, and tooth decay. Most people can manage their symptoms with lifestyle modifications and medications.
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Review Date: 9/10/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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