Steamboat Springs "It happens to almost everyone at one time or another. You bend over to tie your shoes, and stuff from your stomach washes into your mouth," says John Sharp, M.D., gastroenterologist with Yampa Valley Medical Associates. "But if this happens on a regular basis, and you have other symptoms that cause you distress like heartburn, chest pain or painful swallowing, you may be experiencing gastroesophageal reflux disease, or GERD."
GERD, a relatively new term, has been referred to in the past as simply "reflux" or "reflux esophagitis," but it has in essence been around since the advent of heartburn.
Food travels from your mouth to your stomach through your esophagus. Normally when you swallow, the "gate," or sphincter, at the end of your esophagus opens to allow matter to pass. However, the lower esophageal sphincter can either be weakened or can completely relax at inappropriate times to allow leakage. When that happens, acid contents from the stomach wash up into the esophagus. Because the tissue in the esophagus is not designed to tolerate such high acid levels, pain can occur behind the breastbone and up the neck and throat, producing heartburn symptoms.
On a chronic basis, this backwash can damage tissue. "Ongoing damage can cause scar tissue to form and result in narrowing of the sphincter. This can cause food to get stuck," Sharp said. "Repeated exposure to stomach acids can also cause tissues to bleed. Ulceration of the tissue can cause intractable pain, usually in the center of the chest."
If the damage extends up into the throat, chronic sore throat can occur, and if the acid moves down into the lungs, shortness of breath, wheezing and cough can result. This is particularly common in people who experience reflux during the night.
Of the estimated 7 million people in the United States who suffer from GERD, most are between the ages of 45 and 64. Sharp said 40 percent experience some reflux symptoms that are managed with over-the-counter medications. Another 20 percent suffer significantly and require maintenance medications. Sharp suggests trying lifestyle changes initially to control the problem.
"Primarily, management consists of weight loss, smoking cessation, reduction of alcohol intake and raising the head of the bed with 6-inch blocks," he says.
Dietary changes can be helpful. Fried and fatty foods, chocolate, coffee and peppermint can increase symptoms. However, the GERD Web site, www.gerd.com, cautions against enforcing too many food restrictions unless you have noticeable problems when those foods are consumed. Keeping a diary can help to track a pattern in symptoms caused by foods or activities, such as lying down too soon after eating. Medications, especially those for pain and heart conditions, can also cause symptoms. When lifestyle changes are not enough, helpful prescription medications can be taken.
Another option is endoscopy, the passage of a small tube with a video camera into the patient's esophagus and stomach. Sharp feels that any patient older than 35 years of age who has experienced GERD for 10 or more years should undergo endoscopy to check for evidence of pre-malignant changes called Barrett's esophagitis.
These changes can result in a higher risk of esophageal cancer and can be detected by biopsy during endoscopy. In addition, several diagnostic tests and studies can be helpful in some cases, both to establish the diagnosis in questionable cases of chest pain and to determine the extent of esophageal function in preparation for more vigorous treatment, including surgery.
Three other options available for severe GERD patients include a surgical improvement of valve function, application of controlled radiofrequency radiation to the lower esophagus and upper stomach, and internal stitching that tightens the valve.
These latter two outpatient procedures are gaining popularity since being released by the Food and Drug Administration a year ago.
Sharp characterizes these three procedures as very safe. Each has produced excellent results for patients with intractable GERD symptoms, strictures or Barrett's esophagus. The surgical procedure has the longest track record, but the two other less-invasive procedures will gain in popularity as training and experience increase among gastroenterologists, Sharp predicts.
While GERD is not a curable disease, incorporating lifestyle changes can reduce symptoms and prevent complications. Anyone who has more severe symptoms should discuss treatment options with a physician. With appropriate diagnosis and the right kind of care, GERD can be a medical situation that is much easier to swallow.
Carrie Burggraf, P.A., is a physician assistant and wellness counselor for the Yampa Valley Health Plan.