Gastroesophageal Reflux Disease (GERD)
It is suspected or has been determined that you have esophagitis due to gastroesophageal reflux. This is a condition in which the valve between your stomach (the gaster) and your esophagus (the tube that carries food from your mouth to your stomach) is malfunctioning. Acid from your stomach "refluxes" back into your esophagus causing irritation (the "itis").
This condition can cause the symptoms of upper abdominal or chest pain, heartburn, trouble swallowing, regurgitation of food and acid or episodes of choking from acid getting into the lungs. If left untreated, this can cause ulcers, bleeding, narrowing and blockage, or rarely, cancer of the esophagus.
Diagnosis of reflux is usually made by endoscopy (looking into the esophagus with a flexible scope and taking small biopsies), by special X-rays, or by other special studies.
Commonly this problem is blamed on a hiatal hernia. This is NOT correct. Many people with hiatal hernias have no problems at all. Many people who have reflux do not have hiatal hernias. However, people who have both a hiatal hernia and reflux tend to have more difficulty controlling their symptoms.
We all sometimes have symptoms of reflux, especially after overstuffing our stomachs, such as on Thanksgiving Day. Only those people who have frequent symptoms, or are developing complications from their disease need treatment.
The initial treatment consists of:
1) eating three meals a day, without overeating.
2) avoiding eating within a few hours of lying down.
3) elevating the head of your bed by four to six inches with bricks or wooden blocks. This will not work with a water bed! As an alternative DO NOT use more than one pillow to elevate your head, as this actually makes things worse by causing you to bend in the abdomen and increase pressure on your stomach. If you can not elevate your bed, you can sleep on a wedge that elevates your entire upper body down to your waist.
4) avoiding alcohol.
5) avoiding foods that contain chocolate, mint, or are high in fat.
6) avoiding any foods that increase the symptoms, such as citrus juices, tomato products and caffeine. You can usually resume your normal diet as healing occurs.
7) weight reduction to your ideal body weight.
8) avoiding tobacco products.
Many people will find relief with these nonmedical measures.
Some people will need medication. These include:
1) antacids like Gaviscon(which has alginic acid or sodium alginate); two tablets or Tablespoons after meals and at bedtime. Mylanta or Maalox type antacids do not work as well for this disorder.
2) Zantac, Pepcid, Tagamet, Axid, Nexium, Prilosec and other medications of these classes which decrease the amount of acid produced in the stomach.
3) Carafate, which coats the irritated lining of the esophagus. These tablets need to be dissolved in an ounce of liquid before drinking them.
4) Reglan or Metaclopramide, which makes the stomach empty quicker and increases the strength of the valve. This should be used only short term.
Not everyone will need all of these medications. Most people with reflux will need some form of treatment for the rest of their lives, usually antacids and the nonmedical treatments. Occasionally, someone may have their symptoms go away after an initial course of treatment.
Rarely, if symptoms persist despite medication, or if complications occur, surgery may become necessary.
The key to success is working with your doctor who will tailor your treatment to your individual needs. Let him know of any changes in your condition to prevent complications that may require surgical treatment.