Safeguarding against GERD

September 14, 2010 By Rosalind U. van Stolk, M.D.

Nearly half the adult population gets occasional heartburn. Most of us find relief by taking a pink liquid or tablet from the medicine cabinet … and swearing off coffee. But for millions of Americans, heartburn is a daily ailment, marked by burning chest pain, difficulty swallowing, stomach pain, sore throat, hoarseness, weight loss and abdominal distress.

Left untreated, this condition, termed gastroesophageal reflux disease (GERD), can scald tender throat linings with stomach acid that backs up (refluxes) into the throat. Most GERD patients have a weak sphincter — the flap at the bottom of the swallowing tube (esophagus) — that doesn't seal tightly enough to contain stomach acid. In some cases, GERD can lead to more serious disorders including scarring, making swallowing more difficult; as well as changes in the lining cells, known as Barrett's esophagus, which can increase the risk of esophageal cancer developing. The good news is that in nine out of every 10 cases, physicians can treat GERD effectively.

How to fight back
Thankfully, GERD can be managed quite well. In fact, many patients enjoy long-lasting relief from its misery. If you suffer from its symptoms, don't put off a visit to your doctor. A routine exam and a course of acid-blocking medicine often is all it takes. You can take some preventive measures, too, if your GERD is mild enough to treat on your own, such as:

• Avoid foods that cause reflux: coffee, chocolate, fatty or spicy foods, soda, mints, and citrus products.
• Eat smaller meals at times that are more frequent. Eat dinner at least three hours before bedtime. Do not lie down immediately after eating.
• Sleep with your head at least six inches higher than your feet to keep acid from refluxing. Use blocks to raise the bed frame or a foam wedge under your pillow.
• Avoid alcohol.
• Lose both the extra weight and the tight clothes that put pressure on the abdomen.
• Stop smoking. If you smoke, GERD is another reason to quit: Tobacco weakens the sphincter.

Endoscopy
Endoscopic procedures evaluate more difficult and persistent GERD cases. Doctors can explore the affected area with an endoscope, a miniature camera device that can also take tissue samples.

Newer procedures place either stitches or tiny cuts on the sphincter, leaving scar tissue that firms and toughens the passageway into the stomach. Lasers and other treatment through the endoscope may be used to burn away the abnormal cells of Barrett's esophagus, so the esophagus can heal.

Hiatal hernia and surgery
Another test, the barium swallow radiograph, provides an X-ray outline of the esophagus, which can detect hiatal hernia, a condition wherein the top of the stomach slides through the diaphragm into the chest. The standard surgical procedure, called Nissen fundoplication, wraps excess stomach tissue around the end of the esophagus to act as a surrogate sphincter.

Gastroenterologist Dr. Rosalind U. van Stolk is a member of The Hospital of Central Connecticut medical staff. For referrals to HCC physicians, please contact our free Need-A-Physician referral service by phone 800.321.6244.