Don’t let this condition interfere with enjoying the holiday season.
Gastroesophageal reflux disease (GERD) is a chronic digestive disease that affects millions of people every year. Its symptoms, such as heartburn and indigestion, can interfere with not only what we eat and drink, but our lifestyle in general. Knowing how to combat this treatable disease at home and when to seek further treatment are key to keeping it at bay.
Reflux is natural; we all reflux about 4-5 percent of what we eat or drink in a 24-hour period in some way. A good belch after a big meal is reflux. GERD comes into play when a patient has frequent indigestion or burning sensations in the chest or upper abdomen that extends into throat. This might occur most when someone is lying down or even bending over.
More advanced symptoms of the disease include difficulty swallowing, feeling like foods are getting hung up in the throat, or choking sensations. Hiatal hernias — a condition where part of your stomach pushes upward through your diaphragm — can also be frequently seen with reflux
disease. Large hiatal hernias that might need an operation to repair are much more common
in the 7th, 8th or 9th decades of life. There are also a whole litany of esophageal symptoms that can be associated with reflux disease including cough, shortness of breath, asthma and recurrent laryngitis, but these are on a case by case basis.
There’s nothing specific that makes people predisposed to GERD; there is no link to any kind of genetics. But we are seeing more people with the disease likely due to the obesity epidemic in our country. Excess weight around the torso causes more pressure on the stomach and a greater chance for reflux.
While overeating certainly can increase your likelihood of regurgitation, the majority of people with reflux disease have it day and night, so it’s not necessarily associated with diet. However, large meals will cause those with GERD to experience more symptoms, and acidic foods, such as citrus-and tomato-based meals, are usually not well tolerated.
In most cases, symptoms of GERD can be controlled easily with medication and weight loss. If you’re just having heartburn or regurgitation without weight loss, or difficulty swallowing,
or bleeding, it’s probably fine to start with any of the over-the-counter medications to help with symptom relief. There are three drug classes that are used to treat reflux disease.
These over-the-counter solutions are very good at immediate relief, but they are not good maintenance drugs if you are having these symptoms frequently.
Histamine H2-receptor antagonists
These are generally very safe drugs with no known side effects. They are beneficial for the majority of people at reducing the amount of acid production in their stomach or controlling the heartburn from acid regurgitation.
Proton pump inhibitors
There are probably 10 different proton pump inhibiting drugs on the market right now, and they are very effective against reflux disease.
As with all medications, be sure to thoroughly discuss these options with your physician. There is some evidence that proton pump inhibitors might cause long-term side effects, and not all treatment plans are appropriate for everyone. The good news for patients suffering from GERD is, the majority of sufferers will have their heartburn symptoms controlled with medications. I recommend treatment on these medications for 6-8 weeks. If you stop the medication after that time and the symptoms are gone, then you’ve healed the esophagitis, and you can stop the medications. If you continue to have symptoms, my personal advice would be to discuss them with your physician and talk about the possibility of undergoing further evaluation.
There are the options in extreme cases for surgical treatment, but I typically only operate on patients who are refractory to medical therapy. I recommend everyone trying non-operative therapy for at least 3 months prior to surgery.
Everyone deals with reflux from time to time, but it shouldn’t be inhibiting or slowing down your life. If you think you are one of the millions of people that are being plagued by GERD, talk to your doctor about treatment options and what medications are right for you.
Michael D. Holzman, M.D., M.P.H., is a Professor of Surgery at Vanderbilt Medical Center. Dr. Holzman received his M.D. degree from Bowman Gray School of Medicine in Winston-Salem, North Carolina in 1988 and his training in General Surgery at Vanderbilt Medical Center in 1995. He pursued additional training in minimally invasive surgery at Duke University Medical Center, which he completed in 1996 and completed his Masters in Public Health at Vanderbilt University in 1999. He is active with the Society of American Gastrointestinal Endoscopic Surgeons, the Southeastern Surgical Congress and the American College of Surgeons.