- Gastroesophageal reflux disease
Gastroesophageal Reflux Disease (GERD, or GORD when
-oesophageal, the BE form, is substituted) is injury
to the esophagus that develops from chronic exposure
of the esophagus to acid coming up from the stomach
(reflux). In contrast, heartburn is the symptom of acid
in the esophagus, characterized by a burning discomfort
behind the breastbone (sternum). Findings in GERD include
esophagitis (reflux esophagitis) - inflammatory changes
in the esophageal lining (mucosa), strictures, difficulty
swallowing (dysphagia) and chronic chest pain. Patients
may have only one of those findings. Atypical symptoms
of GERD include cough, hoarseness, changes of the voice,
and sinusitis. Complicatons of GERD include stricture
formation, Barrett's esophagus, esophageal ulcers and
possibly even to esophageal cancer.
Occasional heartburn is common but does not necessarily
mean one has GERD. Patients that have heartburn symptoms
more than once a week are at risk of developing GERD.
A hiatal hernia is usually asymptomatic, but the presence
of a hiatal hernia is a risk factor for development
The most prominent symptom of GERD is heartburn, the
sensation of burning pain in the chest coming upward
towards the mouth caused by reflux of acidic contents
from the stomach to the esophagus.
Patients with GERD also tend to get the feeling of
a sour or salty taste at the back of their throats due
to regurgitation. This can sometimes happen even if
the pain of heartburn is absent.
Less common symptoms:
* Chest pain without any of the above
* Dysphagia (difficulty swallowing)
* Halitosis (bad breath)
* Regurgitation (vomit-like taste in the mouth)
* Repeated throat clearing
* Water brash (the sensation of a large amount of non-acid
liquid due to sudden hypersecretion of saliva)
* Strictures or scarring of esophagus (especially
* Barrett's esophagus (sometimes referred to as Barrett's
* Esophageal cancer
Important Warning symptoms:
* Trouble swallowing Dysphagia requires immediate
* Vomiting blood or partially digested blood (looks
like coffee grounds) requires immediate medical attention
as does digested blood in the stools.
GERD in Children
GERD is commonly overlooked in infants and children.
Symptoms may vary from typical adult symptoms. GERD
in children may cause repeated vomiting, effortless
spitting up, coughing, and other respiratory problems.
Inconsolable crying, failure to gain adequate weight,
refusing food and bad breath are also common. Children
may have one symptom or many - no single symptom is
universally present in all children with GERD.
Babies' immature digestive systems are usually the
cause, and most infants stop having acid reflux by the
time they reach their first birthday. Some children
don't outgrow acid reflux, however, and continue to
have it into their teen years. Children that have had
heartburn that doesn't seem to go away, or any other
symptoms of GERD for a while, should talk to their parents
and visit their doctor.
Avoiding aggravating factors
The rubric "lifestyle modifications" is the
term physicians use when recommending non-phamaceutical
treatments for GERD.
Certain foods and lifestyle tend to promote
* Coffee, alcohol, calcium supplements, and excessive
amounts of Vitamin C supplements are stimulants of gastric
acid secretion so avoiding these helps. Calcium containing
antacids such as TUMS (Calcium carbonate) are in this
* Foods high in fats and smoking reduce lower esophageal
sphincter competence so avoiding these tends to help
* Having more but smaller meals also reduces the risk
of GERD as it means there is less in the stomach at
any one time.
Advice generally given:
* avoid eating for 2 hours before bedtime
* elevate the head of the bed on 6 inch blocks. (Pillows
under the head and shoulders have been shown to be ineffective.)
* avoid sodas that contain caffeine
* avoid chocolate and peppermint
* avoid spicy foods like pizza
* avoid acidic foods like oranges and tomatoes
* avoid cruciferous vegetables: onions, cabbage, cauliflower,
broccoli, Brussel sprouts
* avoid fried and fatty foods
* avoid milk and heavily milk based products
Avoiding food for 2 hours before bedtime, as well as
not lying down after a meal, are the most important
of the lifestyle modifications. Elevation to the head
of the bed is the next easiest to implement. If pharmacologic
therapy in combination with food avoidance before bedtime
and elevation of the head of the bed, then the other
steps are recommended.