GERD – My stomach hurts, and burns are a prevalent complaint in our clinic. You will be surprised at the number of people who complain of GERD, heartburn -upper abdomen pain – reflux -burning in their abdomen. I see more than twenty patients with these complaints every week, more than half Latinos.
As we prepare for the holiday season that starts in November with Thanksgiving and continues through January Day of the Three Kings, I want to discuss gastroesophageal reflux disease (GERD). It is a time when we overindulge in rich traditional holiday foods and imbibe in alcohol and plain overeating.
What is heartburn?
Heartburn – is a burning pain in your upper abdomen and chest. Often worse after eating, in the evening, lying down, or bending over – stomach acid refluxes the esophagus. Usually, when you swallow, a band of muscle around the bottom of your esophagus relaxes to allow food and liquid to enter your stomach. Then the muscle acts as a valve and tightens again. When this esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back into your esophagus (acid reflux) and cause heartburn.
Symptoms:
- Burning feeling (heartburn) in abdomen and chest that can radiate to throat and neck.
- A sour, bitter, or lousy taste back of the mouth.
- Regurgitation of food or acid
- Difficulty swallowing – bloating – belching – lump in the throat – nausea
- Cough – wheezing – sore throat – hoarseness.
Risk Factors include:
- Hiatal hernia
- Obesity
- Alcohol use
- Tobacco use
- Pregnancy
- Connective tissue disorders
- smoking
- eating large meals or skipping meals
- lying down or going to sleep shortly after eating
- using NSAIDs such as aspirin or ibuprofen
- deep-fried or high-fat foods
- spicy foods
- chocolate
- citrus fruit
- pineapple
- tomato
- onion
- garlic
- mint
- drinking certain kinds of beverages, such as soda, tea, coffee, or alcohol
Treatment
Lifestyle changes are first-line interventions: and can help ease heartburn: GERD.
Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid back into your esophagus.
- Avoid stooping, bending, and tight-fitting garments, which puts pressure on your abdomen.
- Avoid foods that trigger your heartburn. Avoid lying down after a meal. Wait at least three hours.
- Avoid late meals. Avoid meals 2 to 3 hours before bedtime.
- Elevate the head of your bed.
- Avoid smoking and alcohol.
- Avoid large meals. Instead, eat many small meals throughout the day.
MEDICATION
Over-the-counter medications:
- Antacids, help neutralize stomach acid. Antacids may provide quick relief. But they can’t heal an esophagus damaged by stomach acid.
- H-2-receptor antagonists like ranitidine twice a day or famotidine twice a day can reduce stomach acid. These don’t act as quickly as antacids but may provide more extended relief.
- Proton pump inhibitors, like Prevacid and Nexium or Prilosec OTC, also can reduce stomach acid. These have effective onset within four days and should be taken 30 to 60 minutes before meals.
- See your doctor if over-the-counter treatments don’t work or if you rely on them often. You may need prescription medication and further testing.
Prescribed Medications:
- H-2-receptor antagonists
- Proton pump inhibitors
- Barrier agents like sucralfate 1 hour before meals and at bedtime for 4 to 8 weeks may relieve breakthrough symptoms.
If these do not work, further testing may be required.
Remember that first is lifestyle changes.
