It's not unusual to occasionally experience reflux after eating a large meal. When you start to feel that uncomfortable, burning feeling a few times per week or with more concerning symptoms, there could be a more serious suspect: gastroesophageal reflux disease (GERD).
This disease affects an estimated 20% of the U.S. population. While GERD is common and feels like heartburn, it can cause troublesome symptoms or complications down the road without treatment.
General surgeon Naga Thatimatla, MD, FACS, FASMBS, says, "people at any age, even children, can experience GERD. However, obesity, smoking, hiatal hernia, anxiety and even depression can increase one's risk." Learn more about GERD, its symptoms and treatment options.
Understanding GERD
"GERD occurs when your stomach's contents back up into the esophagus, the muscular tube that carries food from your mouth to your stomach," explains Dr. Thatimatla, "when the lower esophageal sphincter — the muscular ring that separates the esophagus from your stomach — becomes weak and relaxes when it shouldn't, symptoms of GERD may surface."
While this may occasionally happen for some people, for others, GERD is a chronic condition that requires consistent lifestyle modifications and medication.
Symptoms of GERD
Common symptoms of GERD include heartburn (burning sensation behind the breastbone), regurgitation (where acid and or food comes up from the stomach into the mouth) and epigastric pain. Less common symptoms are chest pain, nausea, difficulty swallowing and painful swallowing.
"These symptoms are common, so don't be alarmed if you have one or two of these on occasion," says Dr. Thatimatla. But if you are experiencing these symptoms two or more times a week (especially difficulty or painful swallowing, bleeding or significant weight loss) and/or you're over age 50, it's important to let your doctor know right away.
"GERD should be treated because too much stomach acid in the esophagus can result in inflammation, acid scarring and strictures that can cause the lower end of your esophagus to narrow, making it difficult to swallow." It also may lead to a condition called Barrett's esophagus, where the cells of the tissue lining the esophagus change abnormally and can lead to cancer.
Diagnosing and Treating GERD
"If the patient is 50 or older and has "alarm symptoms," such as difficulty swallowing, pain when swallowing, weight loss, vomiting of blood or blood in their stool, it's important to do more testing to ensure the symptoms are not related to something more serious, like a malignancy," cautions Dr. Thatimatla. However, most patients can begin lifestyle modifications and medications to treat GERD right away.
Lifestyle, especially your diet and body weight, can make a big impact in improving your GERD symptoms. If a patient does not have alarming symptoms and their symptoms are not so troublesome, it's often preferred to try lifestyle modifications first, before medications.
Some of these lifestyle modifications that can help reduce the symptoms of GERD include weight loss, elevating the head while sleeping, avoiding heavy meals two to three hours before bedtime and avoiding high-fat foods, chocolate, peppermint, carbonated drinks and caffeine. If you have GERD, making these changes for life goes a long way to help manage symptoms and improve your quality of life.
When it comes to the medical management of GERD, there are very effective, well-studied medications available.
Medications in GERD Treatment
The first line of medical treatment for GERD is proton pump inhibitors (PPIs).
"PPIs treat the symptoms of heartburn caused by GERD by blocking the stomach's ability to produce too much acid. These medications are often quite successful," explains Dr. Thatimatla. Between 40 to 90% of patients with GERD respond to PPI treatment — a very high response rate — and many patients benefit from these medications when taken appropriately. This includes taking the PPI consistently every morning for 30 minutes before eating anything.
Your doctor can help determine the best treatment plan for you, combining lifestyle changes with PPI treatment and evaluating the results down the road.
Surgical GERD Treatment
Surgery may sometimes be a better option than medications, especially if you are diagnosed with a hiatal hernia since they cannot be repaired by medications. As GERD can be a lifelong problem, people who qualify for surgery may find it an alternative to medical therapy. Many of these procedures are minimally invasive, too, being performed laparoscopically. Learn more about our approach and get the help you need to treat GERD here.
