Gastroesophageal Reflux (GERD)

By Gilda Morales, ANP, DC

As many as 40% of adults in the United States report having the symptoms of gastroesophageal reflux disease, or GERD, what most people refer to as heartburn.  It is also a very common disease of infancy, affecting 50% of infants, usually by the age of 4 months, but the condition usually resolves by 12 months of age.

Most GERD is due to inappropriate relaxation of the lower esophageal sphincter that normally keeps food from coming back up from the stomach.  Certain foods are known to relax the sphincter, including fatty foods, spicy and acidic foods, coffee, nicotine, alcohol, and even some medications like Norvasc, a medication for high blood pressure.

There are other factors that contribute to GERD such as pregnancy, constipation, hiatal hernias and lying down or bending over.  Besides medical interventions, there are several preventive measures that can be effective in controlling GERD.  You should avoid spicy or greasy foods or drinks that can trigger attacks, stop smoking, avoid eating at least two hours before bedtime, and with infants, use of a car seat for two to three hours after meals.

The typical symptoms of GERD include heartburn and acid reflux, the feeling of fullness, pressure, pain or nausea, bloating and burping.  Occasionally, there may be other symptoms like a long-term cough, wheezing, hoarseness, sore throat, and erosion of the enamel on the teeth.  Usually, no lab testing is required to make the diagnosis, but patients should be concerned if there are other symptoms such as difficulty swallowing, bleeding, weight loss, vomiting, or if medication does not help after 4 to 8 weeks of treatment.

Treatment usually follows three phases.  Phase one is very conservative and includes lifestyle and diet changes, antacids, such as Tums or Rolaids, plus medications such as Zantac or Prilosec or Nexium.  Phase two involves advanced diagnostic procedures such as an endoscopy, and Phase three is surgical intervention.