GERD & Heartburn Support Group

Heartburn is the major 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, chronic ear ache, or sinusitis. Complicatons of GERD include stricture formation, Barrett's esophagus, esophageal ulcers and possibly even lead 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 of GERD.

GERD may be difficult to detect 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. The term "lifestyle modifications" is the way physicians recommend non-pharmaceutical treatments for GERD. A 2006 review suggested that evidence for most dietary interventions is anecdotal; only weight loss and elevating the head of the bed were found to be supported by evidence.

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

* Coffee, alcohol, calcium supplements, and excessive amounts of Vitamin C supplements are stimulants of gastric acid secretion. Taking these before bedtime especially can promote evening reflux. Calcium containing antacids are in this group.
* Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help, as well. Fat also delays emptying of the stomach.
Having more but smaller meals also reduces the risk of GERD, as it means there is less food in the stomach at any one time.
* 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 soft drinks that contain caffeine
* avoid chocolate and peppermint
* avoid spicy foods
* avoid acidic foods like oranges and tomatoes(okay when fresh.)
* avoid cruciferous vegetables: onions, cabbage, cauliflower, broccoli, Brussels sprouts
* milk and milk-based products contain calcium and fat, so should be avoided before bedtime.

Avoiding food for 2 hours before bedtime and not lying down after a meal are frequently recommended lifestyle modifications.

Elevation to the head of the bed is the next-easiest to implement. If one implements pharmacologic therapy in combination with food avoidance before bedtime and elevation of the head of the bed over 95% of patients will have complete relief. Additional conservative measures can be considered if there is incomplete relief. Another approach is to advise all conservative measures to maximize response.

Elevating the head of the bed can be accomplished by using blocks as noted above ("cinderblocks" commonly available at hardware stores in the United States are the lowest cost solution) or with other items: plastic or wooden bed risers which support bed posts or legs, a bed wedge pillow, or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be within the range of 6 to 8 inches in order to be as effective as possible in hindering the backflow of gastric fluids. Elevating the bed is also known as "positional therapy".

A number of drugs are registered for the treatment of GERD, and they are among the most-often-prescribed forms of medication in most Western countries. They can be used in combination with other drugs, although some antacids can impede the function of other medications:

* Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase the pH). Alginic acid may coat the mucosa as well as increase the pH and decrease reflux.
* Gastric H2 receptor blockers such as ranitidine or famotidine can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients.
* Proton pump inhibitors such as omeprazole are the most effective in reducing gastric acid secretion, as they stop the secretion of acid at the source of acid production, i.e. the proton pump. To maximize effectiveness of this medication the drug should be taken a half hour before meals.
* Prokinetics strengthen the LES and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing Long QT syndrome.

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. The long term outcomes of both procedures compared to a Nissen fundoplication are still being determined.

Another treatment which involved injection of a solution that is injected during endoscopy into the lower esophageal wall was available for approximately one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.

Some people have found success using dietary change to treat their own acid reflux.