How Can I Treat my GERD Symptoms?
Yazan A. Qwaider, M.D., is a gastroenterologist at North Colorado Medical Center.
Question: How serious is GERD and how can I control its symptoms?
Answer: The vast majority of patients with GERD will not develop serious complications, particularly when reflux is adequately treated.
A number of serious complications, however, can arise in patients with severe GERD. Some of the complications are esophageal ulcers formation, scaring and narrowing of the esophagus, lungs and throat problems such as asthma. Barrett’s esophagus, which is changing in the cell linings of the esophagus, is by itself a risk for esophageal cancer. Unfortunately, esophageal cancer is on the rise in the United States and many other countries. However, only a small percentage of people with GERD will develop Barrett's esophagus and an even smaller percentage will develop esophageal cancer.
GERD is treated according to its severity. Initial treatments for mild reflux include dietary changes and using non-prescription medications, including antacids or histamine type 2 receptor antagonists. Antacids are commonly used for short-term relief of acid reflux. However, the stomach acid is only neutralized very briefly after each dose, so they are not very effective. The histamine antagonists reduce production of acid in the stomach.
Lifestyle modifications such as weight loss and elevation of the head of the bed avoiding large and late meals may be helpful in some, but not all people with mild symptoms of reflux. Lying down with a full stomach may increase the risk of reflux. By eating three or more hours before bedtime, reflux may be reduced. In addition, eating smaller meals may prevent the stomach from becoming overdistended, which can cause reflux.
Other helpful lifestyle changes include:
- Avoid reflux-inducing foods. Some foods also cause relaxation of the lower esophageal sphincter, promoting reflux. Excessive caffeine, chocolate, alcohol, peppermint, and fatty foods may cause bothersome reflux in some people.
- Quit smoking. Saliva helps to neutralize refluxed acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. Quitting smoking can reduce or eliminate symptoms of mild reflux. Chewing gum or using lozenges can increase saliva production, which may help to clear stomach acid that has entered the esophagus.
- Avoid tight-fitting clothing. At a minimum, tight fitting clothing can increase discomfort, but it may also increase pressure in the abdomen, forcing stomach contents into the esophagus.
In cases of moderate to severe symptoms, your provider may prescribe an even stronger group of acid-reducing medications called Proton pump inhibitors.
If symptoms of GERD are not adequately controlled with one Proton Pump Inhibitor, one or more of the following may be recommended:
- An alternate PPI may be prescribed or the dose of the PPI may be increased
- The PPI may be given twice per day instead of once
- Further testing may be recommended to confirm the diagnosis and/or determine if another problem is causing symptoms
- Surgical treatment may be considered. The most common surgical treatment is the laparoscopic Nissen fundoplication. This procedure involves wrapping the upper part of the stomach around the lower end of the esophagus. This minimizes reflux. Although the outcome of surgery is usually good, complications can occur. Examples include persistent difficulty swallowing (occurring in about 5 percent of patients), a sense of bloating and gas, breakdown of the repair (1 percent to 2 percent of patients per year), and uncommonly, or diarrhea due to inadvertent injury to the nerves leading to the stomach and intestines.
Your health care provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.