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These are two very common gastrointestinal issues that millions of people suffer from. GERD and acid reflux are related but are not necessarily the same condition. Acid reflux happens when stomach acid backflows into the esophagus. You may have a sour taste in your mouth, feel a burning sensation in your chest, or taste food that is regurgitated if you suffer from reflux. Acid reflux is also called pyrosis, heartburn, or acid indigestion.
GERD is a more severe form of acid reflux. Heartburn is the most common GERD symptom, and others include; difficulty swallowing, food regurgitation, wheezing, coughing, and chest pain. The symptoms often worsen when you lay down. A diagnosis of GERD is given if your acid reflux happens more than two times a week.
Per the American College of Gastroenterology, more than 60 million Americans have heartburn once a month. As many as 15 million people experience it daily. It affects approximately 20-30 percent of the population in Western countries where it is most common.
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Dysfunction of the Lower Esophageal Sphincter
Despite having the name heartburn, acid reflux is not related to heart issues. It's when acid content backflows up into the gullet, or esophagus. This is what causes the regurgitation of food. To digest food and protect the body from bacteria and pathogens, the stomach uses hydrochloric acid. While the stomach is lined and protected from the strong acid, the esophagus is not.
Within the esophagus is the gastroesophageal sphincter or lower esophageal sphincter (LES). It functions as a valve that closes to prevent acid from backflowing into the esophagus. If the valve doesn’t work or relaxes incorrectly, it allows the contents of the stomach to flow right into the esophagus.
The severity of the condition depends on how dysfunctional the LES is. It also depends on the type of content that backflows from the stomach and how effective saliva is at neutralizing it. It is possible to control the acid flow, but you can still have problems from other stomach contents. Backflow of content other than acid can cause similar symptoms.
Heartburn Pain vs. Heart Problems
Heartburn is the most prominent symptom of acid reflux and GERD. It’s a burning pain that moves from the breastbone up to the throat and neck. People usually describe it as feeling like food is regurgitated into the mouth leaving a bitter or acid taste.
The pain can be intense and last for hours, depending on how serious the problem is. As mentioned above, sometimes it is mistaken for a heart attack, but the symptoms are slightly different. Heartburn is not as associated with exercise or physical activity while exercise may exacerbate heart problems. If you cannot tell the difference, call your doctor or 911 as soon as possible if you experience any chest pain.
Other Factors with GERD
Lifestyle and dietary choices certainly contribute to the severity of GERD. Several drinks and foods generate heartburn such as peppermint, chocolate, fatty and fried foods, alcohol, and coffee. Pregnancy and obesity also contribute to the symptoms of GERD.
Hiatal Hernia and GERD
Doctors and researchers think that hiatal hernias weaken the LES thus increasing a person’s risk of GERD. A hiatal hernia happens when the muscle between the abdomen and the chest (diaphragm) weakens allowing the stomach to bulge through into the chest. The diaphragm assists in supporting the lower part of the esophagus.
Some people with a hiatal hernia may never have reflux or heartburn. However, a hiatal hernia can allow reflux to occur more easily. Treatment isn’t always necessary for hiatal hernias. If it becomes twisted or strangulated it may cut off the blood supply to the intestines or stomach, or if it’s complicated by esophagitis or severe GERD, it may require surgery.
Lifestyle and dietary changes are the primary ways to treat GERD. Along with the foods listed above, you should also avoid citrus juices and fruits, pepper, and tomato products. Eating smaller meals is also advised as large meals trigger acid reflux symptoms. Try not to eat too close to bedtime. Doctors suggest eating at least two to three hours before you sleep. Since obesity is a contributing factor, losing weight could help with the severity of the symptoms.
Smoking also weakens the lower esophageal sphincter so quitting smoking is essential. It's also helpful to sleep on a wedge or something that props the head of your bed up 6-inches to reduce heartburn when sleeping. Using pillows only increases the pressure on your esophagus and stomach, so this is not a viable solution.
Your physician may also prescribe medicine or suggest over-the-counter remedies to reduce or neutralize the acid. Sometimes combining antacids with a foaming agent helps reduce reflux. The medications used are antacids, H-2 blockers, and proton pump inhibitors.
Proton pump inhibitors inhibit a specific enzyme required for acid secretion. These include Prevacid, Prilosec, Aciphex, Zegerid, Dexilant, Nexium, and Protonix. H-2 blockers inhibit the stomach’s acid secretion and include Zantac, Tagamet, Axid, and Pepcid.
Using antacids long-term has side effects like altered calcium metabolism, magnesium build-up, and diarrhea so just be aware of them. Patients with kidney disease may have serious problems with excessive magnesium. If you need to use antacids for over two weeks, consult your doctor.
Acid Reflux Surgery
Sometimes the acid reflux is so severe that surgery is the only way to relieve the symptoms. All other options should be tried first. Leave an operation as a last resort. A surgery called fundoplication helps by increasing the pressure in the lower part of the esophagus. There are also endoscopic procedures that use electrodes to promote scarring on the LES or help it function better.
Long-term Complications with GERD
Sometimes GERD causes severe complications. When there is too much acid, esophagitis occurs and can cause ulcers or bleeding. You can also develop scarring that narrows the esophagus. Another disease called Barrett’s esophagus can also develop and increases your risk of getting esophageal cancer later. Just remember if you have acute symptoms, consult your physician so that they can diagnose and monitor whatever is causing your acid reflux.