Gastroesophageal Reflux (GERD)
Gastroesophageal reflux causes a burning sensation in the lower part of the oesophagus (the duct that transports food from the mouth to the stomach). Reflux occurs when gastric fluids (gastric acid and digestive enzymes) go back up in the oesophagus.
The role of the muscle (sphincter) that separates the oesophagus from the stomach is to keep the stomach’s fluids from going back up the oesophagus. When this sphincter becomes relaxed, gastric secretions are able to go back up the oesophagus. While the stomach has a mucosal barrier designed to resist acid secretion, the oesophageal mucosa is more fragile and becomes easily irritated by contact with these secretions. This irritation is responsible for heartburn. Other symptoms can occur, such as pain or discomfort in the stomach or the chest, nausea, cough, hoarse voice.
What causes gastroesophageal reflux?
Certain medical conditions, such as pregnancy or hiatus hernia, make it easier for reflux to occur because they induce additional pressure on the stomach. A hiatal hernia is an anatomic anomaly characterized by the protrusion of a part of the stomach in the thorax through the diaphragm. This disorder, still poorly explained, can be caused by a congenital malformation of the diaphragm, a trauma, or increase in abdominal pressure, particularly caused by obesity, pregnancy, or chronic constipation. Generally asymptomatic, a hiatal hernia can sometimes aggravate gastroesophageal reflux and result in inflammation of the esophagus (esophagitis).
This kind of reflux cannot be prevented. However, reflux can be the result of many other, often preventable, factors, such as drugs that delay stomach emptying or that decrease the tonus of the lower oesophageal sphincter. These factors increase the reflux of acid content into the oesophagus. Certain nutrients, foods of lifestyle habits can also be involved.
Foods or nutrients to avoid:
- alcohol and soft drinks;
- caffeine (chocolate, tea, coffee, cola drinks…);
- high-fat or spicy foods;
- citrus fruit (orange, grapefruit) and tomato juice
Lifestyle habits to monitor:
- Stop smoking;
- Try to eat and drink more slowly;
- Eat smaller and well-balanced meals;
- Try sleeping on your left side, with your head elevated by 15 cm;
- Avoid very tight clothing;
- Do not lie down after a meal;
- Do not eat very cold or very hot foods;
- Avoid strenuous workouts of efforts after a meal;
- Try to lose those extra pounds;
- Try to reduce your stress level and to promote relaxation.
Certain drugs can delay the emptying of the acid content of the stomach or even cause reflux.
Talk to your pharmacist or doctor if you take drugs or herbal products
How is gastroesophageal reflux treated?
There are four types of drugs used to treat reflux problems:
- Antacids, which temporarily neutralize gastric acidity.
- Alginic acid, which forms a foam barrier in the stomach stopping its content from going back up the oesophagus.
- Drugs that speed up digestion, making food and gastric acids reach the intestine more rapidly.
- Drugs that reduce acid production in the stomach.
Antacids, alginic acid and certain other drugs are available without a prescription, but other more potent drugs require medical supervision.
Each treatment should be tailored to the patient’s needs, especially since there are numerous causes of reflux and people often react differently to medication. To maximize your treatment’s efficacy, drugs should be taken in a specific manner and at specific times, even those available without a prescription. Do not hesitate to seek advice from your pharmacist: he is the most knowledgeable health professional when it comes to medication.
In the case of severe lesions of the esophagus or intolerance to medications, a surgical operation may be performed. Completed under general anesthesia, fundoplication consists in folding the upper part of the stomach to form a sleeve around the lower end of the esophagus. The operation may cause temporary difficulty swallowing and a feeling of distension in the stomach. In 85% of cases, it completely eliminates gastroesophageal reflux.
You should seek medical attention if:
- your symptoms impair your daily activities or occur more than three times a week;
- lifestyle modifications do not improve your symptoms;
- OTC drugs taken regularly for a maximum of 2 to 4 weeks did not relieve your symptoms.
- persistent digestive problem first occurring after the age of 50;
- unexplained weight loss;
- chest pain spreading to the back, neck, jaw, shoulder, left arm (signs of a heart problem);
- pain or difficulty swallowing;
- persistent pain after meals and during the evening;
- severe or prolonged vomiting;
- black stools or vomiting blood;
- no more relief of pain when taking a drug that used to bring relief.