Many individuals suffer from heartburn at least once a month and others more often. Symptoms of GERD are often controlled with modifications in lifestyle or medications but when they persist they may indicate a more serious condition and individuals should see their doctor.

What is Gastroesophageal reflux?
Gastroesophageal reflux (GERD) is a physical condition in which acid from the stomach flows backward up the oesophagus. Individuals will experience heartburn symptoms at some time during their life. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, which moves up toward the neck and throat. Frequent heartburn, that is more than two or more times a week, food sticking in the throat and weight loss may be associated with a more serious problem known as gastroesophageal reflux.

What causes GERD?
When you swallow, food passes down your throat and through the oesphagus to the stomach. A muscle called the lower oesphageal sphincter muscle controls the opening between the oesophagus and the stomach, and remains tightly closed except when you swallow food. When this muscle fails to close properly, the acid-containing contents of the stomach can travel back up into the oesophagus. This backward movement is called reflux. When that stomach acid enters the lower part of the oesophagus, it can produce a burning sensation commonly referred to as heartburn. Several factors may cause reflux. These include the following:
• The position of the body after eating (an upright posture helps prevent reflux)
• The size of the meal (smaller meals decrease reflux)
• The nature of foods eaten (certain foods and chemicals irritate the oesophagus or weaken the sphincter)

How is GERD treated?
In the vast majority of cases GERD can be controlled or treated by lifestyle changes. These lifestyle modifications include the following:
• Avoid foods and beverages that may contribute to GERD, e.g. greasy foods, alcoholic drinks, coffee, tea, fatty food, and spicy foods.
• Stop smoking
• Reduce weight especially if you are obese or overweight
• Do not eat 3-4 hours before going to bed
• Avoid bedtime snacks
• Eat moderate portions of food and smaller meals
• Wear loose belts and clothing

Some individuals may benefit by raising the head of their bed by six inches to allow gravity to help keep the stomach’s contents in the stomach. Individuals should, however, avoid using piles of pillows as this puts the body in a bent position that actually makes GERD worse due to increase pressure in the abdomen.

Many individuals will benefit from over-the-counter medications like antacids, but if symptoms persist you should see your doctor for a full evaluation which may involve looking down the oesphagus with a special instrument.
The vast majority of individuals with GERD can be successfully treated with appropriate medications and life style modifications. Surgery is seldom required to correct the sphincter.

Complications
When GERD is not treated, serious complications can occur. These include severe chest pain that can resemble a heart attack, narrowing of the oesphagus that can result in obstruction, bleeding and a pre-malignant condition called Barrett’s oesophagus.

Conclusion
Gastroesophogeal reflux affects many individuals but, fortunately, it can be controlled or treated with lifestyle modifications. In a few cases various medications are needed to relieve symptoms. Individuals with persistent symptoms of gastroesophogeal reflux should consult with their doctor for a full evaluation so that other more serious conditions can be ruled out.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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