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April 21, 2000
Prevention and Primary Care - Elizabeth Smoots, M.D.

Grrrrr ... GERD

Mary, a patient of mine, had a burning sensation beneath her breastbone and a bitter taste at the back of her throat. The symptoms were familiar -- she had experienced them repeatedly over the years, especially following meals or when lying flat. "Grrrrr," she growled. "I want you to do something about this, doctor. It's making me awfully grouchy."

Like 95 million other Americans, Mary has telltale signs of an increasingly recognized form of indigestion called gastroesophageal reflux disease, or GERD. Periodic relaxation of the lower esophageal sphincter -- the gateway between your stomach and the long tube connecting it to your mouth, called the esophagus -- causes the condition.

Most people have occasional reflux, or backflow of acid and digestive juices from the stomach into the esophagus. But reflux occurs more often and lasts longer in people with GERD. Repeated bouts of reflux may damage the delicate lining of the lower esophagus, causing the signs and symptoms of the illness.

Recognizing GERD

For people like Mary, the condition means more than occasional discomfort or grouchiness. Surveys show lower quality-of-life scores for patients with GERD than for those with heart disease, ulcers, or diabetes. For GERD sufferers, the ability to function or enjoy life may become impaired by problems like these:

  • Heartburn -- a burning pain in the middle of your chest after meals. It usually radiates along your esophagus toward your throat and can be made worse by lying down, bending over, or straining. Although heartburn doesn't involve your heart, occasionally it's confused with the chest pain that is symptomatic of heart disease.
  • Regurgitation -- reflux of stomach acid through your esophagus into your throat, causing a bitter or sour taste in the back of your mouth.
  • Esophagitis -- inflammation of the lining of the esophagus from reflux of stomach acid. This may be complicated by ulcers, bleeding, or strictures (scar tissue that narrows the lower esophagus, making it hard to swallow).
  • Barrett's esophagus -- a precancerous condition of the esophagus created by ongoing exposure to stomach acid. Patients with Barrett's have about a 100-fold greater risk of developing cancer of the esophagus.
  • Other symptoms -- indigestion, nausea, vomiting, belching, bad breath, chest pain, ear ache, sore throat, difficult or painful swallowing, hoarseness, insomnia, coughing, choking, trouble breathing, or asthma.

Living with GERD

If you think you may have gastroesophageal reflux disease, consult with your health care provider. Many medical options are available today to halt the havoc wreaked by this aggravating condition. In addition, there are several steps you can take at home that may ease symptoms of GERD:

  • Stop smoking. Tobacco products promote acid reflux.
  • Lose excess weight. A low-fat diet can help reduce both heartburn and your weight.
  • Wear loose-fitting clothes that don't put pressure on your abdomen.
  • Avoid alcohol, caffeinated beverages, chocolate, and mint as well as fatty, spicy, or acidic foods (such as citrus or tomatoes).
  • Eat small, frequent meals four to six times a day. Large meals can upset your stomach.
  • Avoid exercising, bending over, or straining immediately after eating.
  • Don't eat or drink three to four hours before you lie down or go to bed.
  • Raise the head of your bed four to six inches by putting blocks under your bed frame.
  • Take time to relax when eating a meal. Eating on the run can trigger symptoms of GERD.

Related links:

Rx.magazine feature story: Indigestion: You Can't Believe You Ate the Whole Thing

Outside link: GERD Information Resource Center, sponsored by AstraZeneca LP (a pharmaceutical company)

Elizabeth Smoots, M.D., F.A.A.F.P., is a board-certified family physician in Seattle, Washington. A fellow of the American Academy of Family Physicians, Dr. Smoots specializes in prevention and primary care medicine.