Encyclopedia of Diets - A Guide to Health and Nutrition

heart attack, the individual should seek medical atten-

tion immediately. Heartburn pain does not get worse

with physical activity, but often worsens when bend-

ing over or lying down. As noted above, heartburn is

extremely common. Almost everyone experiences it at

some time, usually after eating an unusually large or

spicy meal.

GERD also has less typical symptoms. Some peo-

ple regurgitate or involuntarily bring up the contents

of the stomach into the mouth. This causes a bitter

taste, and if it occurs often enough can erode tooth

enamel.

Other less typical symptoms are wheezing, short-

ness of breath, increased incidence of asthma, and a

persistent dry cough. GERD can also cause the per-

son’s voice to sound hoarse. Hoarseness is usually

worse in the morning. These symptoms are caused by

contents of the stomach approaching or enter the

airways.

Some people have difficulty swallowing or feel as

if the food they have eaten is stuck behind their breast-

bone. This symptom can also be caused by a narrow-

ing of the esophagus where it enters the stomach.

The most common symptoms of GERD in infants

and children are repeated non-projectile vomiting

(spitting up), persistent coughing, and wheezing.

Diagnosis

Often GERD is tentatively diagnosed on the basis

of the patient reporting heartburn twice or more a

week on a regular basis. Normally the physician will

suggest lifestyle changes (see treatment below), and if

there is no improvement will order more extensive

tests.

An upper GI series, sometimes called a barium

swallow, includes x rays of the esophagus, stomach,

and upper part of the intestine. Often the patient

drinks a solution of barium to improve contrast on

the x rays. These x rays help rule out abnormalities

such as a narrowing of the esophagus (esophageal

stricture) andulcers.

An upper endoscopy is a diagnostic procedure

that allows the physician to see the lining of the esoph-

agus and stomach. It is performed in a doctor’s office

or an outpatient clinic under light sedation. A tube

called an endoscope is inserted down the throat. At the

end of the endoscope is a tiny camera that allows the

doctor to see if there is damage to the cells lining the

esophagus. During this procedure, the doctor may use

also remove small tissue samples (a biopsy) from the

esophagus in order to look for abnormal cells under

the microscope.

Occasionally 24-hour pH monitoring is necessary.

The pH scale measures the strength of acids. In this

test, a tube put down the esophagus measures how

much stomach acid back up into the esophagus. Mon-

itoring usually for continues for 24 hours.

GERD is categorized according to the degree of

damage to the esophagus.

Grade I: redness and irritation of the esophagus

Grade II: some non-adjacent spots of erosion of

esophageal cells

Grade III: increased and continuous patches of

erosion

Grade IV: Barrett’s esophagus, a precancerous con-

dition in which normal cells are replaced by abnor-

mal ones.

Treatment

The goals of treating GERD are to eliminate

heartburn and other symptoms, heal damage to the

esophagus, and prevent return of symptoms. Treat-

ment proceeds in four stages: lifestyle changes, over-

the-counter remedies, prescription drug therapy, and

surgery.

Lifestyle changes are the easiest and least expen-

sive approach to treating GERD. They bring relief to

many people. Recommended lifestyle changes include:

Quitting smoking

If overweight, losing weight

Stopping drinking alcoholic beverages

Avoiding foods likely to cause heartburn

Avoiding eating at least 3 hours before going to bed

Elevating the head of the bed about 4 inches on

blocks or using a sloped piece of foam under the

mattress to raise the head 6 or more inches.

When lifestyle changes are not enough to relieve

symptoms within a few weeks, the next step is to use

over-the-counter medications. Antacids, such as Alka-

Seltzer, Maalox, Rolaids, or Tums, reduce the acidity

of liquid already in the stomach. Many antacids con-

tain aluminum andmagnesium. They should not be

taken regularly for long periods because theseminer-

alsmay disrupt the chemical balance in the body.

Drugs known as H2 blockers help reduce the pro-

duction of acid in the stomach. H2 blockers that are

available without a prescription include cimetidine

(Tagamet), ranitidine (Zantac), ranitidine (Zantac),

and nizatidine (Axid). Some of these are also avail-

able in higher strengths with a doctor’s prescription.

Gastroesophageal reflux disease