Ugh…heartburn again? If that’s your mantra after meals or as you fall asleep, you may have gastroesophageal reflux disease (GERD).
In GERD, the valve between your lower esophagus and stomach weakens. This sometimes lets food and stomach acids to back up into your esophagus. The result is usually a burning sensation behind the breastbone, or heartburn. But GERD can also cause other symptoms: hoarseness, chest pain, a dry cough, the sensation that food is caught in your throat.
A problem for all ages
GERD can develop at any age — during infancy, adolescence, adulthood or late in life. It isn’t caused by your genes, your race or your job.
The problem is that, if your GERD isn’t treated, it can cause long-term problems. Sores and scarring in the esophagus can make swallowing difficult, and the risk of esophageal cancer increases, notes Cleveland Clinic thoracic surgeon Siva Raja, MD, PhD.
Fortunately, there are many ways to relieve symptoms. The first step is to make some changes in your eating habits and lifestyle.
- Shed extra pounds. If you are overweight, the extra fat can push up on your stomach, forcing acid back into the esophagus. “Obesity can also cause the valve between your esophagus and stomach to open when it shouldn’t, resulting in more reflux,” notes Cleveland Clinic gastroenterologist Scott Gabbard, MD.
- Quit tobacco. Nicotine from cigarettes or chewing tobacco can weaken the muscle between your stomach and esophagus. Quitting smoking has been shown to improve GERD symptoms.
- Sleep on an incline. “Using an incline wedge pillow can reduce GERD at night,” says Dr. Gabbard. “Placing blocks under the head of the bed may also help GERD symptoms.”
- Allow for breathing room. Wear clothes that fit well and don’t dig into your waist. Anything that puts pressure on your abdomen — body slimmers included — can force acid from your stomach into your esophagus.
Tips for eating with GERD
- Don’t lie down afterward. “Make sure that you remain upright for at least two hours after all meals,” advises Dr. Gabbard. And stop eating at least two hours before bed. This gives your stomach a chance to empty so that acid won’t wash into your esophagus.
- Steer clear of foods that trigger your heartburn. Everyone has certain foods that worsen their heartburn symptoms. Chocolate, coffee, citrus fruits, tomatoes, alcohol and fatty foods are common triggers. Keep a food journal for a while if you aren’t sure which foods are your triggers.
- Eat small meals, slowly. Eating too much or too fast can force acid from your stomach into your esophagus.
How medical therapy can help
If diet and lifestyle changes don’t relieve your symptoms, try taking over-the-counter antacids, acid-reducers or combination medicines. Then make an appointment to see your doctor. “Medical therapy is still quite effective in treating reflux and some complications of reflux,” says Dr. Raja.
It’s important to see your doctor for three reasons:
- Your doctor can make sure your symptoms aren’t caused by a problem other than GERD.
- Your doctor can prescribe medications that make your stomach produce less acid or that stimulate the muscles between your stomach and esophagus to contract.
- With new research showing that long-term antacid therapy may cause vitamin B12 and magnesium deficiency, your doctor can prescribe lower doses and monitor you for potential problems.
When to consider surgery
“In a highly selected group of patients, anti-reflux surgery remains an effective option to relieve GERD symptoms,” says Dr. Raja.
The most common surgery for GERD is called a fundoplication. The surgeon wraps the top part of the stomach around the lower part of the esophagus and sews it in place. This recreates the valve between the stomach and esophagus, so that less acid washes back up.
Sometimes GERD is caused by a hiatal hernia (where the stomach partially protrudes into the chest cavity). In this situation, medical treatment to decrease acid can help. But if it doesn’t, then hernia surgery can be effective, says Dr. Raja.
A lasting solution
Surgery is very effective in the long term. A recent five-year study of about 800 people with GERD found that those who had surgery reported better health and quality of life than those who took medication and made diet and lifestyle changes.
Dr. Raja says that because any surgery carries risks, it’s important to try all other treatment options first.
“For the best outcome, make sure you have a thorough workup by an experienced physician in a center that treats a high volume of patients with GERD,” he says.