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Treating Gastroesophageal Reflux Disease

Background

Gastroesophageal reflux is the backflow of acid from the stomach into the esophagus. This occurs when there is a relaxation of the valve that connects the stomach and the esophagus, which is called the lower esophageal sphincter. When reflux occurs, it can sometimes cause inflammation of or damage to the esophagus lining, which is referred to as esophagitis or erosive esophagitis. For some people, reflux can lead to a diagnosis of Barrett’s esophagus. Barrett’s esophagus is when the lining of the esophagus changes to look like the lining of the stomach, which can lead to cancer in a small number of patients, but for most patients, reflux is not this severe. Reflux is, however, the leading cause of solid food dysphagia.

Signs and Symptoms of Gastroesophageal Reflux Disease

Most people experience symptoms of reflux occasionally. Common signs of and symptoms of reflux include:

  • Heartburn
  • Acidic or sour taste in your mouth, especially after laying down
  • Food from the stomach backing up into your throat or mouth

 

In more severe cases of reflux, patients may notice some of the following symptoms. If you experience these symptoms, it is important to seek medical attention to determine the cause and proper treatment:

  • Unintentional weight loss
  • Difficulty swallowing (called dysphagia)
  • Sticking sensation in your chest or throat during and after eating
  • Burning chest pain that radiates into the throat
  • Vomiting blood
  • Black stools
  • Sensation of acid coming up into the airway leading to shortness of breath, voice changes, and coughing
  • Symptoms lasting several hours or more

 

How Is Reflux Diagnosed?

Depending on the severity of your signs and symptoms, a doctor may diagnosis your reflux by reviewing your medical history and current symptoms, and performing a physical assessment. Your doctor may also want to perform an endoscopy. An endoscopy is when a flexible tube with a camera is passed through the throat and enters the esophagus and stomach to examine the lining. Patients are generally sedated for this procedure. Some side effects from this procedure may include bloating, gas, cramping and a sore throat, but generally resolve within a couple days.

 

How is Reflux Treated?

Reflux can be treated in several ways. Some patients can resolve their symptoms without pharmacological interventions with changes to their diet and lifestyle.

Changing your diet can significantly decrease signs and symptoms of reflux. Outlined below are ways that you can modify your diet:

  • Avoid eating large meals. Rather, eat 4-5 small meals a day
  • Avoid large amounts of alcohol. If you do drink, drink a small amount with a meal, as alcohol causes the stomach to produce more acid. The food can act as a buffer for the stomach acid
  • Avoid eating 3 hours before bedtime.
  • Avoid foods high in fat and low in fiber
  • Avoid foods and drinks commonly linked to heartburn such as: spicy foods, citrus juices, peppermint, onion, tomato, and caffeine
  • Maintain a healthy weight. Being overweight can increase symptoms of reflux.

 

Below are activities that can decrease the symptoms of reflux:

  • Quit smoking
  • Wearing loose fitting clothing, avoiding belts and tight fitting pants
  • Elevating the head of the bed so that it is 6 or more inches higher than the foot of the bed. Avoid stacking pillows which can cause bending at the waist, making reflux worse
  • Exercising (not within three hours of bedtime)
  • Avoid bending over at the waist

 

There are also various types of medications to treat reflux. The goal of drug intervention is to reduce the symptoms, heal inflammation of the esophagus, and prevent worsening reflux. Below are types of drugs commonly used to treat reflux:

  • Antacids are used to neutralize stomach acid and can be purchased without a prescription. Examples of antacids include Tums® and Rolaids®.

 

  • H2 blockers are used to reduce the amount of stomach acid and decrease the backflow of stomach acid into the esophagus. Low doses can be purchased without a prescription and generally can treat mild reflux. Stronger doses are available with a prescription. Examples include ranitidine (Zantac®) and famotidine (Pepcid®).

 

  • Proton pump inhibitors (PPIs) are used to inhibit the production of acid in the stomach. These drugs are usually used to heal more serious types of reflux. Examples include omeprazole (Prilosec©), esomeprazole (Nexium®), and lansoprazole (Prevacid®).

 

  • Promotility agents are used to prevent backflow to stomach acid by making the valve between the stomach and esophagus stronger. Examples include metoclopramide (Reglan®), which also moves food and gastric juices through the stomach more quickly.

 

To determine the right medication for you, you should tell your doctor what medications you are already taking. Some common medications can cause or worsen reflux symptoms, including anti-inflammatory drugs like aspirin or ibuprofen, Warfarin (Coumadin®), nicotine replacement, albuterol tablets and syrups, iron supplements, and more. Never stop taking a medication without consulting with your doctor.

 

Finding a Specialist

If you are experiencing signs and symptoms gastroesophageal reflux, consult with your doctor to determine necessary intervention, which may include a referral to a gastrointestinal specialist, changes to your diet and lifestyle, or medication management.

 

 



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