Gastroesophageal reflux disease (GERD) is a modern epidemic. According to the Healthcare Cost & Utilization Project, it is estimated that 20 to 30 percent of people in the United States are afflicted with the symptoms of GERD during any given week. It’s a painful, chronic disorder — and tremendous windfall for pharmaceutical companies that make billions in profits for drugs that mask symptoms but do not cure the disease.
It should be noted that not all acid indigestion is GERD. The difference between GERD and a simple upset stomach is the frequency of symptoms. According to the Cleveland Clinic, if you have heartburn or acid indigestion more than twice a week, you may be on your way to developing GERD.
What is GERD?
In order to treat GERD effectively, we must first understand this condition by delving into a little bit of basic anatomy. When you swallow a mouthful of food, it gets to your stomach through the esophagus. This long, muscular tube contracts, and along with gravity, moves the food down. At the bottom of the esophagus is a small ring of muscle called a lower esophageal sphincter (LES). Once food passes through this ring, the LES muscle contracts and it closes, effectively sealing off the stomach from the esophagus and preventing the food and digestive juices from coming back up. In the stomach, enzymes are triggered and acids are released to digest the food. Stomach acid is extremely corrosive, but in normal quantities do not harm the stomach lining.
GERD occurs when this ring of muscle doesn’t close properly. As the stomach contracts and does its work, food and acids are pushed upward. Acid escapes the stomach and flows up into the esophagus, where it causes irritation, and, eventually, erosion of delicate tissues. The irritation causes a painful burning called heartburn, that can even have you feeling like food is caught midway in the esophagus.
Contributing Factors to GERD
The cause of GERD is not directly known, but there are a great many lifestyle choices common to our modern life that contribute to the severity of its symptoms: Smoking, obesity, consumption of fast food or alcohol, eating too fast or late at night, all contribute to the burning pain of GERD. Even the pharmaceuticals prescribed by physicians for treatment of other conditions such as insomnia, Parkinson’s disease, depression, asthma and hypertension can affect the function of the LES, causing GERD. Hiatal hernias also contribute.
Symptoms and Long-Term Effects of GERD
Symptoms of GERD can be mild, moderate or severe, and range from frequent heartburn, hiccups, belching and a bad taste in the mouth to difficulty swallowing, hoarseness and burning pain in the chest. Needless to say, repeatedly exposing the soft tissue of the esophagus to corrosive stomach acid can result in complications. Severe GERD symptoms include esophageal ulcers, bleeding, and narrowing of the esophagus due to scar tissue formation. This narrowing can also cause a feeling of having food caught halfway down, and a panicky feeling of choking. In about 1 in 100 patients with severe GERD, a condition called Barrett’s Syndrome can develop, causing changes on the cellular level that can eventually lead to esophageal cancer. Pulmonary fibrosis can also be caused by chronic, severe GERD.
Now that we understand more about the causes, symptoms and long-term effects of GERD, it’s time to look at treatments and their pros and cons.
GERD Treatment Options
There are almost as many ways to treat GERD as there are symptoms, but they all fall under two basic categories: treatments that prevent stomach acid from forming, and treatments that work with the stomach’s natural acid production and control its volume.
The top four hospitals in the U.S. (Mayo Clinic, Johns Hopkins, Cleveland Clinic and Massachusetts General Hospital) all recommend a range of treatments along with lifestyle changes, many of which alleviate painful symptoms by masking them or shutting them down with drugs. Late-stage treatment options include surgery for removal of scar tissue, and there are several types of surgery that are designed at strengthening the LES muscle, but are only newly approved or still working their way through FDA approval.
Over-the-counter (OTC) Remedies
Antacid tablets and liquids (Mylanta, Tums, Alka-Seltzer, Pepto-Bismol) are usually the first line of defense against mild acid reflux. These preparations contain a mixture of several different salts: magnesium, aluminum and calcium. The salts are mixed with bicarbonate to neutralize acid in the stomach. Each one has side effects if used over a long period; diarrhea and constipation are two of the most common. Over-the-counter remedies generally work only in the stomach, and do not help irritation and damage in the esophagus. They are best for short-term, temporary relief, and are not a cure.
Prescription Medications for GERD
Here’s where Big Pharma makes billions on three basic groups of drugs: proton pump inhibitors, H2 blockers and prokinetics. Pharmaceutical companies make their profits by producing different brand names of the same thing, then getting doctors to prescribe them through relentless marketing.
Proton pump inhibitors (Prilosec, Nexium and Prevacid) work by shutting off the enzymes in the stomach that produce and “pump” digestive acids into the stomach. Less acid in the stomach equals less heartburn, and this class of drugs works over several days’ duration to relieve pain. The problem is that as soon as the medication is suspended, GERD returns. In other words, it only works for as long as the drug remains in the system. The downside is that proton pump inhibitors are only recommended for limited use; just a couple of weeks at a time, a few times a year. The FDA recently reported that long-term, extended use of these drugs can result in an increased risk of hip, wrist and spine fracture, especially in patients that have underlying osteoporosis.
H2 blockers (histamine antagonists) are another class of drugs for masking the symptoms of GERD. Popular brand names include Tagamet, Pepcid AC and Zantac 75, and they are available both over-the-counter and in prescription strength. Histamines are chemicals that initiate acid production in the stomach, and H2 blockers effectively stop histamines from working. These drugs cannot be taken long-term, either, and side effects include dizziness, diarrhea, constipation and headache.
What’s amazing is that some doctors prescribe proton pump inhibitors and H2 blockers in combination, doubling risks and side effects!
Prokinetic drugs are yet another weapon in the pharmaceutical arsenal. Perhaps best-known by the brand name Reglan, prokinetics work to improve the LES muscle, and speed digestion by helping the stomach empty faster. Though it sounds as if this would be the most helpful of medications, unfortunately prokinetics have the highest occurrence of side effects, which range from dry mouth to constipation, incontinence, insomnia and restlessness. Withdrawal from long-term use can cause suicidal thoughts, seizures and tremors that resemble those of Parkinson’s disease.
Lifestyle Changes That Help Relieve GERD Symptoms
Remember, you can either “turn off” stomach acid or work with it. Which sounds better to you? After all, stomach acid are vital to digestion. If you’d rather work to put your normal digestive processes back in proper balance and free yourself of expensive medications that are only a temporary relief at best, read on.
Given that you’ve read this far, you’ve probably realized that no responsible physician will simply prescribe medicines for GERD with recommending lifestyle changes to help address what may be the root of the symptoms.
First, check your body shape and weight. If you are carrying a “spare tire” around your middle, it’s time to lose it. Extra pounds at the waistline put pressure on the abdomen, pushing up on your stomach and causing acid to back up. This is especially true when you’re lying down. Try lying down and putting a ten-pound weight on your stomach and you’ll get the idea. Controlling calories and portion size, combined with 30 minutes of exercise five days a week will go a long way toward reducing extra weight.
Next, examine your diet and the size and timing of your meals. Avoid eating for at least three hours before going to bed or lying down, to keep acid where it belongs while you’re digesting. Eat several smaller meals instead of one or two big ones, and keep them full of fiber, vegetables, nuts and beans instead of red meat. Especially avoid processed, fatty meats like bacon, sausage, salami, and so on. Stay away from cream and tomato sauces and spicy foods that are highly acidic. Don’t use tomatoes or peppers in your cooking. If you consume alcohol or smoke tobacco, stop. Ditch the caffeine (coffee, tea, soda, chocolate). Don’t drink carbonated beverages, because the carbonation continues in your stomach and will cause reflux through belching.
Next, try elevating the head of your bed by 6 to 8 inches by setting the posts on bricks or wooden blocks. This helps gravity keep stomach acid low instead of washing back up during the night.
Finally, remember that GERD can be different for everyone who has it. To rule out more serious conditions, it should always be diagnosed by a physician. As with anything, take control of your own physical health and seek as much information as you can.
We’ve now reviewed the definition, possible causes and several treatment options for gastroesophageal reflux disease. Armed with a better understanding of the signs, causes and treatments of this disorder, you’re better equipped to make intelligent choices in cooperation with your doctor.
Should you decide to avoid prescription drugs like H2 blockers, proton pump inhibitors and prokinetics, you may wish to go a more holistic route. Visit Reflux Remedy for more information on how you can take control of your own digestive health by following a simple and inexpensive regimen that can keep you GERD and pharmaceutical-free.