If you regularly experience heartburn, a painful burning sensation in your chest and throat, there’s a good chance you could have gastroesophageal reflux disease (GERD), a.k.a. acid reflux. It’s estimated that 20 percent of the population suffers from GERD regularly, with heartburn its most prevalent symptom.
“GERD is the most common gastrointestinal disorder in the U.S.,” says William C. Dengler, MD, a gastroenterologist and medical director of RefluxMD.com. It occurs when a muscle at the end of your esophagus (the tube that carries food from your mouth to your stomach) doesn’t close properly. Consequently, stomach acid can back up into your esophagus causing heartburn.
A class of drugs called proton-pump inhibitors (PPIs) has been a godsend for GERD sufferers. Sold over the counter (OTC) and by prescription, PPIs such as Nexium (esomeprazole), Prilosec (omeprazole) and Prevacid (lansoprazole) treat GERD by reducing the amount of acid the stomach produces. Trouble is, “there are millions of people taking PPIs who don’t have GERD,” Dr. Dengler says. There are also people with GERD who are popping PPIs but aren’t getting the relief they need.
How can you tell if you truly have GERD? How can you avoid taking medication you don’t need? Use this symptom guide to get the right help for your heartburn.
Symptom situation: You’ve never had heartburn until now—and it’s bad.
Gut advice: “If you have severe heartburn that you’ve never had before, don’t assume it’s GERD,” Dr. Dengler says. “Get yourself to the emergency department or call 911.”
What do GERD and heart attack have in common? They both have heartburn as a symptom.
Heart disease is the number one cause of death for both men and women. GERD accounts for more than half of the eight million emergency room visits for chest pain each year in which actual heart problems were ruled out. It’s better to be safe than sorry by making sure your heartburn isn’t a heart attack in progress.
Symptom situation: You have occasional heartburn and you’re not sure why.
Gut advice: “For some folks with heartburn, it’s just a nuisance kind of thing,” Dr. Dengler says. They experience heartburn just three to four times per year. If that’s you, a mild sufferer, it’s fine to take an OTC heartburn medication occasionally, such as Tums or Zantac (ranitidine), which neutralizes stomach acid, or an OTC PPI. But don’t stop there.
Do your homework to find out what sets off your GERD attack. Do you typically get heartburn after overeating? A full tummy extends the stomach, which can make preexisting GERD worse, Dr. Dengler says. Certain foods and beverages can bring on GERD as well. Spicy foods have a bad rep but the biggest culprits are foods high in fat, such as marbled steaks, ribs and sausage. “Red wine also tends to be a bad one,” Dr. Dengler says. Tomato sauce is a question mark. “Some people are fine with tomato sauce. Others, it kills them,” Dr. Dengler says.
Take note of when you eat, as well. “You’re prone to reflux if you lie down on a full stomach,” Dr. Dengler says. He recommends eating dinner three to four hours before bedtime and avoiding late-night snacking so that your meal has time to digest.
Being overweight can put you at increased risk for GERD. “Losing weight, even as little as 10 pounds, can reduce the magnitude of GERD symptoms,” Dr. Dengler says.
Keep in mind that anyone can get GERD, even active, healthy people. If you’re an avid exerciser and you’re prone to GERD, try avoiding activities that increase abdominal pressure, such as sit-ups or weight lifting moves, to see if that helps calm your stomach acid. “There’s an athletic population whose symptoms are exacerbated with exercise,” Dr. Dengler says.
Symptom situation: You have frequent heartburn, but medication isn’t helping.
Gut advice: If your heartburn symptoms don’t subside after taking OTC heartburn medication for several weeks and you’re doing everything you can do prevent GERD, such as avoiding eating a big meal before bed, see your doctor.
After reporting your symptoms, expect your doctor to order an upper GI endoscopy, a test in which a thin, flexible tube with a camera on the end is used to look inside the upper portion of your digestive tract. Endoscopy helps rule out underlying conditions, such as esophageal cancer and stomach ulcer. But it’s not a good diagnostic test for GERD. “Even if you have significant reflux disease, there’s an 80 percent chance the endoscopy will be normal,” Dr. Dengler says. “It doesn’t answer the question you’re asking: ‘Why am I not getting better on medicine?’”
With a normal endoscopy result, some physicians will assume it’s GERD because the condition is so prevalent and simply prescribe a PPI or other medication. A better idea? Request an additional diagnostic test if your doctor doesn’t suggest it: an ambulatory pH study. “It’s the only test that can actually detect if stomach acid is flowing back up into the esophagus,” Dr. Dengler says.
For this GERD test, a sensor is placed in your lower esophagus for 48 hours while you go about your day. If an ambulatory pH study determines that you have GERD (a pH value of 1), your doctor will likely prescribe GERD medication. If the test rules out GERD (your pH is 6 or 7, meaning that stomach acid isn’t present in your esophagus), your doctor will continue investigating to determine what’s causing your symptoms. “Two thirds of the people will have reflux, but up to one third of heartburn sufferers will have something else,” Dr. Dengler says. An ambulatory pH study is typically covered by insurance.
If your doctor determines that you have GERD and lifestyle strategies and prescription medication don’t help, surgery and non-surgical techniques are available that can lead to long-term relief. One of the latest non-surgical techniques, transoral incisionless fundoplication (TIF), tightens the valve between the esophagus and stomach using stitches. In a recent study, 67 percent of patients who received TIF reported that their GERD symptoms improved.
Bottom line? Don’t just learn to live with your GERD symptoms and pop OTC medication, which is a common scenario. Lingering GERD can cause serious complications, including a condition called Barrett’s esophagus, which can increase the risk of esophageal cancer. “GERD is a wellness issue,” Dr. Dengler says. Be vigilant, do what you can do keep your condition in check, and get help if your heartburn continues.