It starts as a burning sensation in the chest, before slowly making its way up toward the neck and throat. At one time or another, nearly everyone experiences heartburn.
Occasional heartburn is normal. However, when heartburn occurs more than twice a week it can signal gastroesophageal reflux disease, or GERD.
An estimated 5 percent to 7 percent of the United States population is affected by GERD. Anyone, including men, women and children, can have GERD. The disease occurs when acid in the stomach flows backwards, into the esophagus. Under normal conditions, a muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach, helping to prevent acid reflux. When it fails to close properly, acid can leak back into the esophagus.
What are the Treatment Options for GERD?
There is no cure for GERD. It is a chronic disease, requiring long-term treatment. Most people with mild symptoms can ease their symptoms by making lifestyle changes. These may include losing weight; avoiding alcohol; eliminating foods and beverages such as chocolate, coffee, or greasy foods; and not eating late at night.
For many people, prescription medications may help. Over-the-counter antacids, such as Alka-Seltzer, Mylanta or Rolaids are often recommended to relieve mild symptoms. Antacids help neutralize stomach acid.
GERD sufferers also might benefit from proton pump inhibitors (PPI). These drugs, including Prilosec, Prevacid, Protonix, Aciphen and Nexium, provide long-term symptom relief and heal erosive esophagitis. Proton pump inhibitors provide the safest and most predictable treatment for GERD. Prilosec is available over-the-counter, cost isn’t an issue.
Proton pump inhibitors work by reducing the production of acid in the stomach, leaving little acid to back up into the esophagus. Studies have shown that proton pump inhibitors are more effective than other heartburn medications. However, new research suggests that taking proton pump inhibitors for prolonged periods may increase the risk of developing pneumonia. A Dutch study found the risk of pneumonia nearly doubled for people taking the drugs for prolonged periods.
“Despite the slight evidence of chronic pneumonia, proton pump inhibitors are safe,” says Dr. “Some drug companies have the attitude that once on a PPI, always on a PPI. There is a subset of people who may continually need PPI, but most don’t.” Dr. also suggests that PPI dose reduction may be appropriate for some patients.
Surgical and Endoscopic Options
Some patients may want to seek an alternative to taking medication for their symptoms. Surgical techniques to improve the barrier between the stomach and the esophagus can help. When performed by a skilled, high volume surgeon, laparoscopic antireflux surgery is very effective.
In recent years, endoscopic techniques have been introduced as promising treatments for GERD. These procedures are performed through a flexible tube inserted through the mouth and down the throat.
One of the more popular endoscopic procedures is Enteryx. Doctors inject a sponge-like material that thickens the valve at the base of the esophagus, stopping stomach acid from coming back up. Other endoscopic approaches include the EndoCinch system and Streta system.
Doctors advise caution for patients considering endoscopic techniques. “These therapies need to be carefully investigated. Complications have ranged from failure to correct the problem to death.”
There have been documented deaths from endoscopic procedures. People shouldn’t die from reflux disease. Federal agencies need to take a stronger look at these procedures, the studies are not going through close enough scrutiny.
The Consequences of Untreated GERD
Without proper treatment, GERD can cause serious complications. Years of exposure to stomach acid may cause cancer of the esophagus, or Barrett’s esophagus, a precancerous condition. Inflammation of the esophagus can cause bleeding or ulcers. Persistent symptoms of heartburn and reflux should not be ignored. The best way to prevent these conditions is by seeing a doctor early.
Further Hope Through Research
Despite treatment, there are still some individuals who continue to suffer persistent symptoms of GERD. Research is underway to investigate why.
Some researchers are focusing on nonerosive reflux disease. Individuals with nonerosive reflux disease present the same symptoms as others with GERD, although nonerosive reflux disease does not cause esophagitis. This does not mean that nonerosive reflux disease is less serious that erosive reflux. New therapies are needed for people with nonerosive GERD. They often do not respond to acid suppressants.
“Nonerosive disease is actually the most common presentation of GERD,” says Ronnie Fass, M.D., University of Arizona in Tucson. “The whole issue of nonerosive disease has really started to explode. These patients fall under the definition of GERD, but they really don’t have GERD, making them difficult to treat.”