Reflux occurs when the lower esophageal sphincter (LES) At the lower end of the esophagus where it enters the stomach is not working properly.
Symptoms and Causes of GERD
Frequent heartburn is the most common symptom. However, patients may also experience some of the following:
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sour or bitter taste
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bitter stomach fluid coming into the mouth, especially during sleep
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hoarseness
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repeatedly feeling a need to clear the throat
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difficulty swallowing food or liquid
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wheezing at night
Certain diet and lifestyle choices can contribute to the condition. For example, certain foods increase acid production, and fatty foods increase the time food remains in the stomach. Chocolate, peppermint, coffee, alcoholic beverages, and especially nicotine in cigarette smoke weaken or relax the LES. Obesity places added pressure on the upper abdomen, and during pregnancy the LES weakens for unknown reasons.
Treatment of Reflux:
There are general measures the patient can take to reduce reflux:
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Eat smaller and more frequent meals.
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Do not lie down immediately after eating, and avoid eating for several hours before going to bed.
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Excessive bending, lifting, abdominal exercises, girdles, and tight belts all increase abdominal pressure and provoke reflux.
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If overweight, lose weight. Being overweight
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promotes reflux.
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Stop using all tobacco; nicotine weakens the LES.
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Avoid fatty foods, alcohol, coffee, chocolate, and peppermint.
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Elevate the head of the bed 8" to 10" so gravity keeps stomach juices out of the esophagus while the patient sleeps. Follow the diagram. Extra pillows, by themselves, are usually not helpful.
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Certain prescription or over-the-counter medications can weaken the LES or aggravate reflux. Review all medications you are taking with the physician.
Drugs and anti-acid -- Medicines are now available that effectively reduce and even eliminate the secretion of stomach acid and increase the strength of the LES muscle. The most potent of these are called proton pump inhibitors. These remarkable drugs are often dramatically effective in severe cases of reflux.
Surgery -- when the treatment programs are ineffective, surgery must be considered to strengthen the LES muscle.
In conclusion, Heartburn occurs so commonly that it is normal for everyone to experience it at some time. However, when heartburn is persistent, it needs to be evaluated, and long-term follow-up care is often required. Medical treatment is usually very effective and can prevent complications. For the few patients who are not helped by medical treatment, surgery offers a viable and usually successful alternative.
