“Josh,” age 45, was just beginning to experience some of the aggravating physical complaints common to middle age. Having packed on more than a few extra pounds, his BMI of 29 placed him well within the ranks of the overweight and right on the cusp of obesity. Once-simple activities like climbing the stairs left him out of breath, his knee joints ached, and lower-back pain frequently prevented him from getting restful sleep.
Josh was also vexed by another problem: Severe heartburn was becoming an almost nightly ritual. Oftentimes, a nagging dry cough would accompany the burning sensation, and he would occasionally awake suddenly with a sour taste in his mouth after having regurgitated a small amount of stomach fluid. On some nights, propping his upper body with several pillows prevented these symptoms, and popping antacid tablets offered temporary relief, but the root problem persisted. A visit to his primary care physician revealed that Josh had gastroesophageal reflux disease, or GERD.
GERD is a chronic digestive disorder that develops when stomach acid frequently refluxes—or backwashes—into the esophagus (the tube through which food passes to the stomach) and irritates and inflames the esophageal lining. This reflux occurs because the circular band of muscle located at the lower end of the esophagus—called the esophageal sphincter—functions abnormally.
When it’s doing its job as it should, the esophageal sphincter remains closed until food or liquid flows down to the stomach. Then, it relaxes just long enough to allow the food or liquid to pass and then closes again. But if this band of muscle relaxes abnormally or becomes weakened, stomach acid, and possibly bile, can travel the wrong way and back up into the esophagus, causing heartburn and other unpleasant symptoms. In addition to heartburn, these symptoms might include (among others) hoarseness or sore throat, a dry cough, difficulty swallowing or a sensation of swelling in the throat, regurgitation of food or stomach acid, and even chest pain.
Over time, constant acid reflux can also lead to the formation of scar tissue and consequent narrowing of the esophagus, ulceration and bleeding of the esophagus, precancerous changes to the esophageal lining, as well as other complications.
Risk factors for GERD include, but aren’t limited to, obesity, asthma and other respiratory diseases, smoking, excessive alcohol consumption, diabetes, hiatal hernia, and pregnancy.
As Josh’s doctor explained, his excess body weight was likely a major contributing factor to his problem. Essentially, his abdominal fat was applying pressure to the stomach and diaphragm, causing the lower esophageal sphincter to open when it shouldn’t.
Some lifestyle changes were definitely in order for Josh. Under his doctor’s supervision, he began a weight-loss program based on exercise and nutrition and gradually shed 20 pounds over the course of several months. In the process, he also shed most of his symptoms and began to enjoy much more restful sleep. He still experiences occasional heartburn, but he can usually manage it with over-the-counter medications.
As in Josh’s case, GERD can often be diagnosed through a simple medical history, but various tests are also available to assist in diagnosis when necessary. In addition to encouraging Josh to shed excess pounds, his doctor recommended the following lifestyle modifications to help reduce the frequency of his heartburn symptoms:
Eat smaller meals and avoid eating for at least three hours before going to bed.
Avoid foods or beverages that seem to trigger GERD symptoms. Examples of common dietary triggers include fried foods, fatty foods, garlic and onion, tomato sauce, alcohol, and caffeine.
Avoid wearing tight-fitting clothes.
Elevate the head of the bed, either by placing a wedge (available at drug stores and medical supply stores) between the mattress and box springs or by placing wood or cement blocks under the feet of the bed.
Certain over-the-counter and prescription-strength medications can be helpful in managing heartburn symptoms, as well. However, you should consult with your physician before taking any medication to ensure it will be both safe and effective for you and won’t have any harmful interactions with other medications you may be taking.
Like Josh, most GERD sufferers find symptom relief with over-the-counter or prescription-strength medications and lifestyle changes. However, if this conservative approach is not effective, your doctor may recommend one of several different surgical procedures that can be performed to prevent stomach acid from refluxing into the esophagus.