Can stress increase GERD

Stress affects all people differently. Each individual's body reacts differently to stress, whether it comes in the form of a new assignment at work or a stressful conversation at home. Stress incorporates itself into your life and must be dealt with daily. If stress always led to GERD, most people would experience heartburn and reflux almost every day But this is not the case. In stressful situations, your body responds by producing hormones that regulate organ function. During times of...

What are the symptoms of a hiatal hernia

Symptoms you might experience are heartburn and regurgitation. A hiatal hernia causes the LES to be less effective, resulting in GERD, but the hiatal hernia itself really has no symptoms. Many patients report dyspepsia, which is the feeling of a sour stomach, and they think that means they have a hiatal hernia. But dyspepsia is a nonspecific stomach disorder treated with a proton pump inhibitor (PPI). The chance of developing a hiatal hernia increases with

What kind of foods should I eat ifI have GERD

Question 32 discusses the foods you should avoid. Eating smaller meals should be your goal because they are emptied from the stomach faster and do not increase pressures within the stomach like a large meal does. Smaller and lighter meals can also help with weight control. Most fruits and vegetables are preferred because they are healthy, low in fat, empty from the stomach relatively quickly, and are lower in acid. Some may actually settle your stomach. On the other hand, juices such as orange,...

How many people are affected by GERD

GERD is not a new disease it is a common disease that affects many people. In 1994, the U.S. Department of Health and Human Services reported that about 7 million people in the United States at that time suffered from chronic GERD. That number has grown since, likely because of the increasing incidence of obesity and people being overweight, which are contributing factors to reflux problems. These days, Americans work longer hours, buy more fast food, and eat on the run. Poor dietary habits and...

What factors cause GERD

GERD is affected by many different factors. It can be caused by factors out of your control as well as other factors that you can change or eliminate. A major cause of GERD and regurgitation is an incompetent valve, or barrier, between the esophagus and stomach. The circular muscle at the bottom of the esophagus is called the lower esophageal sphincter (LES). The LES contributes to the high-pressure zone at the junction of the esophagus and stomach that keeps ingested material out of the...

Can smoking cause GERD

Smoking is a dangerous habit that can result in many health risks. Smoking is associated with many cancers, heart disease, vascular disease, stomach ulcers, and lung disease, to name a few. Some studies have shown a link between smoking and GERD. Even though smoking does not directly cause GERD, it can exacerbate GERD symptoms. The nicotine in cigarette smoke can reduce the ability of the lower esophageal sphincter to contract or close, allowing acid to reflux. The LES is a muscle that keeps...

Does GERD get worse with age

Aging is inevitable and unavoidable the body becomes less efficient at functioning and does not seem to work like it used to. As you age, the tendency is that you will slowly gain weight, which contributes to GERD symptoms. Acid in the esophagus is neutralized by saliva, and saliva production decreases with age. Further, many medications used by the elderly cause dry mouth and decrease saliva production, compounding the problem. With increasing age, stomach emptying is slowed and further...

What are alarm signs of GERD

When symptoms start affecting your overall health, you should seek medical attention. Look for the following key signs to distinguish the severity of your GERD Do you experience GERD or heartburn 3 or more times per week Is the pain in your chest from heartburn or reflux debilitating Does the pain radiate to your arm or cause you to become short of breath Does the pain wake you from sleep or prevent you from getting a full night's rest High reflux can irritate your...

Can medicines exacerbate GERD

Most medications are taken by mouth they are absorbed through the gut and then enter the bloodstream. From the bloodstream, medications can act on various organs. All medications have desired actions and possible side effects. Sometimes when a medicine is prescribed for one problem, it can end up leading to another problem. Every individual's body can react differently to various medications, and it is not always possible to predict drug effects and side effects. Some medications can exacerbate...

When should I see my doctor about my GERD symptoms

You should see your doctor about GERD or heartburn before waiting too long. A burning chest discomfort may be GERD or it could be something else such as a heart problem. Angina or heart pain can be difficult to differentiate from GERD. If you are not sure or have any questions, this should prompt a visit to your doctor, especially if the discomfort is associated with shortness of breath, dizziness, sweating, and or arm or jaw pain or if the chest discomfort is associated with exercise. People...

What are the longterm risksbenefits of endoscopic antireflux procedures

The short answer is we really do not know the long-term risks of endoscopic anti-reflux procedures because they have only been on the market for a few years. Likewise, we do not know their long-term durability to control GERD symptoms and provide heartburn relief without medications. These are promising technologies that make sense from a medical standpoint, but they have not yet stood the test of time. Because these technologies are still fairly new, think carefully before you have your...

What is an esophageal dilation

Esophageal dilation is the technique of stretching the esophagus and is used to treat difficulty swallowing caused by strictures or rings. Most patients with GERD do not need dilation. It is done at the time of endoscopy while patients are sedated. Several different kinds of dilators and different tools are used for different jobs. Your doctor will choose the appropriate dilator based on the location of the narrowing, its length, how tight it is, and experience. We discuss only two kinds of...

If my GERD is chronic and possibly lifelong do I need to take medications for life or are there any other options

If you have long-standing frequent GERD and lifestyle modifications such as weight loss do not improve your symptoms, then you may need to take medications for life. The good news is that H2 blockers are safe for long-term use and have been on the market for more than 25 years demonstrating their safety. Proton pump inhibitors are felt to be safe for long-term use as well, and these have been on the market for more than 15 years. There were early concerns with long-term PPI use because initial...

What kind of doctor treats GERD

Your primary care doctor should do the initial evaluation of GERD. This kind of doctor is usually an internist or doctor who does general internal medicine and only treats adults. Other primary care doctors might be family practitioners who treat both adults and children. Your doctor may treat you with medication for GERD and or order tests. If you are on medication that is not working or have any of the symptoms from the preceding question, your doctor may refer you to a gastroenterologist....

Can I have chest pain caused by conditions other than GERD

GERD is only one of the many conditions that can cause chest pain. Other causes of chest pain range from life-threatening to minor inconveniences. Of course, a severe and life-threatening cause of chest pain is a heart attack as discussed earlier (see Question 13). For instance, a pulmonary embolism is a life-threatening condition that can cause severe chest pain. A pulmonary embolism is a blood clot that travels to the lungs and decreases blood flow to the lungs. It can lead to difficulty...

Do I need a biopsy of the esophagus and does it hurt

It is fairly common to do biopsies during an endoscopy. A small biopsy forceps is passed down the endoscope and a tiny pinch of tissue is removed. This is sent to a pathologist, who examines the tissue under a microscope. This can be extremely helpful for the evaluation of patients with GERD. A normal-appearing esophagus on endoscopy can have microscopic clues to the presence of reflux disease. Abnormal areas can be biopsied to check for cancer. As previously mentioned, chronic reflux can put...

Can exercise affect my reflux

Exercise is generally good and beneficial, but not always. Exercise is good for improving strength, heart conditioning, weight control, and overall health. On the other hand, it can affect reflux and make it worse. Exercise can cause problems with reflux because of its effects on the digestive system and the physical positioning and pressures it places on the stomach and the esophagus. However, acid reflux should not be a reason to avoid exercising because exercise has so many positive and...

Which medications can affect both esophagus and stomach

The esophagus and stomach are exposed to a wide variety of consumed substances that are potentially irritating or damaging. For this reason, a protective layer of cells called the mucosa lines the stomach and esophagus. The mucosa is a microscopic layer of cells, like skin that it is constantly changing and renewing itself. In the esophagus, the mucosa is a smooth surface that is slippery and allows substances swallowed to pass easily through to the stomach. Stomach mucosa is different it has...

Can GERD manifest as mouth symptoms in the absence oftypical chest discomfort

Yes, mouth symptoms can occur in the absence of chest discomfort. The acid can travel up from the stomach through the esophagus and into your mouth this is called regurgitation. Most individuals experience symptoms with acid reflux however, this is not always the case. Occasionally, people may not feel any pain because their esophagus has a decreased sensation to pain, or over the years they have become accustomed to the feeling and might not even notice it. This is called silent reflux....

What is apHstudy and why is it done

The stomach makes acid that aids in digestion of food. GERD, or heartburn, is movement of the acid into the esophagus. Sometimes patients have vague, odd, or atypical symptoms instead of classic burning chest discomfort. A trial of antacid medication can help sort this out if your symptoms go away with treatment. But other things can cause chest pain like heart or lung problems and can be very difficult to differentiate from GERD. Additionally, patients with GERD symptoms may be on a maximum...

What is an Endo Cinch or endoscopic plication

A Nissen fundoplication is, as mentioned earlier, surgical reinforcement of the lower esophageal sphincter accomplished by wrapping the top of the stomach around the bottom of the esophagus and stitching it into place. Several companies have manufactured endoscopic devices that can sew or staple and effectively provide a similar effect as a Nissen procedure. Currently, three endoscopic stitching or sewing devices are approved by the FDA and are on the market. Each device is different and...

What does an endoscopy show when patients have GERD

Patients with chronic GERD symptoms undergoing endoscopy have been studied by Winters and colleagues. In a report published in Gastroenterology in 1987, the authors found that of approximately 100 patients with longstanding or chronic GERD who had an upper endoscopy, 42 were normal, 45 demonstrated erosive esophagitis, and 12 had Barrett's esophagus. So, it is reassuring that more than 40 of patients were found to be normal however, it is the other nearly 60 of patients who have a positive exam...

Which specific medications can exacerbate GERD or damage the esophagus

As mentioned, medications can act in different ways to affect GERD and reflux symptoms (see Table 1). Medications can either affect the nerves that control the LES or the muscles that control the tightness of the LES. All muscles, including the LES, are controlled by nerves. Muscles of the gut are called smooth muscle and you cannot consciously control them by thinking about it. The nerves transmit signals from the brain to the rest of the body. Nerves that make up what is called the autonomic...

Do I need to be checked for H pyloric

If you have a history of stomach or duodenal ulcers even in the remote past, then yes, you should be checked. If you have a primary relative like a parent or brother or sister who has stomach cancer, then it is probably a good idea to be checked for H. pylori infection. Treating an H. pylori infection can decrease your chances of getting future ulcers and your risk for getting stomach cancer. In an endoscopy, if your physician finds any irritation of the...

If antacids do not work or are not appropriate for my GERD what is the next step or tier ofmedications to try

Antacids are first-line therapy for mild or infrequent heartburn however, sometimes these medications will not work or are simply not appropriate. To properly understand the other options available for anti-reflux therapy, it is important to know the biology of the stomach and how it produces acid for digestion. The stomach has multiple actions that aid in digestion of food. The stomach stores food and, with strong muscles, grinds food material into pieces less than a half inch in size....

What are the different proton pump inhibitors How should they be taken

Proton pump inhibitors completely shut down stomach cells that produce acid because they work directly on the site of acid production. Because they are the strongest acid-blocking medication, they are considered third-tier treatment for GERD. The tiers represent the step-wise management of GERD symptoms, starting with the cheapest and safest medication as first tier and ending with PPIs as third tier. PPIs are the most expensive medications for GERD and have, generally speaking, more side...

What are antacids and how and when should they be used

Antacids are compounds that can be used to neutralize acid on the spot, thus providing immediate relief of heartburn symptoms. Antacids are available at any drugstore, convenience store, and supermarket. All antacid products are over the counter and do not require a prescription. They are available for the general consumer to use at his or her own discretion. As mentioned, more than 7 million people suffer from regular GERD, and even more people suffer from occasional or infrequent heartburn...

What is a Stretta procedure

Stretta Procedure

Generally, a weak or lax lower esophageal sphincter causes reflux, although some reflux is related to inappropriate relaxation of the LES. Historically, antireflux surgical procedures wrap part of the stomach around the LES to tighten or reinforce this region. As mentioned earlier, several techniques have been developed to accomplish this nonoperatively with an endoscope to avoid the risks and discomfort of surgery. When tissue is damaged, it scars and shortens or contracts and becomes stiffer....

If my symptoms get better can I stop taking medication

It is reassuring to know that symptoms can respond to medication therapy. However, if your symptoms get dramatically better on prescription medication, it is important you continue this medication for a course of time, or at least until your doctor evaluates you again. As previously discussed, medications work in two ways they heal acid damage and they maintain healing. Generally speaking, it takes about 8 weeks to heal esophagitis, and the maintenance phase can last from months to years. Once...

What is esophagitis

Esophagitis is inflammation of the lining of the esophagus that is diagnosed by a barium X-ray or endoscopy. Generally, it is not a diagnosis that can be made by a doctor in the office through a history or physical examination. The inflammation is usually caused by reflux of acid that burns, damaging the esophagus. However, medications can sometimes cause esophagitis, for example, aspirin or over-the-counter pain relievers, iron pills, potassium pills, some antibiotics, and certain drugs used...

What is an esophageal stricture or ring

Patients with and without chronic problems with GERD may be at risk of having a stricture or an esophageal ring. These are two different types of constrictions or narrowing of the esophagus. An esophageal ring manifests as rare episodic difficulty swallowing with solid food getting stuck (see color plate 1). The sensation of food getting stuck can occur a couple times a year or may happen only once every few years. It is nonprogressive, meaning that over time swallowing generally does not get...

What is the relationship between ulcers and GERD

An ulcer is a break in the lining of the gut generally defined as greater than 5 millimeters, which is about a quarter of an inch. Ulcers can occur anywhere in the gut from the mouth to the anus. The causes of ulcers vary depending on their location. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen (Naprosyn) can cause ulcers anywhere in the gut. Classically, ulcers are located in the stomach and first part of the small intestine (called the duodenum)....

What is Enteryx

Enteryx is a material that could be injected into the area of the LES at the time of endoscopy. It is a liquid polymer that stays in place where it is injected and solidifies into a spongy material. This material can bulk up the LES and become a barrier to reflux. Small studies suggested that Enteryx was effective for GERD. Side effects included chest pain, difficulty swallowing, bloating, nausea, garlic odor, and fever. Enteryx was previously FDA approved, but because of complications (11...

What about other chest symptoms with GERD

GERD can affect other systems in your chest besides your mouth and stomach. To understand how it can affect other systems in your chest, it is important for you to visualize the anatomy of the human body. affect other systems in your chest besides your mouth and stomach. Visualize the path food takes as it moves through your body (see Figure 6). You can see that it moves to the back of the mouth and then makes a sharp turn down into the esophagus. Similarly, when you breathe through your nose,...

Does GERD affect one gender more than the other

Females are slightly more affected by GERD than males are. The reason women are more prone to develop GERD may be related to female hormones. The female body produces the hormones estrogen and progesterone. One of the many functions of these hormones is to relax muscles in the body. For example, during pregnancy, women produce larger amounts of these hormones to relax the muscles in the uterus to allow it to grow along with the baby. Just as hormone levels change during pregnancy, women...

Antacids seem benign Do they have side effects

Antacids are medications, and even though they are available without a prescription, you should be advised that they too can cause side effects and have adverse effects. Antacids are drugs that contain multiple ingredients in addition to the active agent that neutralizes acid. There are dyes for coloring, flavors, fillers to form the actual tablet or pill, and other additives. Any one of these can cause problems in certain people. Some antacids are mixed with aspirin to act as a pain reliever,...

Neeral L Shah MD

Department of Gastroenterology Lahey Clinic Burlington, MA Sudbury, Massachusetts BOSTON TORONTO LONDON SINGAPORE Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario London W6 7PA Jones and Bartlett's books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax...

Is there a difference between daytime and nighttime GERD

GERD can occur at any time because the stomach is constantly producing acid, but acid production varies at different times. Food enters the mouth and moves down to the stomach, stimulating production of stomach enzymes and acid for digestion. The first major step in food processing is in the stomach, which slowly moves material into the small intestines where nutrients are absorbed. Certain fried and high-fat foods can stimulate the stomach to produce more acid and digestive juices than normal....