Gastroesophageal Reflux Disease (GERD)

November 2020

What is GERD?

GERD (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-containing contents in your stomach persistently leak back up into your esophagus.

Acid reflux happens because a valve at the end of your esophagus, the lower esophageal sphincter, doesn't close properly when food arrives at your stomach. Acid backwash then flows back up through your esophagus into your throat and mouth, giving you a sour taste.

Acid reflux happens to nearly everyone at some point in life. Having acid reflux and heartburn now and then is totally normal. But, if you have acid reflux/heartburn more than twice a week over a period of several weeks, constantly take heartburn medications and antacids yet your symptoms keep returning, you may have developed GERD. GERD should be treated by your healthcare provider. Not just to relieve your symptoms, but because GERD can lead to more serious problems.

Gastroesophageal reflux is common in babies under the age of 2. Most babies spit up a few times a day during their first 3 months. According to John Hopkins Medicine, it does not cause any problems in babies with most outgrowing reflux by 12-14 months. Children ages 2-19 may also experience reflux from time to time, but this does not mean that they have GERD.

When does gastroesophageal reflux/heartburn become Gastroesophageal Reflux Disease?

Your baby, child, or teen may have GERD if:

• Your baby’s symptoms prevents them from feeding. Symptoms may include vomiting, gagging, coughing, and trouble breathing.

• Your baby has reflux for more than 12-14 months

• Your child or teen has reflux more than twice a week for a few months

Adults may have GERD if:

• You have reflux more than twice a week for several weeks

What causes GERD?

Gastroesophageal Reflux Disease is often caused by something that affects the lower esophageal sphincter (LES). The LES is located at the bottom of the esophagus. It opens to allow food in, but if it is open for too long, then acid and/or stomach contents can come back up causing vomiting or heartburn. Everyone can experience heartburn from time to time. Babies are more likely to have a weak LES. This makes it relax (open) when it should stay shut.

Some foods can affect the muscle tone of the LES. They let it stay open longer than it should. Foods include:

• Chocolate

• Peppermint

• High-fat foods

Foods that increase acid production in the stomach include:

• Citrus foods

• Tomatoes and tomato sauces

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What are the risk factors for GERD?

Certain conditions can increase your risk of GERD. These include:

• Obesity

• Hiatal hernia

• Pregnancy

• Connective Tissue Disorders, such as scleroderma

• Delayed stomach emptying

• Genetics

• Frequent use of NSAIDs (Ex: ibuprofen, naproxen)

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What are the symptoms of GERD?

Different people experience GERD in different ways. Children under 12 tend to have different symptoms than adults like dry cough, asthma symptoms, or trouble swallowing. The most common symptoms of GERD are:

• Heartburn

• Regurgitation

• The feeling of food caught in your throat

• Coughing

• Chest pain

• Problem swallowing

• Vomiting

• Sore throat and hoarseness

What are the treatment options for GERD?

Before starting any new medication, check with your doctor or pharmacist to see if it is right for you.

Over-the-counter Options

Antacids – Antacids, such as Mylanta, Tums, or Rolaids, will neutralize stomach acid and can provide quick relief.

Medications to reduce acid production – H2 receptor blockers, such as famotidine (Pepcid) or nizatidine (Axid AR), don’t act as quickly as antacids but provide longer relief and may decrease acid production for up to 12 hours.

Medications that block acid production and heal the esophagus – Proton pump inhibitors (PPIs), such as Nexium or Prilosec, are stronger acid blockers than H2 receptor blockers and allow time for the esophagus to heal.

Prescription Options

Prescription-strength H2 receptor blockers – These

include prescription-strength famotidine (Pepcid) and nizatidine. They are generally well-tolerated, but long-term use may lead to a slight increase in risk for B12 deficiency and bone fractures.

Prescription-strength proton pump inhibitors – They

are a plethora of options including pantoprazole (Protonix), esomeprazole (Nexium), lansoprazole (Prevacid). These medications are also generally well-tolerated but can cause diarrhea, headache, nausea, and B12 deficiency. Chronic use may increase your risk of hip fracture.

Medication to strengthen the lower esophageal sphincter – Baclofen may ease the symptoms of GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects can include fatigue or nausea.

How can compounding help with GERD?

Babies and children require different dosing than adults. Compounding allows flexibility in dosing and how you administer the medication. Custom doses are available. We can also make PPIs into suspensions that make giving medicine to your baby or child much easier. Multiple flavors available for even the pickiest of kids.

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What lifestyle and diet changes will help GERD?

For many people, diet and lifestyle changes can help ease the symptoms of GERD.

For babies:

• After feedings - hold your baby in an upright position for 30 minutes.

• If bottle-feeding - keep the nipple filled with milk. This way your baby won't swallow too much air while eating. Try different nipples. Find one that lets your baby's mouth make a good seal with the nipple during feeding.

• Adding rice cereal to feeding may be helpful for some babies.

• Burp your baby a few times during bottle-feeding or breastfeeding - Your child may reflux more often when burping with a full stomach.

For children:

• Watch your child's food intake - Limit fried and fatty foods, peppermint, chocolate, drinks with caffeine such as sodas and tea, citrus fruit and juices,

and tomato products.

• Offer your child smaller portions at mealtimes - Add small snacks between meals if your child is hungry. Don't let your child overeat. Let your child tell you when he or she is hungry or full.

• If your child is overweight - contact your child's provider to set weight-loss goals.

• Serve the evening meal early, at least 3 hours before bedtime.

For adults:

• Maintain a healthy weight – Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.

• Stop smoking – Smoking decreases the lower esophageal sphincter's ability to function properly.

• Elevate the head of your bed – If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn't effective.

• Don't lie down after a meal – Wait at least three hours after eating before lying down or going to bed.

• Eat food slowly and chew thoroughly – Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.

• Avoid foods and drinks that trigger reflux – Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.

• Avoid tight-fitting clothing – Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

Can GERD lead to other health problems?

Esophagitis – Esophagitis is irritation and inflammation of the esophagus. It can lead to ulcers of the esophagus, heartburn, chest pain, bleeding, and trouble swallowing.

Barrett’s esophagus – It is a condition that develops in some people (~10%) who have long-term GERD. The damage from stomach acid can cause the cells in the

esophagus to change. It is also a risk factor for esophageal cancer.

Esophageal cancer – There are two main types of esophageal cancer. Adenocarcinoma usually develops in the lower part of the esophagus. This type can develop

from Barrett's esophagus. Squamous cell carcinoma occurs in the cells that line the esophagus. It usually affects the upper and middle part of the esophagus.

Strictures – Sometimes the damaged lining of the esophagus becomes scarred, which can cause a narrowing of the esophagus. This can interfere with eating and drinking by preventing food/liquids from reaching the stomach.