Heartburn (GERD)

What Is GERD? What is a Hiatal Hernia?

GERD stands for Gastro Esophageal Reflux Disease. “Gastro” refers to the stomach. Esophageal refers to the esophagus , the tube that carries food from the mouth to the stomach. Reflux means to back-up or flow backwards. GERD is a condition in which acid, bile and partially-digested food in the stomach back up into the esophagus.

Acid reflux; GERD

  • Partially digested food contains a strong acid. It also contains powerful enzymes that break down food. When acid and enzymes come into contact with the esophagus, they cause irritation, inflammation, pain, and other symptoms.
  • The stomach lining has a special protective layer that protects the stomach from acid attack. However, this protective layer does not exist in the esophagus, making it vulnerable to damage from stomach acid and digestive enzymes.

Stomach lining

  • Many people think that heartburn (or acid indigestion) is a separate disease. It actually is one symptom of GERD. Heartburn is an unpleasant burning sensation behind the breastbone that usually occurs after a meal.
  • Most individuals with GERD also have hiatal hernias , which make it easier for stomach contents to reflux into the esophagus. Ahiatal hernia occurs when part of the stomach bulges into the chest cavity through an opening in the diaphragm (hiatus). The diaphragm is a sheet of muscle that separates the stomach cavity from the chest cavity.

Hiatal hernia

Facts About GERD

  • One 1 in every 4 Americans, or about 60 million people, experience heartburn at least once a month.
  • Almost 15 million people have heartburn each day.
  • Heartburn is very common during pregnancy. More than 50 percent of pregnant women have it occasionally and 5 per cent have it daily.
  • About 80 percent of people with GERD have a hiatal hernia, which makes heartburn and other symptoms more likely.
  • Hiatal hernias are very common, affecting about 15 percent of Americans. Yet only a small number of people with hiatal hernias have any symptoms.
Nice To Know:

Is GERD a new disease?

GERD is a relatively new term for recognized conditions commonly called “acid indigestion,” “heartburn,” “reflux,” “reflux esophagitis,” and “hiatal hernia.” Doctors started using the term “GERD” in the 1980s because it better describes the real problem – reflux of irritating stomach contents into the esophagus. GERD is becoming the preferred medical term for these conditions.

  • Many people have never heard the term GERD and are not aware that GERD can have potentially serious health effects.
  • Doctors may still use other terms for conditions that actually are symptoms of GERD.
Nice To Know:

Q. What is heartburn, anyway? How does eating certain foods make the heart burn?

A. Heartburn has nothing to do with the heart. It’s a popular term for the burning sensation that occurs behind the breastbone, right in the area where the heart is located. The esophagus also runs through the same region of the chest. It carries food from the mouth into the stomach, where a strong acid and enzymes help to digest it. When stomach contents back up into the esophagus, the acid and enzymes cause irritation and inflammation. That’s the burning sensation in heartburn.

 


What Are The Symptoms Of GERD?

Heartburn is the most common symptom of GERD. It feels like a burning chest pain right behind the breastbone. Pain may move upward toward the throat. It often is worse after meals. Bending over or lying down also may make heartburn worse. Standing up may bring relief. Heartburn often occurs after going to bed at night.

Other GERD symptoms include:

  1. Burping-up, or regurgitation, of sour-tasting, acidy material into the mouth.
  2. Difficult or painful swallowing.
  3. Sore throat, hoarseness, and/or cough.
  4. Wheezing in people with asthma.

GERD also occurs in young children who may have the same symptoms as adults but cannot describe them. The only noticeable symptoms in infants and children may be vomiting, coughing, wheezing or other respiratory problems, and failure to gain weight normally.

Need To Know:

GERD symptoms can resemble those of a heart attack or other heart disease. The symptoms may also be similar to those of an ulcer, gallstones, or pancreatitis

Your doctor’s examination, and special investigations if needed, will identify the cause of the symptoms.

 


What Causes GERD?

GERD occurs when a muscle at the lower end of the esophagus does not work properly. The muscle is called the lower esophageal sphincter (LES)Sphincters are ring-like bands of muscle that contract, or squeeze together, to close off body passageways. The body has many sphincters. Perhaps the most familiar is the anal sphincter, which seals off the rectum between bowel movements.

  • The LES acts like a one-way valve that closes off the esophagus. It allows food to travel freely downward into the stomach. But it also seals off the stomach, preventing partially digested food from refluxing, or passing back up, through the esophagus.
  • Normally, the LES closes immediately after a person swallows food, keeping irritating stomach acid and digestive enzymes out of the esophagus.
  • In individuals with GERD, the LES may not close in a normal way or relaxes inappropriately between swallows. Stomach juices and partially digested food may flow back up and burn the lower esophagus. The result is heartburn and other symptoms ofGERD.

GERD and Hiatal Hernia

hiatal hernia occurs when part of the upper stomach bulges, or herniates, into the chest cavity. It bulges through a natural opening in the diaphragm where the esophagus enters the abdominal cavity. A hiatal hernia is named for the opening, which is called the esophageal hiatus. Some people are born with a hiatal hernia. Others develop one later in life.

hiatal hernia can contribute to GERD in two ways:

  • The diaphragm muscles normally wrap around the lower esophageal sphincter (LES). These muscles contract with the LES, adding their force to help close off the esophagus and prevent reflux. When a hiatal hernia occurs, the LES slides up into the chest cavity. But since the diaphragm remains in the same place, it can no longer add its muscle power to the LES. As a result, the LES does not contract completely.
  • The esophagus normally connects to the stomach at a sharp angle. Tissue from the esophagus and stomach at this point form a bend that acts like a second stomach valve. When the stomach is full, the bend can help seal off the stomach and prevent reflux. When a hiatal hernia pulls the stomach into the chest, the bend becomes less sharp and is less effective as a valve.

Nice To Know:

Is there a link between GERD and asthma?

Although the two diseases seem very different, doctors think that a connection may exist. Asthma is a condition in which the small airways in the lungs are inflamed. Many people with asthma also have an abnormal lower esophageal sphincter. In addition, there have been medical reports of asthma patients being cured after surgery for hiatal hernia. Treatment of GERD with drugs or lifestyle changes may also reduce asthma symptoms.

Doctors think that GERD can cause asthma symptoms in two ways:

  1. By irritating the lungs. People with GERD may inhale droplets of acid material into their lungs without being aware of it. The acid material irritates the delicate lining of the lungs, causing small airways to go into spasm. The irritation may trigger an asthma attack or chronic cough.
  2. By irritating nerve endings. Acid may dissolve the lining of the esophagus, exposing parts of a major nerve that also affects the lungs. Irritation of the nerve sends a signal to the lungs, causing small airways to go into spasm.

Doctors often suspect that GERD is causing asthma when:

  • Asthma begins in an adult.
  • Asthma symptoms get worse at night, after meals, or after lying down.
  • Standard asthma treatments do not relieve symptoms.

 


How Are GERD And Hiatal Hernia Diagnosed?

Doctors can often diagnose GERD just on the basis of symptoms that individuals with the disease describe. Primary care doctors are very familiar with the symptoms of GERD and can diagnose and treat most cases. Some individuals, however, may require care from gastroenterologists, doctors who specialize in GERD and other diseases of the digestive system.

If the symptoms are relatively mild, the doctor may first try treatment before performing tests. However, if the symptoms continue, or get worse, tests can determine what is causing the problem.

Barium x-rays

Endoscopic examination

Barium X-rays

Barium x-rays, also called an “upper GI series,” are x-rays of the upper gastrointestinal tract. The procedure is performed as follows:

  • The patient swallows a drink containing barium, a material that is visible on x-rays. Barium coats the inner lining of the esophagus and stomach and gives them a white highlighted appearance. The individual having the x-ray usually has to fast several hours in advance, so the stomach is empty and clearly visible.
  • The radiologist watches the flow of barium as the patient swallows. He checks to see whether the esophagus and stomach are normal. Hiatal hernias, narrowing of the esophagus, ulcers, and other problems may be clearly visible. The radiologist also may tilt the examining table slightly so that the patient’s head is slightly lower than the feet. That position encourages reflux of the stomach contents into the esophagus. Reflux may be visible as a backward flow of the white-colored barium.

Endoscopic Examination

Endoscopic examination of the esophagus and stomach is performed by the doctor passing a thin, flexible tube through the mouth and into the esophagus and stomach. The tube is called an endoscope, an instrument with a tiny viewing camera at the end that allows the doctor to see the esophagus and stomach directly. By passing mini-instruments through the channel in the endoscope, the doctor also can take samples of tissue for examination under a microscope.

Nice To Know:

  • The endoscope is thin and easy to swallow.
  • Individuals getting the test don’t gag because the doctor sprays an anesthetic solution into the throat before the test.
  • A mild sedative also helps by relieving anxiety about the examination.

Acid Testing

Certain tests (the “Bernstein Test” and others) can be performed to determine if the symptoms originate from acid in the esophagus. Testing for acidity levels (pH) over a 24-hour period may also give the doctor more information that will help in selecting the most appropriate treatment.


What Is The Treatment For A Hiatal Hernia?

Treatment depends on the kind of hiatal hernia. A hiatal hernia can be either para-esophageal or sliding.

Sliding Hernias

  • Sliding hiatal hernias are the most common. They occur when part of the stomach bulges through the diaphragm and into the chest cavity when a person swallows food. The hernia actually slides back and forth between the abdominal and chest cavities.
  • Sliding hiatal hernias usually do not cause symptoms and do not require treatment.
  • When symptoms do occur, their treatment is the same as for GERD.

Para-esophageal Hernias

  • Para-esophageal hernias are the least common. They occur when part of the stomach bulges into the chest cavity and stays there all the time. A large para-esophageal hernia may make it difficult for food to pass normally into the stomach. In addition, ulcers may form in the herniated part of the stomach.
  • Surgery is the treatment for large para-esophageal hernias. During the operation, the surgeon moves the herniated area of stomach back into the abdominal cavity. He then tightens the esophageal hiatus, making it smaller so the stomach can no longer bulge through. Finally, he makes sure that the esophagus is firmly attached to the diaphragm.

How Is GERD Treated?

GERD can be treated with lifestyle changes, medication, or surgery. Many people with GERD improve a great deal by eliminating factors in their daily lives that contribute to reflux. Lifestyle changes often are used in combination with non-prescription or prescription drugs. In the rare cases, however, when those measures fail, surgery can provide relief.

  • Lifestyle changes
  • Medication
  • Surgery

Lifestyle Changes

GERD may occur less often or disappear after individuals make simple changes in daily life. Changes involve eliminating factors that cause reflux.

  • Some common foods and beverages increase the risk of reflux by relaxing the lower esophageal sphincter (LES). Reflux triggers include alcoholic beverages, chocolate, carbonated beverages, coffee, tea, soft drinks containing caffeine, spicy foods, and fatty foods.
  • Cigarettes contain chemicals that also relax the LES as they pass from the lungs into the blood.
  • Obesity increases abdominal pressure, forcing stomach contents past the LES. In some cases, GERD symptoms disappear completely after an overweight person looses 10-15 pounds.
  • Sleeping habits can trigger GERD. Lying down flat presses the stomach’s contents against the LES. When a person goes to bed within two-three hours of heavy eating or drinking, a meal which includes GERD-triggering foods – spicy food, wine, coffee, and a chocolate desert, for instance – makes matters much worse.
  • Clothing that fits tightly around the abdomen squeezes the stomach. It can force food up against the LES. Problem clothing includes tight-fitting belts and slenderizing undergarments.

How-To Information:

Tips on Avoiding Heartburn and Other GERD Symptoms

  • Eat smaller meals. A full stomach puts extra pressure on the lower esophageal sphincter (LES), increasing the chances that food will reflux into the esophagus.
  • Loose weight if you are overweight. Obesity increases abdominal pressure, which can push stomach contents up into the esophagus.
  • Stop smoking. Chemicals in cigarette smoke weaken the LES .
  • Sleep with your head raised a few inches. Sleeping with the head higher than the stomach reduces the pressure at which partially digested food in the stomach presses on the LES. Try using an extra pillow. Place books, bricks, or blocks securely under the legs at the head of your bed. A foam wedge extending from buttocks to head provides the best form of elevation.
  • Avoid eating within two-three hours of bedtime. Lying down with a full stomach results in stomach contents pressing harder against the LES, increasing chances that food will reflux.
  • Avoid tight-fitting belts or garments around the waist. They squeeze the stomach, and may force food to reflux into the esophagus.
  • Avoid bending over or stooping after meals. Lift objects by keeping the upper part of your body straight and bending your knees.
  • Avoid foods and beverages that can trigger GERD. Some foods weaken the LES. They include: alcohol; coffee, tea, cola drinks, and other beverages containing caffeine; carbonated beverages; chocolate; citrus fruits and juices; tomatoes and tomato sauces; and spicy foods.

Medication

Medications can be used when lifestyle changes alone do not bring adequate relief. Many people with heartburn and GERD self-treat their symptoms with non-prescription drugs. Antacids and other products can ease the immediate symptoms. But they seldom bring complete relief. Several prescription drugs can be more effective. Doctors use three groups of medications to treat GERD.

  1. Prokinetic medications work by increasing the pressure of the lower esophageal sphincter (LES) . By causing the LES to contract with greater force, they reduce the chances that food will reflux into the esophagus. These medications include Propulsid(cisapride), Reglan (metoclopramide), and Bethanacol(urecholine). Propulsid is being removed from the market because of evidence that it can cause serious disturbances in heart rhythm. People taking Propulsid should contact their physician about an alternative medicine.
  2. Proton pump inhibitors suppress almost all acid production in the stomach. These medications include Prilosec (omeprazole),Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix(pantoprazole), and Nexium (esomeprazole). Although they do not prevent GERD, these drugs allow inflammation and other damage in the esophagus to heal by reducing the acidity of refluxed stomach contents.
  3. Histamine blockers partially suppress the production of stomach acid by blocking the action of histamine on cells in the stomach lining. Histamine is a protein that signals stomach cells to make hydrochloric acid. These drugs help inflammation in the esophagus to heal by reducing the acid that causes it. Some are available as non-prescription medicines in a lower strength. Examples of non-prescription histamine blockers include Zantac (ranitidine),Tagamet (cimetidine), and Pepcid (famotidine).

Nice To Know:

Q. I’ve always used an antacid for heartburn. Is there anything more effective?

A. Antacids counteract, or neutralize, acid after the stomach produces it. They must be taken repeatedly as the stomach makes more acid. Several drugs do a much better job than antacids. Non-prescription strengths of TagametZantac, and Pepcid, for instance, block some acid production in the stomach. Several prescription drugs likePrilosec, Prevacid, Aciphex, and Nexium actually shut off almost all acid production. Other prescription drugs like Propulsid and Reglan attack the real cause of GERD by making the valve between the stomach and the esophagus contract with greater force; these drugs help most by improving or speeding up the emptying of the stomach. Your doctor will suggest the most appropriate medication.

Surgery

When severe symptoms of GERD persist after lifestyle changes and drug treatment, surgery may provide relief. In the past, surgical treatment of GERD required a large abdominal incision and meant a long period of recovery. The use of a laparoscope, a thin viewing tube, and the development of laparoscopic surgery methods, however, has made surgery for GERD easier on patients. Laparoscopic surgery, a minimally invasive procedure, is done through small incisions. Patients can leave the hospital quicker, and recover faster.

For further information about laparoscopy, go to Laparoscopy.

  • Laparoscopic anti-reflux surgery is the most common form of surgery for GERD. The operation is sometimes called Laparoscopic Nissen Fundoplication. It involves strengthening the lower esophageal sphincter (LES) by wrapping part of the upper stomach around the sphincter and lower esophagus. The flap of stomach fits around the esophagus much like a hot dog bun fits around a hot dog. It reinforces the LES, helping the sphincter to close more strongly.
  • In some cases, the conventional “open” surgery (called Nissen Fundoplication) which requires a larger abdominal incision, may be needed. It is used mainly when surgeons are not able to see abdominal structures through the laparoscope because of scar tissue from past operations or other complications.
  • If a hiatal hernia also is present, it usually will be repaired during anti-reflux surgery.

Nice To Know:

Q. Will I need surgery for a hiatal hernia? The doctor thinks a hiatal hernia is causing my stomach problems, He wants me to have a series of upper GI x-rays to be sure. Now I’m worried that if the x-rays show a hernia, I’ll have to undergo an operation.

A. Hiatal hernias are very common. In most people they don’t even cause symptoms. A hiatal hernia, however, may cause heartburn and other symptoms of GERD. Those symptoms usually can be treated with lifestyle changes or medications. Relatively few people with hiatal hernias need surgery. Even then, new laparoscopic surgery is a lot easier on patients because it involves less discomfort and a faster recovery.

 


What Can Happen If GERD Persists?

In some cases, GERD may occur for a brief period of time and then disappear forever. Women, for instance, may experience GERD during pregnancy and never again. Obese people who permanently lose weight may be cured of GERD. Often, however, GERD is a chronic disease that does continue. Fortunately, most people have mild GERD that occurs once in a while. It almost never causes any serious or permanent damage to the body. People with mild GERD learn what foods and other factors trigger their symptoms and can usually avoid GERD attacks.

However, severe GERD that continues for years without proper treatment can damage the esophagus and result in serious health problems:

  • Esophagitis, an inflammation of the lining of the esophagus that may cause bleeding and ulcers .
  • Esophageal stricture, a narrowing of the inner part of the esophagus caused by scar tissue.
  • Dysphagia means difficulty swallowing and is due to the strictures and narrowing that obstructs the esophagus, causing difficulty swallowing food and saliva. When swallowing food, especially meat, individuals with strictures may feel that food is sticking in the esophagus in middle of their chest.
  • Barrett esophagus, a condition in which stomach-lining cells start growing in the esophagus. This condition slightly increases the risk that a person will develop cancer of the esophagus.

How Are The Complications of GERD Treated

People with complications of GERD may be treated with the same methods used to prevent reflux. Lifestyle changes, medication, or anti-reflux surgery can reduce reflux and additional damage to the esophagus. Further treatment, however, is usually needed if serious complications develop.

  • Esophageal stricture and dysphagia
  • Barrett esophagus and esophageal cancer

Esophageal Stricture And Dysphagia

Several non-surgical procedures are available for treating esophageal stricture the narrowing of the esophagus that may result in difficulty swallowing. They involve dilating (which means widening) the narrowed area of esophageal tissue.

  • An endoscope can be used to place an uninflated balloon into the opening of the stricture. The balloon is then inflated to open the stricture and restore the channel in the esophagus.
  • Surgical instruments called dilators can be inserted into the esophagus from the mouth to open the stricture. The doctor starts with small dilators, and uses larger ones until the stricture has been opened.
  • If a piece of meat or other food gets trapped in an esophageal stricture, completely obstructing the esophagus so that the person is unable to swallow – even saliva, the obstruction usually can be removed using an endoscope.
  • Very rarely surgery is required to bypass the blockage

Barrett Esophagus And Esophageal Cancer

Doctors should advise individuals with Barrett esophagus to have regular endoscopic examinations of the esophagus since there is a small risk that cancer can develop in this area. If cancer does occur, it will then be detected early and in a more curable form. Esophageal cancer usually is treated with surgery or radiation therapy.


How Are The Complications of GERD Treated?

People with complications of GERD may be treated with the same methods used to prevent reflux. Lifestyle changes, medication, or anti-reflux surgery can reduce reflux and additional damage to the esophagus. Further treatment, however, is usually needed if serious complications develop.

  • Esophageal stricture and dysphagia
  • Barrett esophagus and esophageal cancer

Esophageal Stricture And Dysphagia

Several non-surgical procedures are available for treating esophageal stricture the narrowing of the esophagus that may result in difficulty swallowing. They involve dilating (which means widening) the narrowed area of esophageal tissue.

  • An endoscope can be used to place an uninflated balloon into the opening of the stricture. The balloon is then inflated to open the stricture and restore the channel in the esophagus.
  • Surgical instruments called dilators can be inserted into the esophagus from the mouth to open the stricture. The doctor starts with small dilators, and uses larger ones until the stricture has been opened.
  • If a piece of meat or other food gets trapped in an esophageal stricture, completely obstructing the esophagus so that the person is unable to swallow – even saliva, the obstruction usually can be removed using an endoscope.
  • Very rarely surgery is required to bypass the blockage

Barrett Esophagus And Esophageal Cancer

Doctors should advise individuals with Barrett esophagus to have regular endoscopic examinations of the esophagus since there is a small risk that cancer can develop in this area. If cancer does occur, it will then be detected early and in a more curable form. Esophageal cancer usually is treated with surgery or radiation therapy.


What Is The Outlook For GERD?

Scientists are trying to develop better drugs to treat GERD. These include medications that have more powerful effects on encouraging the lower esophageal sphincter to clamp shut and prevent acid reflux into the esophagus. In addition to being more effective, new drugs may be safer with fewer undesirable side effects.

Future developments also include improved forms of surgery for GERD. Scientists are developing smaller surgical tools for laparoscopic, or minimally invasive, surgery. These tools may permit anti-reflux operations with even smaller incisions.

New techniques for endoscopic treatment of reflux have been introduced and offer some promise of providing relief from GERD symptoms. If these new methods are proven effective and safe, this will mean less discomfort and faster recovery for patients. Scientists also are studying the long-term effects of surgery to see whether it should have a wider role in the treatment of GERD.


Heartburn (GERD): Frequently Asked Questions

Here are some frequently asked questions related to heartburn and hiatal hernia (GERD).

Q: The doctor thinks my acid indigestion actually is a different disease. She calls it GERD. Is this a new disease?

A: GERD is just a fairly new term for diseases that once were called heartburn, acid indigestion, and hiatal hernia. It stands for Gastro Esophageal Reflux Disease. Doctors use the term because it describes the problem – a back flow of acid from the stomach into the esophagus – that causes the symptoms of these diseases. A lot of patients and even some doctors are still not fully aware of GERD.

Q: What is heartburn, anyway? How does eating certain foods make the heart burn?

A: Heartburn has nothing to do with the heart. It’s a popular term for the burning sensation that occurs behind the breastbone, right in the area where the heart is located. The esophagus also runs through the same region of the chest. It carries food from the mouth into the stomach, where a strong acid and enzymes help to digest it. When stomach contents back up into the esophagus, the acid and enzymes cause irritation and inflammation. That’s the burning sensation in heartburn.

Q: My husband complains about bad heartburn after big meals. Sometimes he can barely breathe. My husband also is overweight and smokes a lot. He insists it’s just indigestion. Shouldn’t he see a doctor to be sure?

A: Absolutely. Doctors usually must do tests to be sure. A surprising number of people with heart attacks delay getting emergency medical help because they think the pain is just indigestion. It can be very difficult to decide when chest pain is indigestion and when it’s something more serious. Your husband already is at high risk for a heart attack from smoking and being overweight. He should discuss the symptoms with a doctor.

Q: Will I need surgery for a hiatal hernia? The doctor thinks a hiatal hernia is causing my stomach problems, He wants me to have a series of upper GI x-rays to be sure. Now I’m worried that if the x-rays show a hernia, I’ll have to undergo an operation.

A: Hiatal hernias are very common. In most people they don’t even cause symptoms. A hiatal hernia, however, may cause heartburn and other symptoms of GERD. Those symptoms usually can be treated with lifestyle changes or medications. Relatively few people with hiatal hernias need surgery. Even then, new laparoscopic surgery is a lot easier on patients. They have less discomfort and recover quicker.

Q: One of my friends at work read that GERD can cause asthma, especially in adults. I started having asthma attacks at age 35. Asthma drugs don’t work very well for me, either. How could a stomach problem like GERD cause a lung problem like asthma.?

A: Doctors have found a link between GERD and asthma. They think that people with GERD may inhale droplets of the acid material that backs up into the esophagus. That material may irritate the lungs, causing small airways to go into the spasm that occurs in an asthma attack. Another theory is that acid irritates nerve endings in the esophagus. The same nerve serves the esophagus, lungs, and other structures in the chest. Irritation of nerve endings in the esophagus may send a signal to the lungs, causing airways to go into spasm.

Q: I’ve tried lifestyle changes and drugs. But I’m still having indigestion and other GERD symptoms several times a week. The doctor is recommending surgery to keep acid from refluxing into my esophagus. I’d rather put up with the indigestion. Can untreated indigestion cause any serious health problems?

A: Left untreated for years, severe GERD can have potentially serious effects. It may damage the esophagus so much that scar tissue forms causing narrowed areas called strictures. Strictures can trap food and cause difficulty with swallowing. About 10 percent of people with severe GERD also develop Barrett esophagus. That’s a condition in which stomach cells grow in the esophagus. Barrett esophagus may increase the risk of cancer of the esophagus.

Q: The doctor said lifestyle changes may cure my GERD. One suggestion was to elevate the head of my bed so that gravity helps to keep my stomach contents in my stomach. How can I elevate the bed?

A: One simple way is to use an extra pillow to raise the upper part of your body. Another is to place objects under the legs at the head of your bed. Try putting a couple of thick books, bricks, or blocks of wood under each leg. It takes a strong person to lift one side of the bed, while another person other places the objects. Once the bed is raised, make certain that the objects are stable and won’t slip out.

Q: I’ve always used an antacid for heartburn. Is there anything more effective?

A: Antacids counteract, or neutralize, acid after the stomach produces it. They must be taken repeatedly as the stomach makes more acid. Several drugs do a much better job than antacids. Non-prescription strengths ofTagametZantac and Pepcid, for instance, block some acid production in the stomach. Several prescription drugs like Prilosec and Prevacidactually shut off almost all acid production. Other prescription drugs attack the real cause of GERD by making the valve between the stomach and the esophagus contract with greater force. Discuss this with your doctor.


Heartburn (GERD): Putting It All Together

Here is a summary of the important facts and information related to heartburn and hiatal hernia (GERD).

  • GERD means Gastro Esophageal Reflux Disease. It involves the “backward flow” of stomach contents into the esophagus.
  • GERD is a relatively new term for heartburn, acid indigestion, and hiatal hernia.
  • Hiatal hernia occurs when part of the upper stomach herniates, or bulges, into the chest cavity.
  • Heartburn is a symptom of GERD, and not a separate disease.
  • Most people with GERD also have a hiatal hernia.
  • Simple lifestyle changes, often combined with medication, can treat most cases of GERD.
  • If severe and untreated, GERD can have serious complications.

Heartburn (GERD): Glossary

Here are definitions of medical terms related to heartburn and hiatal hernia (GERD).

Abdomen: The body cavity located just below the ribcage that contains the organs of digestion.

Asthma: A condition in which the small airways in the lungs are inflamed and become narrow when the person is exposed to something to which he or she is sensitive, causing difficulty in breathing.

Barrett esophagus: A rare complication of GERD where stomach cells start growing in the esophagus, sometimes leading to esophageal cancer.

Diaphragm: A sheet of muscle that separates the chest and abdominal cavities.

Dysphagia: A condition in which swallowing is difficult or painful and food is held up in its passage to the stomach.

Endoscope: A thin, flexible tubular instrument with a light at the end that is used to view the interior of the body, help in diagnosing diseases, and perform minimally invasive surgery.

Esophageal hiatus: An opening in the diaphragm that allows the esophagus to pass through into the abdominal cavity.

Esophageal stricture: A narrowing in the esophagus from chronic scarring, sometimes caused by acid damage, that interferes with swallowing of food and saliva.

Esophagitis: An inflammation of the lining of the esophagus that may cause bleeding and ulcers.

Esophagus: The muscular tube through which food passes from the mouth to the stomach.

Gastroenterologist: A doctor who specializes in diseases of the digestive system.

Heartburn: A burning sensation behind the breast bone that occurs when stomach acid flows back up into the esophagus.

Hiatal hernia: A condition that occurs when part of the stomach bulges up into the chest cavity through the hole (hiatus) for the esophagus.

Histamine blockers: Drugs used to treat GERD, such as Zantac andTagamet, that partially reduce the amount of acid produced in the stomach.

Laparoscope: An illuminated viewing tube and surgical instrument that is inserted through a small incision in the abdominal wall to perform minimally invasive surgery.

Lower esophageal sphincter (LES): A band of muscle tissue that contracts during swallowing, preventing stomach contents from flowing back up into the esophagus.

Prokinetic medications: Drugs used to treat GERD, such as Reglan, that reduce backflow of stomach contents by causing the lower esophageal sphincter to close more completely.

Proton pump inhibitors: Drugs used to treat more severe cases of GERD, such as Prilosec and Prevacid, that act in the last stage of acid secretion in the body and almost completely suppress acid production in the stomach.

Radiologist: A specialist who uses x-rays and other forms of radiation in diagnosing and sometimes treating diseases.

Reflux: The backflow of stomach contents up into the esophagus.

Sphincter: A band of tissue that acts like a one-way valve, allowing substances in the body to flow in one direction.

Ulcer: A break in the skin or in the mucous membrane lining the digestive tract, which may become inflamed..

Upper GI series: (also called barium x-rays), A series of x-rays of the esophagus and stomach taken as the patient swallows a drink containing barium, a material that is visible on the x-rays.


Heartburn (GERD): Additional Sources of Information

Here are some reliable sources that can provide more information on heartburn and hiatal hernia (GERD).

National Digestive Diseases Information Clearinghouse 
www.niddk.nih.gov/health/digest/nddic.htm

American Gastroenterological Association 
Phone: 301-654-2055
www.gastro.org

American College of Gastroenterology 
Phone: 703-820-7400
www.acg.gi./org

National Institute of Diabetes & Digestive & Kidney Diseases Office of Communications and Public Liaison 
www.niddk.nih.gov


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