Identifying the BURNING: Is it heartburn, acid reflux or GERD?
Most people experience it occasionally: that uncomfortable, aptly named sensation called heartburn that feels like punishment for a hearty meal. When indigestion is more than an occasional occurrence, doctors recommend checking for acid reflux or gastroesophageal reflux disease (GERD).
"The quality of life for people with chronic GERD can be just as diminished as the quality of life of someone suffering from chronic angina," said Mark Worthington, MD, AGAF, gastroenterologist, Yavapai Regional Medical Center (YRMC).
According to the National Institutes of Health, more than 60 million Americans experience heartburn-a symptom of acid reflux disease-once a month and 25 million have it every day. Some 48 million Americans, approximately 20 percent of the U.S. population, suffer from GERD.
What's the difference between acid reflux and GERD? The two conditions are closely related, but they aren't identical. Acid reflux occurs when the stomach acid produced during digestion flows backward into the esophagus, the tube that connects the throat and the stomach.
"The acid produced in the stomach serves many important functions," said Worthingon. "It kills bacteria, helps the body absorb nutrients and breaks down food. When stomach acid flows back into the esophagus, however, it can be very uncomfortable."
Acid reflux that worsens can progress to GERD, where actual tissue damage occurs. The symptoms of GERD include frequent heartburn, difficulty swallowing as well as coughing and wheezing. Some people experience chest pain, particularly when lying down. Many people report a bitter taste in the back of the throat. GERD can cause scarring and even a precancerous change in the esophagus called Barrett's esophagus, which affects up to 15 percent of people with GERD. People with Barrett's esophagus have an increased risk of esophageal cancer, a rare type of cancer that is difficult to treat.
Acid reflux and GERD can be caused by a hiatal hernia. This happens when a part of the stomach pushes upward toward the small opening in the diaphragm. Called the hiatus, this is the area through which food passes on the way to the stomach.
Other causes of acid reflux and GERD include:
Pressure on the stomach-Overweight adults suffering from acid reflux may find relief after losing five to 10 pounds. Some pregnant women report acid reflux, due to pressure on the stomach.
People who pursue activities that put pressure on their stomach muscles-marathon runners, weight lifters and opera singers - also may find themselves dealing with acid reflux.
Tobacco, alcohol and caffeine - Smoking can trigger acid reflux as can alcoholic beverages, coffee and tea.
Diet - Acid reflux culprits include: citrus fruits, chocolate, garlic, onions, peppermint, tomatoes and wintergreen. Also on the acid reflux trigger list are fatty foods, fried or spicy foods, and high-fat dairy products.
Treatment for acid reflux often begins with lifestyle changes such as:
losing excess weight;
eliminating trigger foods;
eating smaller meals; and
avoiding snacks before bedtime.
People who suffer from acid reflux or GERD should avoid aspirin, taking ibuprofen or naproxen and take acetaminophen, instead.
Over-the-counter medications, including antacids, histamine H2-blockers and proton pump inhibitors, may temporarily relieve occasional acid reflux symptoms. Prescription medications are also available to treat acid reflux and GERD.
Worthington may recommend medical devices, such as balloons and other dilators, to treat someone with a narrowed or scarred esophagus who is having difficulty swallowing.
"There are a number of treatment options for patients to limit acid contact with the esophagus," he said. "The prescription medications are very good and medical device manufacturers are also working on an optimal cure for acid reflux."
Worthington warns people with acid reflux and GERD to be aware of new symptoms associated with the conditions. Hoarseness or difficulty swallowing could signal Barrett's esophagus. If you're concerned about heartburn, contact your healthcare provider to find out if you're suffering from acid reflux or GERD. After all, everyone wants to enjoy mealtime.