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Acid reflux

Left untreated, heartburn can turn into this more serious digestive disease: GERD

Because tens of millions of people are used to experiencing acid reflux or heartburn regularly, many don't realize when it becomes a more serious medical condition. Heartburn is the burning sensation you feel in your upper chest or that unsavory sour taste you get in the back of your mouth or down your throat. It's an extremely common condition that is treated by lifestyle or dietary modifications, or by antacids such as Tums, Pepcid Complete or Alka-Seltzer.

But when heartburn symptoms persist or go untreated, it often becomes a more worrisome condition called gastroesophageal reflux disease, or GERD. "It’s important to distinguish the difference between GERD and what we call heartburn," explains Matthew Hoscheit, MD, a gastroenterologist at the Neurogastroenterology & Motility Center at Cleveland Clinic. "GERD refers to the long-term damage to the esophagus and/or stomach that happens in people who have had heartburn for a long time."

What is GERD? 

In other words, GERD is a more serious form of acid reflux and a condition that often requires medical attention. Like heartburn, GERD is a digestive disease in which stomach acid and other contents reflux back up into one's esophagus after being swallowed, causing inflammation and bothersome symptoms. "Over time, GERD can lead to swelling and narrowing of the esophagus, which can also make swallowing difficult," says Allon Kahn, MD, a gastroenterologist at Mayo Clinic who specializes in GERD.Swallowing difficulties are called dysphagia.

Two features are especially prominent in a person dealing with GERD. The first is heartburn and the second is regurgitation. "Many GERD patients regurgitate acidic material mixed with small amounts of undigested food," says Michael Fredericson, MD, director of the Physical Medicine and Rehabilitation division of Stanford University. Regurgitation is often accompanied by more stomach acid than acid reflux alone, which can cause more damage or scarring to one's esophagus.

Other symptoms of GERD include intense chest pain and esophageal symptoms such as a chronic cough, hoarseness, or wheezing. "Though acid reflux may not seem like the obvious cause of these symptoms, it’s important to consider that it often is," says Hoscheit.

What is the main cause of GERD? 

GERD is caused by continual acid reflux from the stomach into the esophagus over a long period of time. This happens when the thick muscle we have at the bottom of our esophagus (known as the lower esophageal sphincter) doesn't stay tight when we aren't eating or drinking, "which allows things in the stomach to reflux back up into the esophagus," explains Hoscheit. While this is what happens to anyone experiencing acid reflux, it can happen more frequently in people with GERD. "This can lead to ulcers in the esophagus, a narrowing in the esophagus, and can be a risk factor for esophageal cancer," Hoscheit adds.

Kahn says this lower esophageal sphincter muscle barrier fails to stay tight for any number of reasons. "These include genetic predisposition, obesity, and even lifestyle factors such as the way we eat," he says.

How do you cure GERD? 

Because of this, treating GERD often begins with lifestyle changes such as "weight loss, avoiding food triggers, eating earlier before bedtime, and elevating the head of the bed," offers Kahn. Eating slower and limiting one's portion size may also be beneficial.

Medications can be helpful as well in patients with mild or intermittent GERD symptoms. Over-the-counter antacids can still be effective if GERD is caught early enough and, in moderate cases, proton pump inhibitors are frequently recommended. These medicines work by reducing the amount of stomach acid produced in the lining of one's stomach.Fredericson says these medications are safe and effective in treating GERD, but are initially recommend "at a low dose and then increased to standard doses if required." 

In more advanced cases, "anti-reflux surgery can be a very effective long-term approach for those with more severe symptoms or those that don’t respond to medication and lifestyle changes," says Kahn.This may involve a procedure where the opening of one's diagram is tightened to prevent stomach acid and other contents from refluxing.

And if scarring or inflammation has occurred, any narrow parts of the esophagus can be widened by a physician guiding a small dilator down the throat to expand it as needed. This minor procedure is called an esophageal dilation and can be helpful for treating GERD patients who are experiencing difficulty swallowing.

"If GERD is left untreated, it can lead to serious complications," says Kahn. "Therefore, it is important that patients with chronic symptoms of GERD be evaluated by a medical provider."

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