01.08.2015 Nutrition

Understanding GERD

Dr Sandra Cabot discusses the common condition Gastro-Esophageal Reflux Disease (GERD) in this extract from her book Healthy Bowel Healthy Body

This is a common problem and is known by the acronym GERD and stands for Gastro-Esophageal Reflux Disease. Over time the reflux of stomach acid causes reflux esophagitis (meaning inflammation of the esophagus). GERD is also called "heartburn," although it has nothing to do with the heart. It may produce a burning discomfort behind the sternum which may extend up into the throat or may not produce any symptoms. If reflux occurs during sleep when you are horizontal, you may awake with a sore throat or a husky voice and an irritating cough.

GERD is caused by the acid contents of the stomach regurgitating or flowing backwards into the esophagus. The lining of the esophagus is not designed to handle these high acid conditions, which lead to inflammation, and in severe cases, scarring and ulceration of the lining of the esophagus.

The stomach produces a lot of hydrochloric acid during eating and for good reason, because without it, you cannot digest proteins efficiently and you will not absorb calcium and other minerals from foods.

There is a circular muscle around the lower esophagus, which divides it from the stomach, and this normally remains contracted to prevent back flow of stomach acid. During swallowing this muscle normally relaxes, allowing food to pass from the esophagus into the stomach, after which it should remain contracted. If this circular muscle becomes weakened or too relaxed, reflux can occur after meals.

If you are overweight and/or have a fatty liver, this will cause too much pressure on the stomach, and reflux becomes worse. If you eat a lot of sugar or refined carbohydrates such as cakes and biscuits,

this will feed unhealthy bacteria in the stomach and this will make your stomach inflamed and overly sensitive to the hydrochloric acid. Thus is it vital to avoid sugary foods.

In some people with reflux there is also a hernia (protrusion) of the upper part of the stomach through the diaphragm into the lower chest. This is called a hiatus hernia and can be hereditary and is more common with age and in those who are overweight. A hiatus hernia will impair the function of the circular muscle around the lower esophagus. This increases reflux and heartburn symptoms. These symptoms are much worse after eating a large meal and while bending over.

If you suffer with long standing esophageal reflux it is important to see your gastroenterologist regularly, because prolonged exposure of the fragile esophageal mucosa to acid can result in an increased risk of esophageal cancer, severe scarring and narrowing (stricture formation). The passage inside the esophagus can become so narrowed that a stricture develops. This causes difficulty in swallowing normal amounts of food and results in pain, obstruction, or vomiting up the food that gets stuck. Surgery to enlarge the lower esophagus may then become necessary.

In severe cases of reflux esophagitis, medications to block stomach acid production should be taken if natural therapies fail. These are very effective and examples of these drugs are cimetidine, famotidine, nizatidine, rantidine and omeprazole.

Antacid drugs

The most common drugs used to reduce acid production by the stomach are Proton Pump Inhibitors (PPIs) and Histamine 2 Receptor Antagonists. Examples of these drugs are esomeprazole and pantoprazole.

These drugs are amongst the world's most commonly prescribed drugs. They are used to medically treat gastric and duodenal ulcers and Gastro-Esophageal Reflux Disease (GERD). They may also be used to prevent stomach and duodenal ulcers associated with the use of non-steroidal anti-inflammatory drugs. PPIs reduce the production of stomach acid by blocking the enzyme in the wall of the stomach that produces acid.There may be side effects from using these drugs long term and they include –

An increased risk of developing osteoporosis (bone loss). High dose therapy with PPIs and/or Histamine-2 Receptor Blocker drugs can significantly increase the risk of hip fractures.Impaired absorption of minerals (such as magnesium, zinc and calcium)An increased risk of vitamin B12 deficiency - this can be serious as B12 is required for the nervous system to function normally. In people taking antacid drugs, an annual test for vitamin B12 blood levels should be done. If vitamin B12 levels are found to be low, B12 injections must be given every 6 weeks.Long term side effects of these drugs have even proven to be fatal in some extreme cases. An article in the JAMA Internal Medicine 2013 cites a 50% increased death risk post-discharge from hospital in elderly patients who have been given too many drugs (known as poly-pharmacy), including the proton pump inhibitor drugs. It is best to use the smallest dose of these drugs possible to try to avoid these potentially serious side effects.

Natural therapies and weight control can often bring great relief to those with excess stomach acidity or reflux.

Next month we'll look at simple techniques to reduce GERD symptoms.

Healthy Bowel Healthy Body by Dr Sandra Cabot is available in all good bookstores or online at cabothealth.com.au Also available from Amazon and Apple iBooks as an e-book.

Dr Sandra Cabot