Indigestion & GERD: An Overview

Maybe you call it heartburn, or indigestion or acid reflux.  Its not quite nausea…its GERD (rhymes with nerd).  Gastro Esophageal Reflux Disorder (GERD) is a bother to  over 40% of US people at some time in their life.  10% of the US Population experiences daily symptoms.  That’s a lot of people!!!  So lets take a few minutes to break down GERD, review what you’re actually feeling and review your treatment options. 

Ok, the top of your stomach sits at the bottom of your breast bone.  GERD feels like burning in your chest, tastes like stomach acid in your mouth and it might even make you vomit.  Some people feel like they can’t actually swallow their food, and others actually throw up.  What’s actually going on is the top of your stomach has a sphincter (ummm, yes, just like your backside…) and it works to keep your stomach acid inside your stomach where it belongs.  For a number of reasons that sphincter can malfunction.  It could just be the muscle tone isn’t there and it occasionally opens.  This is what happens most commonly.  Sometimes the pressure in your abdomen is more than the pressure of that sphincter, so it opens, spilling stomach acid.  (Think about a huge meal of tomato sauce, a loaf of bread and 4 beers). 

Sometimes stomachs don’t empty properly and this delay in digestion can also be a contributing factor to GERD.  Basically the bottom door of the stomach isn’t opening into the small intestines so the top door has constant pressure, thus GERD is present.

It could also be a physical problem called a hiatal hernia.  This is when the stomach (or part of the stomach at least) is actually sitting inside your chest.  This requires imaging to diagnose.  Until its really bad and you have surgery you treat this exactly like typical GERD. 

Also, people who are morbidly obese tend to have a combination of increased abdominal pressure, poor tone in their stomach sphincter AND a bunch of fancy interactions that puts them at an increased likelihood for GERD.  So just your weight alone can be a factor in this indigestion game!

SO WHAT CAN YOU DO IF YOU HAVE GERD?

Luckily, there are a lot of treatments options and almost all of them are available over the counter.  Yay!  So here goes:

All GERD treatment should have 2 equal pieces:

  1. Medicine that controls stomach acid
  2. Lifestyle modification

Medications:  These come in a few big classes, lets go from weakest up to the strongest….

Antacids: TUMS, Milk of Magnesia, Pepto….These are all medications that weakly counteract stomach acid.  They work fast, but they aren’t the most effective.  These are really only good for very occasional and/or mild GERD.  Also they can mess with digestion (like constipate you OR give you diarrhea…) . 

H2 Blockers: Zantac/Ranitidine or Pepcid/Famotidine, (Think of these as STRONG antacids):   Ok, now we’re cooking with gas.  H2 blockers are first line therapy for people with mild to moderate GERD.  These take about 30 minutes to work, but provide relief for a lot of people.

PPI:  Prilosec/omeprazole, Prevacid/lansoprazole or Nexium/esomeprazole.  These are the big dog and most effective GERD medications.  They’re the mainstay of treatment and many people take long courses of these medications.  Sometimes a few weeks of treatment works but often times people take PPIs daily for months or years.  If you’ve been taking OTC PPIs for months or years talk with your medical provider!!!  These medications take about 2-3 hours to start working, but control acid for 24 hours and work best if you take it about 30 minutes prior to breakfast. 

Try a PPI daily for at least 2 weeks, and buy the generic!!!

Lifestyle Modification: This should happen no matter what medicine you’re using to control GERD.  Ok, I know all of these sound like no fun – but if you’re suffering from indigestion…give them a try!

  • Avoid foods that cause GERD (Duh).  If you know your offender – avoid it!  Or take an H2 30 minutes prior to eating it.  Common foods that cause GERD include alcohol, tomato products, onions, chocolate and citrus. 
  • Eat smaller, more frequent meals.  Large meals cause an increase in stomach pressure, so eating smaller meals helps stop GERD.
  • Wait at least 3 hours after a meal before lying down.  We want to help your anatomy work, not make it work harder. 
  • Lose Weight.  It decreases abdominal pressure, helps about a million digestive hormones and chemicals work better and allows that stomach sphincter to operate properly.  Even losing 10 lbs can help GERD symptoms disappear.

TL/DR: Stomach sphincter malfunctions and acid gets into your esophagus.  Take an H2 blocker or a PPI daily for at least 2 weeks to relieve symptoms.  Buy the generic; name brand isn’t better.  Lose weight and avoid foods that cause GERD.

Ok – I remember a lot of this from my GI rotation, but I did have to look a few things up.  I used this article //https://emedicine.medscape.com/article/176595-overview  Its free for the public to access, but you do need to create an account.  Check it out if you want more info.  You can also email me at ceccard@gmail.com anytime if you have questions.

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