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## mxz583 (Mar 19, 2000)

http://www.gerd.msn.com/gerd.asp What is GERD?Special to MSNBCMany of us experience heartburn from time to time, particularly after eating a spicy or fatty meal. But for as many as one in five Americans adults, persistent heartburn and other symptoms stem from a more serious, chronic condition known as gastroesophageal reflux disease, or GERD.With normal digestion, a circular band of muscle located between the esophagus and stomach widens to allow food to enter the stomach and then tightens. But when this muscle, known as the lower esophageal sphincter, weakens or relaxes inappropriately, acidic digestive juices in the stomach can flow back up, or ï¿½reflux,ï¿½ into the esophagus. Unlike the stomach, the esophagus does not have a protective barrier against the acid. As a result, reflux can cause irritation, inflammation and other damage to the esophagus that is often perceived as heartburn, an uncomfortable, burning sensation behind the breastbone. Occasional heartburn tends to occur after meals that are very large, eaten late in the evening or consisting of high-fat or spicy foods. Usually, itï¿½s nothing to worry about. ï¿½Everybody can have a little heartburn, but that doesnï¿½t mean you have a disease,ï¿½ says Dr. Joel Richter, chairman of the gastroenterology department at the Cleveland Clinic in Ohio. ï¿½You have GERD if the heartburn occurs two times a week or more.ï¿½ MILLIONS AFFECTEDStatistics on the incidence of heartburn and GERD vary. According to some estimates, 7 percent of Americans have heartburn daily and 14 percent have it at least once a week. Other figures suggest that GERD affects about 20 percent of the adult population in the United States, mostly those in their 40s or older. However, it can affect people of all ages, including children.In addition to frequent, persistent heartburn, GERD sufferers often experience regurgitation, in which the acidic stomach contents cause a sour taste in the mouth and may produce excess saliva. And because the disease tends to flare-up at night, sufferers may be plagued by disrupted sleep and daytime drowsiness. Still, others with GERD have no symptoms at all.While those with occasional heartburn can usually self-medicate with one of the various over-the-counter products, people with frequent heartburn who arenï¿½t helped by drugstore products, particularly if symptoms persist for four weeks or more, should consult a physician, experts say. ï¿½ALARMï¿½ SYMPTOMSA prompt trip to the doctor is absolutely essential for people who have what doctors call ï¿½alarmï¿½ symptoms. These include: Difficulty swallowing or feeling like food is stuck in the throat Vomiting or coughing up blood Bloody or very dark stools Unexplained weight loss Hoarseness Chest pains Because these could be signs of a more serious condition, such as cancer or heart disease, doctors will need to perform tests to identify the underlying cause.ï¿½Every year Iï¿½ll see two or three patients who think their chest pain is related to reflux when itï¿½s actually caused by heart disease,ï¿½ Richter said. ï¿½A lot of people die from undiagnosed heart disease.ï¿½Over the long-term, uncontrolled GERD can cause worrisome complications. One is esophagitis, an inflammation and erosion of the esophagus resulting from stomach-acid damage. Another is esophageal stricture, in which scar tissue causes the esophagus to narrow. In rare instances, a condition known as Barrettï¿½s esophagus, which is marked by changes to cells lining the lower esophagus, can lead to cancer.Statistics show that men are about twice as likely as women to develop esophagitis and nearly 10 times as likely to get Barrettï¿½s esophagus. And whites are at greater risk for Barrettï¿½s esophagus and esophageal cancer than non-whites.While GERD has been linked with asthma, cough and other pulmonary symptoms, a panel convened by the American Gastroenterological Association concluded there is not enough evidence to determine whether acid reflux can actually cause them.THE RIGHT DIAGNOSISWhat is clear, experts say, is that proper diagnosis and treatment are key in preventing complications from GERD and allowing patients to live their lives without disruptive, painful symptoms.Primary care doctors usually diagnose GERD based on the extent and duration of a patientï¿½s symptoms and whether the symptoms resolve with medication.Patients who arenï¿½t helped by even the strongest prescription medications and those who have alarm symptoms are advised to consult a specialist known as a gastroenterologist. The doctor may perform tests including an endoscopy, in which a thin lighted tube is placed down the throat to examine the esophagus and stomach. A tissue sample may be taken to check for cancer.Resources: American Gastroenterological Association (www.gastro.org) American College of Gastroenterology (www.acg.gi.org)International Foundation for Functional Gastrointestinal Disorders (www.iffgd.org)


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