# Webmd Article on GERD: How You Can Spell "Relief"



## JeanG (Oct 20, 1999)

The url for this article is: http://my.webmd.com/content/article/1728.64014 How You Can Spell "Relief" Heartburn Is a Serious Problem, But It's Treatable By Susan A. Steeves WebMD Medical News Reviewed by Dr. Dominique S. Walton Nov. 13, 2000 -- Television ads for the over-the-counter tablets designed to relieve heartburn often are almost comical. But the disorder is no laughing matter for the 60 million Americans who experience it at least once a month. Long-term, severe cases often result in destruction of the esophagus and may lead to one of America's most rapidly increasing forms of cancer. Fortunately in recent years, doctors have found effective ways of treating acid indigestion, chronic cases of which are called gastroesophageal reflux disease (GERD). But many of the treatments people often rely on, such as sleeping with their head propped up, or avoiding spicy foods, might not always be what it takes to get rid of heartburn, according to a recent study. Doctors from the Medizinische Klinik der TU Mï¿½nchen in Germany, say that lack of scientific evidence to support lifestyle and dietary changes as a mode of treatment, and availability of effective drugs, means doctors must carefully and individually consider each patient before recommending such behavioral modification. Alexander Meining, MD, and Meinhard Classen, MD, reviewed clinical studies of diet and lifestyle measures used to control acid reflux and published their findings in the most recent issue of The American Journal of Gastroenterology. They say that while these modification therapies have not been conclusively shown to be generally beneficial, for some individuals, they might be appropriate. Although called heartburn, GERD is actually an illness of the digestive track, most specifically a defect of a muscle called the lower esophageal sphincter. When this juncture of the esophagus and the stomach is not working properly, stomach acid flows backward into the esophagus. Doctors believe that this happens because the lower esophageal sphincter relaxes too often rather than contracting to prevent acid reflux. According to the American College of Gastroenterology (ACG), the symptoms of heartburn, or acid indigestion, are more common among the elderly and pregnant women. The most frequent symptom is a burning feeling behind the breastbone, that moves up the neck and throat and can last for hours. Some people even taste the acid's bitterness at the back of their throats. But in severe cases, known as GERD, when heartburn strikes two or more times a week, food may stick in the area of the lower esophageal sphincter, and regurgitation of blood and weight loss may occur. Approximately 15 million Americans suffer from acid indigestion daily, says the ACG. "If you have it once a month, modifying your lifestyle and eating habits will handle it," says Rajeev Jain, MD, a gastroenterologist at Presbyterian Hospital of Dallas. "If you have it every day, this won't do it. However, if you have recurring episodes, then use of lifestyle and diet changes will help." These changes include avoiding greasy and spicy foods, tomatoes, citrus products that contain a lot of acid, alcohol, smoking, and carbonated drinks. Doctors also warn that obesity contributes to GERD and that wearing tight fitting clothing or doing anything that increases pressure on the abdomen can worsen symptoms. But Meining and Classen say scientific evidence for many of these recommendations either doesn't exist or is equivocal because large enough studies have not been undertaken. Also they say that prescription drugs now available for treating GERD are so safe and effective, most people should not have to compromise their quality of life in favor of treatment. According to their article, they would not generally recommend avoidance of fatty meals, sweets, spicy food, raw onions, caffeinated beverages, citrus products, or alcohol. They also don't believe that elevating the head when sleeping helps prevent acid reflux for most people. However, they do believe that for those who have symptoms, it's best to avoid carbonated beverages, try to lose weight, quit smoking, and avoid excessive physical activity that will put pressure on the lower esophageal sphincter. They say studies have shown that smoking and obesity are risk factors for cancer of the lower part of the esophagus near the stomach. "The criteria for evidence-based medicine are consequently not met when lifestyle modifications are recommended to a patient with symptoms suggestive of GERD, or with an already established diagnosis of GERD," Meining and Classen report. "Also, it needs to be taken into account that adaptations of diet and lifestyle factors are difficult to follow for some patients and that they can significantly impair the quality of life." But the researchers recommend that patients keep a diary of their dietary and lifestyle habits so that their doctor can help them determine what might be associated with their individual cases of GERD. "Behavioral modifications that are not generally recommendable might nevertheless still be of considerable value in individual patients," they write. Presbyterian's Jain, who is also a clinical assistant professor at University of Texas Southwestern Medical Center at Dallas, says that it's important for people with heartburn symptoms to contact their doctors. Undiagnosed they run a great risk of developing Barrett's esophagus, a precancerous condition in which the cells in the lining of the esophagus change so they resemble those in the intestine. According to the ACG, patients who develop this disorder are 30 times more likely to develop esophageal cancer, an extremely lethal disease. Those with frequent, chronic heartburn are eight times more likely to develop a malignancy while those with long-term, chronic GERD have a risk 43.5 times higher than those with no symptoms. But Jain says that many people don't seek medical advice because so many over-the-counter remedies are available that they believe with solve their problems. He warns this is a dangerous notion because some people don't have symptoms or don't realize what acid indigestion is or understand its repercussions. "We've had people come in with cancers the size of grapefruits that they'd just been ignoring because they thought it would go away," Jain says.


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