Almost everyone has had a case of heartburn. But if you experience heartburn more than twice a week for an extended period of time, it is a condition known as GERD or gastroesophageal reflux disease.

When you eat food, it travels down the esophagus and ends up in the stomach. There is a muscle separating the esophagus from the stomach, known as the lower esophageal sphincter (LES), which closes during digestion preventing the acid in your stomach from rising or “refluxing” into the esophagus. People with GERD have a malfunctioning LES, which can either open sporadically or fail to close properly. This gives the acid in your stomach an opportunity to rise up into the esophagus. When that stomach acid makes contact with your esophagus and throat, it causes irritation.

If GERD is left untreated, it can bring on some major illnesses. If the esophagus is continually battered with stomach acid, it can narrow and make it hard to breathe and swallow. Ulcers and bleeding in the lining of the esophagus can also occur, a condition known as esophagitis. The condition also opens you up to Barrett’s esophagus, which is a pre-cancerous condition that replaces the regular cells in your esophagus with cells closer to the intestinal lining. Finally, recent studies have shown that long-term GERD highly increases your risk of esophageal cancer by almost 44 times.

Treatment

There are three approaches to the treatment of GERD: medication, lifestyle changes, and medical procedures.

The most common medication for GERD, antacids and acid reducers, can be purchased over the counter. Antacids neutralize acid in the stomach while acid reducers decrease production of acid. Antacids are designed to provide immediate, short-term relief from heartburn. On the other hand, acid reducers offer relief from heartburn symptoms for a longer period of time.

Prescription medications are also available including proton pump inhibitors, which diminish the amount of acid produced by the whole body instead of just in the stomach area. For heartburn that cannot be cured by acid reducers or antacids, proton pump inhibitors can provide long-lasting relief. Finally, there are prescriptions designed to strengthen the lower esophageal sphincter and move contents through the stomach. These are known as prokinetics. Unfortunately, prokinetics come with a number of side effects – including fatigue, sleepiness, depression, and anxiety – that prevent them from being completely effective.

Treating GERD normally involves changing how you live your life. You can get relief from GERD symptoms by avoiding foods that might trigger reflux such as:

• Chocolate

• Caffeine, alcohol, or carbonated beverages

• Acidic fruits and foods

• Garlic, onions, and mint

• Fried foods

• Spicy foods

For someone who is overweight, a change in diet may also result in weight loss, which can lessen the impact of GERD. Excess weight puts pressure on the abdomen and can force acid into your esophagus. In addition, eating food slower and in smaller portions can give the stomach time to process foods. Avoid eating before bed or lying down after a meal for about two hours. A full stomach produces more acid and lying down stretches the LES, pulling it open slightly, so acid flows easily into the esophagus.

In addition, some lifestyle changes may make things more comfortable. Raising the head of the bed can prevent acids from moving into the esophagus with a little help from gravity. Wearing loose clothing that does not restrict the stomach may help. Finally, for those who smoke, it might be time to put the pack down for good; smoking can trigger acid reflux. Tobacco also inhibits the production of saliva, an important buffer to acid in the esophagus.

Medical procedures can be performed as a long-term solution to GERD. Almost two million people with GERD take the surgical path when lifestyle changes and medicine are ineffective. There are several procedures available, some more successful than others, but the goal of each is to strengthen the LES.

Nissen Fundoplication

Fundoplication surgery aims to correct a malfunctioning lower esophageal sphincter (LES) by wrapping the top part of the stomach around the lower esophagus to stop acid transfer. There are two ways to perform a fundoplication; open or closed. Open surgery calls for an incision in the abdomen while closed is conducted through the use of smaller incisions and a small camera.

In some cases, GERD is caused by a hiatal hernia, which is when part of the stomach itself moves into the esophagus. Fundoplication can also correct this issue, and overall, is typically a successful operation. More than 90 percent of patients are free of reflux following the surgery. However, there can be complications from fundoplication including difficulty swallowing, bloating, and diarrhea, all of which can last up to a year following the procedure.

Endoscopic Procedures

Endoscopic procedures are not necessarily considered surgery, since there is no need to cut into the body. Instead, a tube is sent down the mouth to the esophagus.

There are two types of endoscopic procedures used to treat GERD. The first is called the Stretta system. It sends a catheter down the throat and uses heat to create scar tissue on the esophagus. This strengthens the lower esophageal sphincter and prevents acid from backing up into the esophagus.

The second procedure is called EndoCinch. Its goal is to stitch up the lower esophageal sphincter and provide a barrier between the stomach and esophagus. This procedure is conducted in the same way as Stretta, but the catheter has a suturing device attached to the end of it.

Endoscopic procedures are a more recent approach to GERD, so there is no available research to prove its long-term success. It also carries the potential for serious complications, including bleeding, pneumonia, and even death. It is not recommended for people who are overweight, do not respond to medication, or have more serious symptoms beyond heartburn. And while it has shown to lower acid reflux, endoscopic procedures will not completely eliminate the problem. In addition, with the development of safe and effective drugs, it has begun to fade in popularity.

With the variety of options available for the treatment of GERD, it is important to talk to your doctor about your specific needs to determine the proper course of action for you.