Gastroesophageal Reflux Disease (GERD)
After basketball practice, Ella looks forward to hanging out with her teammates and sharing a large pizza with extra cheese and a pitcher of soda — a well-deserved reward after hours of shooting free throws and running laps.
Lately, though, Ella hasn't been enjoying her post-practice treat like she used to. After eating, she feels an odd burning sensation in her chest and sometimes in her throat. It's that uncomfortable feeling people call "heartburn."
Frequent, strong heartburn is one of the signs of gastroesophageal reflux disease, more commonly known as GERD or acid reflux. GERD doesn't just affect older people who eat too much while watching TV. Active, healthy teens can have GERD, too.
What Is GERD?
Gastroesophageal (pronounced: gas-tro-ih-sah-fuh-JEE-ul) reflux disease is a disorder that results from stomach acid moving backward from the stomach into the esophagus. GERD usually happens because the lower esophageal sphincter (LES) — the muscular valve where the esophagus joins the stomach — opens at the wrong time or does not close properly.
When the stomach contents move backward into the esophagus, this is known as gastroesophageal reflux. (Because the stomach makes acid to help a person digest food, gastroesophageal reflux is also known as acid reflux.) Almost everyone has this type of reflux at some time. Often a person isn't even aware this is happening.
Sometimes reflux causes the burning sensation of heartburn that most of us occasionally feel. But although lots of people have heartburn from time to time, that doesn't mean that they have GERD. When a person has GERD, heartburn or other symptoms happen much more often and cause serious discomfort.
GERD can be a problem if it's not treated because, over time, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. In adults, long-lasting, untreated GERD can lead to permanent damage of the esophagus and sometimes even cancer.
What Causes GERD?
No one knows for sure why people get GERD. Although lots of different things may contribute to the condition, doctors believe that the way the LES works is the main reason why people have gastroesophageal reflux.
The LES is a muscular ring at the bottom of the esophagus where it joins the stomach. As a person swallows, muscles in the esophagus move the food down into the stomach. The LES relaxes just enough to allow food and liquids into the stomach, but then the powerful muscles in the LES contract (tighten) to stop food and liquids from moving back up the esophagus. In other words, the job of the LES is to prevent reflux.
Sometimes, though, the LES might not be able to do its job for various reasons. In some people, the LES doesn't tighten properly. In other cases, the LES doesn't close quickly enough or at the right time, allowing stomach contents to wash back up.
If a person has eaten way too much, the stomach may be so stretched full that the LES can't do its job properly.
In some people who have GERD, a hiatal (pronounced: high-AY-tull) hernia is to blame. A hiatal hernia is an opening in the diaphragm (the muscle that separates the abdomen and chest) where the esophagus joins the stomach. The hernia can allow the uppermost part of the stomach to bulge through the diaphragm into the chest area, interfering with how the LES works. Most teens who have GERD do not have a hiatal hernia.
Doctors do know that some things can make GERD worse, including obesity, drinking alcohol, and pregnancy. Certain foods and medications can also worsen GERD symptoms; for example, these foods affect some people with GERD:
- citrus fruits
- drinks or foods with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, like spaghetti sauce, chili, and pizza
How Do People Know They Have GERD?
Often, people who have GERD notice that they regularly have the pain of heartburn in the chest or stomach — and their heartburn can last up to a couple of hours. Lots of people who have GERD notice their heartburn is worse after eating.
Regurgitation is also a sign that a person may have GERD, although, like heartburn, occasional regurgitation is common for everyone. (Regurgitation is when food and liquid containing stomach acid comes back up into the throat or mouth.)
Other symptoms of GERD include:
- a sore, raw throat or hoarse voice
- a frequent sour taste of acid, especially when lying down
- a feeling of burping acid into the mouth
- trouble swallowing
- a feeling that food is stuck in the throat
- a feeling of choking that may wake someone up
- a dry cough
- bad breath
You should talk to your parents and visit your doctor if you've had heartburn that doesn't seem to go away or any other symptoms of GERD for a while.
How Doctors Diagnose GERD
If a doctor thinks you might have GERD, he or she will do a physical examination. Your doctor will also ask about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.
If your doctor suspects you might have GERD, he or she may refer you to a pediatric gastroenterologist, a doctor who treats kids and teens who have diseases of the gastrointestinal system (the esophagus, stomach, intestines, and other organs that aid in digestion).
Doctors sometimes run the following tests to diagnose GERD or rule out other possible problems:
- A special X-ray called a barium swallow radiograph can help doctors see whether liquid is refluxing into the esophagus. It can also show whether the esophagus is irritated or whether there are other abnormalities in the esophagus or the stomach that can make it easier for someone to reflux. With this test, the person drinks a special solution (barium, a kind of chalky liquid); this liquid then shows up on the X-rays.
- A gastric emptying scan can help show whether a person’s stomach is emptying too slowly, which can make reflux more likely to happen. This test is done either by drinking milk that has a tracer in it or eating scrambled eggs that have a tracer mixed in. A special machine that doesn’t use radiation can detect the tracer to see where it goes and how fast it empties the stomach.
- An upper endoscopy (pronounced: en-DAS-ko-pee) allows the doctor
to look at the esophagus, stomach, and part of the small intestines using a tiny camera.
For this test, the doctor may give the patient a medicine to help him or her relax,
and may spray the throat to numb it. This makes the test more comfortable. Most patients
are given anesthesia and are "asleep" when this procedure is done.
The doctor then slides a thin, flexible plastic tube called an endoscope down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. During the endoscopy, the doctor also may use small tweezers (forceps) to remove a piece of tissue for biopsy. A biopsy can reveal damage caused by acid reflux or infection and help rule out other problems.
- In another kind of test, called a 24-hour impedance-probe study,
the doctor puts a tiny tube through the nose and down into the esophagus until the
tip is just above the opening to the stomach. The tube will stay there for 24 hours.
The tube is connected to a device that monitors the acid levels in the esophagus as
the person goes about normal daily activities. It also monitors how many acid and
non-acid reflux episodes take place.
This test is useful for diagnosing people who have symptoms of GERD but have no damage to the esophagus. It also can detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing.
How Is GERD Treated?
Treatment for GERD depends on how severe symptoms are. For some people, treatment may just include lifestyle changes, such as changing what they eat or drink. Others will need to take medicines. In very rare cases, when GERD is particularly severe, a doctor will recommend surgery.
The following lifestyle changes can help ease the symptoms of GERD or even prevent the condition:
- quitting smoking
- avoiding alcohol
- losing weight if you are overweight
- eating small meals
- wearing loose-fitting clothes
- avoiding carbonated beverages
- avoiding foods that trigger reflux
It also can help to not lie down for 3 hours after a meal and to not eat 2 to 3 hours before going to bed. Doctors sometimes also recommend raising the head of the bed about 6 to 8 inches. Before you start a major bedroom makeover, though, talk to your doctor and your parents about the best sleeping position for you.
A doctor may also recommend different medications to relieve symptoms. Over-the-counter antacids, such as Alka-Seltzer or Maalox, work by neutralizing stomach acid and can help with mild symptoms. Other medicines called H2 blockers are available over the counter and by prescription and help by blocking the production of stomach acid. If your doctor thinks you should take these, he or she will recommend certain over-the-counter medications or write you a prescription.
More powerful prescription drugs called proton pump inhibitors also reduce the amount of acid the stomach produces. Some of these are also available over-the-counter. Doctors also prescribe these for people with more severe or persistent GERD.
Medications that belong to a class called prokinetics also can be used to help reduce the frequency of reflux by strengthening the lower esophageal sphincter muscle and also helping the stomach empty faster.
For some teens, doctors advise combining medicines to control different symptoms. For example, people who get heartburn after eating can try taking both antacids and H2 blockers. The antacid goes to work first to neutralize the acid in the stomach, while the H2 blocker acts on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.
Surgery is a last resort for people with GERD and is rarely needed in healthy teens. The typical surgical treatment for GERD is called fundoplication (pronounced: fun-doh-plih-KAY-shun). During the surgery, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent reflux. Fundoplication has been used in people of all ages, even babies with severe GERD.
Living With GERD
The key to living with GERD is to not ignore it. Early diagnosis and treatment can help reduce or even stop uncomfortable symptoms. Left untreated, however, GERD can cause permanent damage to the esophagus.
One possible long-term effect of GERD is something called Barrett's esophagus. In this condition, the cells in the esophagus change and become precancerous because they have been irritated by stomach acid for so long. Eventually, it may lead to cancer of the esophagus. Barrett's esophagus is mostly found in adults who have had GERD for many years. But you can help avoid it by dealing with your GERD now.
You'll probably find that one of the simplest ways to make living with GERD easier is to avoid the things that trigger your symptoms. Some people will have to limit certain foods; others may have to give them up entirely. It all depends on your individual symptoms.
It can be hard to give up sodas or favorite foods at first. But after a while, lots of people discover that they feel so much better that they don't miss the problem foods as much as they thought they would.