By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

PHYSICIAN’S DIAGNOSIS A GOOD IDEA BEFORE TREATING GERD

Question: I have seen the ads on TV for medication for GERD. I think I may have it, but I would like to know more about GERD before I make an appointment with my doctor. What are the symptoms? Maybe I just have heartburn.

Answer: Gastroesophageal Reflux Disease (GERD) occurs in about one third of the population in the United States. It is also call acid reflux, heartburn, water brash and reflux esophagitis. This common ailment is frequently self diagnosed, and many people use over-the-counter medications for a few years before seeing their physician.

GERD is caused by relaxation of a muscle at the junction of the esophagus and the stomach. This muscle -- called the lower esophageal sphincter (LES) -- is supposed to open up when you swallow food or drink and then close tight to seal off the acidic stomach content. If the LES opens at other times, it can allow acid from the stomach to splash back up into the esophagus.

Several factors -- ranging from medications to lifestyle issues -- can cause this sphincter to relax inappropriately. Some blood pressure medications and breathing medication can weaken the LES. Caffeine and tobacco can be at fault. Pregnancy is another cause. And, one of the most common causes is being overweight, which puts additional pressure on the stomach and the LES.

The classic symptoms of GERD are a burning feeling in the upper stomach region and behind the breastbone. Some people actually have stomach acid reflux into their mouth or throat. This can be worse when lying down or bending forward. It’s not too uncommon for a patient with GERD to come into his or her family physician’s office with abdominal pain, chronic cough, hoarseness or burping as the major complaint. Interestingly, GERD is one of the most common causes of chronic cough. And, you may find it even more surprising that some people with GERD have wheezing as a primary presenting problem and come into their doctor’s office thinking they’ve developed asthma.

GERD is treated by eliminating causative agents such as tobacco and caffeine. If you are overweight, your family physician may advise you to reduce your calorie intake to shed some pounds. You may notice that certain foods also cause you problems. Those foods should be avoided as well. Avoiding eating for a couple of hours before bedtime can relieve nocturnal symptoms. If symptoms are infrequent, using an antacid can help.

There can be serious complications from longstanding GERD, including the development of esophageal cancer. In fact, when the symptoms of untreated chronic GERD appear to be improving, it can be a sign that a pre-cancerous condition called Barrett’s esophagus is developing. This is one of the reasons that before using any over-the-counter medication regularly you should see your physician and see what he or she thinks you should do. Further evaluation, such as an upper GI endoscopy (a look at your esophagus with a special fiber-optic scope) may be indicated. If you are already using OTC medications regularly to treat your heartburn, you should discuss this with your doctor at your next appointment. Always include routine OTC medications when giving your medication list to any health-care professional.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.