Dr. David Gremse, professor and chair of pediatrics at the University of South Alabama College of Medicine and a pediatric gastroenterologist with USA Physicians Group, said gastroesophageal reflux disease, or GERD, is a condition in which the stomach contents leak backwards from the stomach into the esophagus.
This action can irritate the esophagus, causing heartburn and other symptoms.
When you swallow, Dr. Gremse said, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. At the end of swallowing it will tighten up to hold the acid and food in the stomach where it belongs.
In people with GERD, the valve opens more frequently. When this valve opens, the contents of the stomach are more likely to come up into the chest portion of the esophagus, giving pain under or just below the breast bone.
Unlike the stomach, the lining of the esophagus cannot protect itself from acids. Thus, GERD can lead to esophageal erosions from acid damage. If untreated, it can lead to the formation of scar tissue, causing an esophageal stricture that can result in difficulty swallowing normal bites of food.
According to Dr. Gremse, the prevalence of gastroesophageal reflux disease is increasing. One factor that likely contributes to this increase is the obesity epidemic. “Higher fat diets tend to not empty from the stomach as well as high carbohydrate/low fat diets,” he said. “As a result, it is more likely for materials in the stomach to come back up into the esophagus. We see more children battling weight problems, and that increases the number of school-age children we see with reflux.”
According to Dr. Gremse, implementing appropriate lifestyle modifications and using acid-suppressing medications, such as proton pump inhibitors (PPIs), can improve GERD symptoms in both children and adults.
“PPIs work best if taken 30 minutes before meals,” Dr. Gremse said. “I usually recommend that patients take them 30 minutes before breakfast. If you skip breakfast, take it 30 minutes before your evening meal.”
Some patients, he said, need twice-a-day therapy to control their acid reflux. “If someone needs the medication twice a day for full control of their stomach acid, they should take one 30 minutes before breakfast and one 30 minutes before dinner.”
In addition to heartburn, stomach aches, and upper digestive symptoms, there are also extraesophageal symptoms of acid reflux that can occur in children and adults. Acid reflux has been associated with asthma, sleep apnea, sinusitis, chronic bronchitis, non-cardiac chest pain, atypical loss of dental enamel, hoarseness, chronic cough, and chronic laryngitis.
Dr. Gremse said nighttime awakening is also a common symptom of acid reflux. “When you’re up and around during the day, the acid has the chance to drain off the stomach,” he said. “But when you’re lying flat in bed at night you can get a buildup of acid in the stomach.” Patients with extraesophageal symptoms of GERD may need higher doses of PPIs and a longer duration of therapy.
Dr. Gremse said those suffering from acid reflux should consider the following lifestyle modifications along with acid suppression therapy:
- Avoid large meals, especially prior to exercising
- Do not eat or drink two hours prior to bedtime
- If obese, consider a weight loss program to maintain a healthy weight
- Limit foods and drinks that provoke GERD symptoms (caffeine, chocolate, spicy foods, fatty foods, acidic foods, citrus juices, carbonated beverages)
- Avoid cigarette smoke exposure and alcohol use
Dr. Gremse gave an overview of GERD at the April Med School Café lecture. To view the lecture in its entirety, click here.
A report co-authored by Dr. David Gremse recently received national attention. The report, published by the American Academy of Pediatrics, says pediatricians should differentiate between gastroesophageal reflux (GER), the uncomplicated regurgitation of gastric contents in the esophagus, and gastroesophageal reflux disease (GERD), troublesome symptoms associated with GER, before determining a course of treatment.
You can read the full report here, and you can read USA TODAY's story about the report here.