Understanding Acid Reflux and GERD

Buttery mashed potatoes, caramelized sweet potato casserole, creamed onions, turkey stuffing, pumpkin pie, pecan pie, and perhaps one more piece of pecan pie — Thanksgiving starts the time of year when many of us relax our eating restrictions. The holiday also happens to overlaps with Gastroesophageal Reflux Disease (GERD) Awareness Week.

Dr. Andy Liu, a gastroenterologist at NewYork-Presbyterian/Columbia University Irving Medical Center and an assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, spoke to us about what happens to our digestive system when we overeat over the holidays and how to manage symptoms to prevent discomfort.

What is GERD? Is it Acid Reflux?
Dr. Liu: Acid reflux and GERD are related, but not the same.

It is normal to have a small amount of acid reflux, especially if the symptoms — heartburn, regurgitation — are short-lived and only slightly bothersome. Acid reflux occurs when acid that normally sits in the stomach flows back up into esophagus, throat, and mouth. It generally occurs when the valve that separates the esophagus and stomach, called the lower esophageal sphincter, opens temporarily to help vent gas from the stomach.

When you have a long-standing and frequent history of acid reflux, exposure to esophageal acid may eventually cause GERD.

GERD stands for gastroesophageal reflux disease. As its last letter describes, GERD is a disease and can lead to damage and, eventually, complications to the esophagus over time.

Unlike acid reflux, GERD is not normal and should be treated.

What are the symptoms of GERD?
Like acid reflux, GERD has two classic symptoms: heartburn (the feeling of burning pain behind the chest) and acid regurgitation (when stomach acid and undigested food flow back up into the throat and mouth in an effortless manner).

These two symptoms typically occur after meals, especially larger ones. Lying down makes it easier for stomach contents to move up to your chest so take a walk, not a nap, after a big meal.

GERD can also cause upper abdominal burning or pain, difficulty swallowing, chronic cough, hoarseness, and sore throat. More rarely, it causes asthma and dental erosions. GERD does not cause shortness of breath, back pain, diarrhea, or pale stools. People with those symptoms should consult a doctor.

What causes GERD?
Caffeine, alcohol, and especially cigarette smoking can facilitate acid reflux and GERD, in part by opening the lower esophageal sphincter valve.

A common risk factor that allows acid reflux to occur more readily is obesity, where the presence of extra tissue in front of the stomach helps push stomach acid up into the esophagus.

In people with GERD, big holiday dinners can be problematic. It’s difficult, but resist that extra serving of stuffing, no matter how good it is, as overeating can be triggering. Try limiting the amount of cranberry sauce you consume; it is acidic and can worsen symptoms too. Finally, avoid excessive alcohol intake. Your esophagus will thank you!”

How is GERD diagnosed?
A simple conversation with your doctor can diagnose GERD. If there is any doubt, your doctor may order tests, such as an upper endoscopy (inserting a camera tube into your esophagus and stomach to look for signs of GERD) or a pH test to measure how much acid is truly flowing back up into the esophagus.

Does GERD go away on its own?
Mild forms of GERD can go away, particularly if an offending risk factor is removed. For instance, in overweight patients, weight loss can be very effective. Quitting cigarette smoking or limiting caffeine, alcohol, and other dietary triggers can also be very helpful.

How do you treat GERD?
Lifestyle changes should always be considered first when it comes to GERD treatment. This includes weight loss and the avoidance of triggers.

Raising the head of your bed by six inches can help by taking advantage of gravity to keep your stomach acid down. I suggest placing wooden blocks under the top legs of your bed. My patients often describe using pillows to prop up their heads, but I would advise against this practice. Using pillows only elevates your head without changing how much acid comes up at night and may possibly increase abdominal pressure that can even promote reflux.

Should these lifestyle changes not work, medications are generally effective. These can range from familiar over-the-counter agents such as antacids and histamine blockers to more powerful prescription-strength proton-pump-inhibitors. In more severe cases, GERD may never go away, necessitating lifelong anti-reflux medications. Certain patients may benefit from surgery to resolve their GERD.

What should you not eat if you have GERD?
The usual GERD triggers are caffeine, alcohol, chocolate, peppermint, fatty foods, spicy foods, and acidic foods. Some people have their own unique triggers. Pay attention to your body and avoid anything that instigates acid reflux and GERD.

For everyone, overeating and eating just before bedtime can worsen acid reflux, so these should be avoided, too.

This story originally ran on Columbia University Irving Medical Center’s Newsroom.

Andy Liu, MD, is assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and a gastroenterologist at ColumbiaDoctors and NewYork-Presbyterian/Columbia University Irving Medical Center.