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Gastroesophageal reflux disease and heartburn

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of GERD.

Alternative Names

Heartburn; GERD

Prevention

People with heartburn should first try lifestyle and dietary changes. In one study, 44% of patients who experienced symptoms of gastroesophageal reflux disease (GERD) reported improvement after changing their diet. Some suggestions are the following:

• People with heartburn should avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, and alcohol. Both caffeinated and decaffeinated coffee increase acid secretion.
• All carbonated drinks increase the risk for GERD.
• Although physicians often advise patients with GERD to cut down on fatty foods, studies are finding no evidence that a low-fat or high-fat meal make any difference in symptom exacerbation. Better studies are needed to confirm this. In any case, as a rule, it is always wise to avoid saturated fats (which are from animal products), and cut down on all fats if one is overweight.
• Increasing protein may help strengthen muscles in the muscle valve. Patients should choose low-fat or skim dairy products, poultry, or fish, in such cases.
• Whole grain products rich in selenium may have some protective role against dangerous cells changes in Barrett's esophagus.
• Patients should have a diet rich in fruits and vegetables, although avoid acidic vegetables and fruits (e.g., oranges, lemons, grapefruit, pineapple, tomatoes).

Patients who have trouble swallowing should avoid tough meats, vegetables with skins, doughy bread, and pasta.

Prevention of Nighttime GERD

Nearly three-quarters of patients with frequent GERD symptoms have them at night. Patients with nighttime GERD also tend to experience severe pain. It is very important to take preventative measures before going to sleep. Some suggestions for preventing acid reflux at night are as follows:

• After meals, take a walk or, at the very least, remain upright.
• Avoid bedtime snacks. In general, avoid eating for at least two hours prior to bedtime.
• When going to bed, try lying on the left side rather than on the right. The stomach is located higher than the esophagus when a person sleeps on the right side, which can put pressure on the lower esophageal sphincter (LES), increasing the risk for fluid back-up.
• Sleep in a tilted position to help keep acid in the stomach at night. To do this, raise the bed at an angle using four -to six- inch blocks at the head of the bed and use a wedge-support to elevate the top half of the body. (Extra pillows that only raise the head actually increase the risk for reflux.)

Other Preventive Measures

• Quitting smoking is essential.
• People who are overweight should try to reduce food intake.
• People with GERD should avoid tight clothing, particularly around the abdomen.
• If possible, GERD patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve), among others. Tylenol (acetaminophen) is a good alternative pain reliever.

Although gum chewing is commonly believed to increase the risk for GERD symptoms, one study reported it might be helpful. Because saliva helps neutralize acid and contains a number of other factors that protect the esophagus, chewing gum 30 minutes after a meal has been found to help relieve heartburn and even protect against damage caused by GERD. Chewing on anything at all can help since it stimulates saliva production.

• Review Date: 6/20/2006
• Reviewed By: Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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