In this video from Medcram, Dr. Seheult untangles common misconceptions and provides general information for treating GERD. GERD is also known as gastroesophageal reflux disease or heartburn. There are a few things that patients and even doctors may not know about this disease. They often think it’s as simple as just taking an antacid, h2 blocker or proton pump inhibitor.
What is the anatomy of GERD?
In the anatomy of gastroesophageal reflux disease, the stomach has a tube coming into it. That is called the esophagus. The esophagus comes into the stomach. It goes through a muscle called the diaphragm which is the major muscle involved in respiration. This area it goes through is called a hiatus which means a break and this is exactly what happens as the esophagus goes through this muscle into the stomach. At this junction between the upper portion, where the lungs are, and lower portion, where the abdomen and bowels are, is this division where the hiatus is. Located also here is the lower esophageal sphincter. Both the lower esophageal sphincter and hiatus are going to work together to try and keep fluids and food from going up the esophagus. This works most of the time, but you can get things that will reflux up this as well and cause GERD. Some people will have a hiatal hernia and this results simply because there is a hernia that is going through this hiatus in the diaphragm. If there is increased abdominal pressure, such as from obesity it can push the stomach through this hiatus, creating a hiatal hernia. When this happens the lower esophageal sphincter is no longer located at the section of the diaphragm and eventually no longer is able to function appropriately. Now that the sphincter is not near the hiatus, this allows for reflex to occur much more easily. Given the stomach has a very high acidic load, as the acid then comes up the esophagus, a person may experience a significant burning sensation and hence the term heartburn. If the contents of the stomach are able to go all the way up to the upper esophageal sphincter, near the mouth, thenn this can reflux into the back of the throat and cause irritation and inflammation and erythema in the back of the throat. It can affect the vocal cords and cause hoarseness and also get into the mouth and cause erosion of the enamel on your teeth. Even more concerning is that it can actually then go back down into the lungs and cause inflammation there as well.
Treatment for GERD
So what is the treatment for gastroesophageal reflux disease? Many times physicians will just write for medication. What many people don’t understand is that these medications, such as the H2 blockers and proton pump inhibitors only reduce the acidity of the acid. This allows a person to not have significant symptoms from the acid. What needs to be noted is that even though the acidity has been decreased, the amount of the reflux has not been reduced. So especially when people are sleeping in the supine position, the reflux is still coming up and can still lead to symptoms of hoarseness, etc. However, people now may not have the irritation due to the reduced acidity.
Lifestyle modifications for GERD
So what does Dr. Seheult recommend to treat his patients? He states that he does still put patients on a proton pump inhibitor and/or H2 blocker, but in addition to this , it is important to do some lifestyle modifications. This includes elevating the head of the bed. This can be done physically by elevating the whole head of the bed, such as on some bricks or one can purchase a wedge from a medical supply store to sleep on. A practical reason for the wedge is that it is simply based on gravity. When you are sleeping peristalsis or the stomach’s movement slows down and hence reflux can occur. If you are elevated, the acid will have a harder time going back up. The other important thing to do is make sure you do not eat at least three hours before going to bed or laying down. You also want to avoid anything that will weaken the lower esophageal sphincter and this includes things like tobacco, alcohol, spicy foods, chocolate and peppermint and citrus to name a few.
Implications of untreated GERD
It is important to try and get this acid reflux under control because over time as the cells in the lower esophagus are exposed to this chronic acid there and develop a condition called Barrett’s esophagus which can be a precancerous lesion. To evaluate for this you would need to have an EGD or esophagogastroduodenoscopy, which is a camera that goes down and looks into the esophagus and stomach. Dr. Seheult reports that he has seen many persons with gastroesophageal reflux disease have improvement in their symptoms after following his recommendations. He has had patients with asthma that have also corrected just by correcting the gastroesophageal reflux disease..