Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when stomach contents (food and/or stomach juices) re-enter the esophagus through a faulty lower esophageal sphincter (LES). The LES is supposed to function in a way to allow food to enter the stomach from the esophagus but not allow the food to flow back up into the esophagus. GERD can occur when the acidity level is too high in the stomach or when dyskinetic bowel exerts abnormal pressure on the stomach causing the LES to open prematurely. GERD can affect people of all ages—from infants to the elderly.
People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back into the esophagus. Some older asthma medications (eg: theophylline) may worsen GERD symptoms.
On the other hand, acid reflux can worsen asthma by causing inflammation in the airways of the lung. This can lead to progressively more serious asthma which can be refractory to medication. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke, perfumes, or cold weather.
Symptoms & Diagnosis of GERD
Most people have experienced gastroesophageal reflux at some point in their lives. It happens when you belch, have an acid taste in your mouth, or have heartburn. If these symptoms interfere with your daily life it is time to see your physician.
Other symptoms that occur less frequently but can indicate that you could have GERD are:
- Acid regurgitation (retasting your food after eating)
- Difficulty or pain when swallowing
- Sudden excess of saliva
- Chronic sore throat
- Laryngitis or hoarseness
- Inflammation of the gums
- Bad breath
- Chest pain (seek immediate medical help)
Several tests may be used to diagnose GERD including:
- X-ray of the upper digestive system
- Endoscopy (examines the inside of the esophagus and stomach)
- Ambulatory acid (pH) probe (monitors the amount of acid in the esophagus)
- Esophageal impedance test (measures the liquid movement in the esophagus)
Treatment & Management of GERD
If you have both GERD and asthma, taking better care of your GERD may help control your asthma symptoms.
Studies have shown that people with asthma and GERD saw a decrease in asthma exacerbations after treating their GERD.
Lifestyle changes to treat GERD include:
- Elevate the head of the bed 15-30 degrees
- Lose weight
- Stop smoking
- Decrease alcohol intake
- Limit meal size and avoid heavy evening meals
- Do not lie down within two to three hours of eating
- Decrease caffeine intake
- Avoid theophylline (if possible)
Your physician may also recommend medications to treat reflux and relieve symptoms. Over-the-counter antacids and H2 antagonists (eg: Zantac, Pepcid) may help decrease inflammation caused by stomach acid. Proton pump inhibitors (eg: Prilosec, Nexium, Protonix) mitigate acid production and are often very effective at alleviating the symptoms of reflux.
In severe cases where medications do not work, surgery may be recommended such as a Nissen Fundoplication.