A Guide To Gastroesophageal Reflux Disease - American College ...

A Guide To
Gastroesophageal Reflux Disease
[ GERD]
3

Copyright © 2007
AstraZeneca LP
242419
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The sponsor (AstraZeneca LP), the producers (Conrad Productions and Alan
Weiss Productions), the guidebook author (Stephen Braun), the video
scriptwriter (Deborah Gobble), and the partner (American College of
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Contents
What is Gastroesophageal Reflux Disease? 6
What Causes GERD? 8
What Does Acid Reflux Feel Like? 10
What’s the Danger? 11
How Can My Doctor Tell if I Have GERD? 12
What Can I Do to Reduce Acid Reflux? 14
Treatments for GERD 15
For More Information 23
5

What is Gastroesophageal
Reflux Disease?
When you eat, food travels down the tube (esophagus)
connecting your mouth to your stomach. Your stomach makes
acid that helps break down the food so your body can use it.
The acid normally stays in your stomach where it belongs.
But sometimes the valve at the base of the esophagus, where it
connects to the stomach, doesn’t work right. If the valve
relaxes or opens when it shouldn’t, stomach acid can rise up
into the esophagus, which creates a burning feeling called
“heartburn.” If a large amount of stomach fluid rises up the
esophagus and enters the back of the throat, this is called
regurgitation. Heartburn and regurgitation are the two most
common symptoms of gastroesophageal reflux disease, a
common problem that is better known simply as GERD.
Most people have heartburn or regurgitation once in awhile.
That’s normal. But if you have frequent, persistent heartburn
and regurgitation, acid may be hurting your esophagus. And
the pain or discomfort caused by the heartburn may disrupt
your sleep, work, or general well-being. GERD can be serious
because without treatment it may get worse and could end up
badly damaging your esophagus.
GERD is very common. More than 60 million Americans
experience heartburn at least once a month and more than 15
million Americans experience heartburn symptoms every day!
6
Stomach
Here’s the important point:
GERD is a long-term condition that
doesn’t usually go away by itself. It is
a chronic disease. That’s why it’s vital
that you talk with your doctor and, if
a treatment is recommended, that
you stick to the treatment as
prescribed by your doctor.
Esophagus
Valve
Sometimes the
valve at the base
of the esophagus,
where it connects
to the stomach,
doesn’t work right,
allowing stomach
acid to rise up into
the esophagus.
7

What Causes GERD?
In some people, the valve between their esophagus and
stomach is simply weaker than normal for unknown reasons.
Other factors can make the situation worse, such as pressure
on the stomach from tight clothing or extra body fat. Eating
fatty or oily foods causes the stomach to empty more slowly,
which can also make acid reflux more likely. And certain
medications can cause the valve to relax, allowing acid up
into the esophagus.
8
Other factors may make it more likely
you will experience acid reflux:
• Alcohol use
• Smoking
• Pregnancy
Eating certain types of foods also raises
the risk of acid reflux:
• Citrus fruits such as oranges,
grapefruit, or lemons
• Chocolate
• Caffeine-containing drinks such as
coffee or tea
• Fatty and fried foods
• Garlic and onions
• Mint flavorings
• Spicy foods
• Tomato-based foods,
like spaghetti sauce, chili, and pizza
9

10
What Does Acid Reflux
Feel Like?
Acid reflux usually begins with a rising, burning
sensation in the chest or throat. Sometimes
with regurgitation, stomach contents rise to
the back of the mouth and you can taste a
sour or bitter flavor. Symptoms most
commonly occur after meals. People
report that symptoms get worse
when they bend over, lie down, or
exert themselves physically.
Be careful!
Sometimes the chest pain
of an impending heart
attack can feel like GERD
or indigestion. If you have
any doubt, call your doctor
or 911 immediately!
What’s the Danger?
If you don’t treat GERD, stomach acid can cause a number
of problems in the lower region of your esophagus. The
lining of the esophagus in this area can become red and
irritated. This is
called esophagitis.
If damage
Esophagus
continues, the
Irritation
lining of the
esophagus can
form erosions
and bleed. Scars
formed when this
type of damage
heals can narrow
the esophagus,
making it hard for food to go all the way down to the
stomach. This feels as if food is getting “stuck” on the way
down. And if the stomach acid repeatedly rises high enough,
you may have a chronic sore throat or voice hoarseness.
Sometimes the lining of the lower esophagus changes
because of the constant irritation. This change is called
Barrett’s esophagus and it may increase your risk for getting
cancer of the esophagus.
11

How Can My Doctor Tell if I
Have GERD?
Unless you have developed complications from GERD such
as difficulty swallowing or bleeding, your doctor may
recommend diet changes, weight loss, quitting smoking,
and/or medication. If this approach works, the diagnosis of
GERD is confirmed. If not, then more tests may be ordered.
If your doctor suspects that your esophagus may be
damaged, it is important to take a look. You will be sent to
see a specialist called a gastroenterologist, who may do a test
called endoscopy. A thin, flexible tube with a tiny lens at the
tip (called an endoscope) is used to look at the inside of the
esophagus. You’ll be given a relaxing medication and asked
to lie on your side. Then the endoscope will be passed
through your mouth, past your throat and down the
esophagus. The doctor will be able to clearly see what your
esophagus looks like and can check for damage that might
signal a risk of cancer. The doctor may also remove a small
sample of tissue to look at with a microscope. This is
painless.
If you have difficulty swallowing, and food seems to be
getting stuck on the way down, your doctor may suggest an
x-ray exam. In this procedure you’ll be asked to swallow a
liquid that clearly shows up on an x-ray. The doctor will
watch as the liquid goes down your esophagus and will be
able to see if there are problems with swallowing, or if there
are any obstructions.
For some patients with typical GERD
symptoms who do not respond to
medication, additional tests are
needed. Two types of tests can be
used to confirm the presence of
GERD. In one method, the
monitor is attached to a thin tube
that passes through your nose
down to the esophagus. The
other method uses a wireless
capsule, placed during
endoscopy, that transmits
results to a recorder.
Unless
you have
developed
complications
from GERD
such as difficulty
swallowing or
bleeding, your doctor
may recommend diet
changes, weight loss,
quitting smoking,
and/or medication.
12 13

What Can I Do to Reduce
Acid Reflux?
The old saying “An ounce of prevention is worth a pound of
cure” applies to GERD. Depending on the severity of your
symptoms, you may find that making one or more of the
following changes can bring relief:
• Eat dinner at least three hours before you go to bed.
• Avoid, or eat sparingly, high-fat foods such as cream sauces
and fried foods.
• Avoid the “trigger” foods
listed earlier.
• If you are overweight, try losing
some of those pounds.
• Don’t wear tight-fitting clothing.
• Stop smoking.
• Reduce or stop drinking alcohol.
• Raise the head of your bed
4-6 inches.
When making significant lifestyle changes
such as quitting smoking or losing weight,
you should consult with your doctor.
Also consider enlisting the support
and encouragement of friends and
family members.
14
Treatments for GERD
If lifestyle changes don’t relieve your symptoms and your
doctor suspects or confirms that you have GERD, there are
several possible ways to treat the problem. First, there are
different types of medication:
H2 blockers
H2 blockers reduce the amount of acid that the stomach
makes. This reduction in the amount of acid often prevents
the symptoms of GERD. Several brands of H2 blockers are
available, both by prescription and over-the-counter. H2
blockers are usually taken at least twice a day. They are fairly
inexpensive, readily available, have a long safety record, few
side effects, and usually work well for mild or moderate
cases. However, they don’t work as well as some newer
medications in serious cases. They are also not as good at
promoting actual healing of the esophagus if irritation or
ulcers are present.
Proton-pump inhibitors
Proton-pump inhibitors (PPIs) are medications used to treat
GERD. They stop acid production more completely because
they more effectively block the stomach from making acid.
PPIs are the most effective medicines to heal ulcers and
irritation of the esophagus. Proton pump inhibitors are
usually taken once a day.
15

At the moment, most proton pump inhibitors are only
available by prescription and are more expensive than H2
blockers. One disadvantage is that they don’t work immediately.
Several doses are required for acid to be reduced. Your
doctor may prescribe an over-the-counter antacid or fastacting
medication such as an H2 blocker to use at first.
Surgery
If long-term treatment with medications is undesirable,
surgery to tighten the valve is an option. Note that surgery is
not more effective than medicines and it does not prevent
Barrett’s esophagus. In addition, surgery always has some
risk of complications or unwanted side effects. With the help
of your doctor, you will need to weigh the risks of surgery
against its possible benefits.
16
When You See Your Doctor
To get the most out of a doctor’s visit, it helps to be
prepared. Take a pen and a notebook. Consider bringing
along a trusted friend or family member. Here are some
other tips:
• Before your visit, write down all your questions.
• Learn more about acid reflux before your visit
at the library or on the Internet.
• Be as specific as possible when describing
how you feel and what usually occurs
when you feel pain.
• Be persistent if you are confused.
The Key to
Success:
Whatever medication
your doctor prescribes
for you, be sure to
keep taking it as your
doctor directed even
though you may be
feeling better!
GERD usually won’t
disappear…but it may
be successfully
managed.
17

The Good News
18
The pain, discomfort,
and potential harm
caused by GERD can
almost always be avoided
these days. By staying clear of
known “trigger” foods, making
some of the suggested lifestyle
changes, and consistently using
your medications, you can reduce
GERD, and avoid its painful or
uncomfortable symptoms.
Questions to Ask the Doctor
19

GERD-friendly recipes from:
Chef Nathalie Dupree
Author, nine cookbooks (two James Beard Awards)
Host, more than 300 programs for The Food
Network, PBS and The Learning Channel
20
RECIPE
Cream of Carrot
Soup
Serves 6 to 8
2 tablespoons butter
5 to 6 medium carrots, sliced
1 onion, thinly sliced *may be excluded if onion is a trigger
4 cups fresh or canned chicken stock or broth
3/4 cup plain yogurt (optional)
1 1/2 tablespoons sugar, or to taste
Freshly ground white pepper to taste *possible trigger
1 small garlic clove crushed with salt *possible trigger
Finely chopped cilantro, chives, parsley, or thyme (optional)
Melt the butter in a large pot. Add the carrots and onion, cover, and
cook over low heat until soft, but not brown, about 10 minutes. Stir in
the stock, cover, and simmer until the vegetables are very soft, about
30 minutes. Remove the solids with a slotted spoon and puree in
batches in a food processor or blender until very smooth. (You may
need to add a little of the cooking liquid to the food processor.) If you
want a really smooth soup, force the puree through a fine-mesh sieve.
Stir the puree into the cooking liquid and whisk in the yogurt. If serving
hot, bring just to a boil and remove from heat. Season to taste with
sugar, white pepper, and garlic. Pour into a soup tureen or individual
bowls and sprinkle on some chopped herbs.
Serve hot or cold.
RECIPE
Asparagus Topped with
Shrimp or Scallops
Serves 4 to 6
The pale green thin asparagus I've seen growing
in Georgia and South Carolina seem the essence of
Southern to me. They bend gracefully with the coastal
winds, and are plucky enough to grow in our sandy soil. They have an
affinity for shrimp and scallops, and are available around the same times
of the year. No acid (lemon juice, vinegar) is needed as the lemon peel
adds enough zing, and the acid changes the color of the asparagus. If you
are fortunate enough to have lemon grass, add it to the asparagus water
before you bring the water to the boil. Remove when the asparagus are
cooked and discard.
2 pounds asparagus, preferably thin
4 tablespoons light olive oil
1 medium onion or 2 or 3 shallots, chopped *possible trigger
1 pound medium peeled uncooked shrimp or scallops
4 tablespoons freshly grated lemon or orange peel (no white attached)
Salt
Freshly ground black pepper *possible trigger
1 tablespoon chopped herbs, preferably fresh
Cut off any woody ends of the asparagus. Peel any thick stalks or
tough skin, beginning at the little offshoots near the tips. Add to a
large pot or frying pan with enough boiling water to cover until just
done and still crisp, about 3 to 5 minutes, drain, rinse in cold water to
stop the cooking and set the color. Top with half the grated peel, salt
and pepper and leave at room temperature, or refrigerate if done more
than an hour or two in advance.
If using bay scallops, slice horizontally into 2 or 3 thinner slices. Heat
the 2 tablespoons oil in a large saucepan, add the scallops or shrimp
and cook 1 to 2 minutes, then turn and cook quickly until done. When
ready to serve, arrange some of the room temperature asparagus on
each plate, and top with the seafood, grated peel, oil, salt and pepper
as needed to render flavorful and pretty.
21

Notes
22
For More Information
To learn more about GERD and how you can manage it,
contact the following organizations or find them on the Internet:
American College of Physicians
Philadelphia, PA
www.doctorsforadults.com
American College of Gastroenterology
Bethesda, MD
301-263-9000
www.acg.gi.org
American Gastroenterological Association
Bethesda, MD
301–654–2055
www.gastro.org
International Foundation for Functional
Gastrointestinal Disorders Inc.
Milwaukee, WI
888–964–2001
www.aboutgerd.org
National Digestive Diseases Information Clearinghouse
Bethesda, MD
http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/#4
MedlinePlus
http://www.nlm.nih.gov/medlineplus/gerd.html
23

Sponsor
AstraZeneca LP
AstraZeneca is a major international health care business
engaged in the research, development, manufacture, and
marketing of prescription pharmaceuticals and the supply
of health care services. It is one of the world's leading
pharmaceutical companies focusing in gastrointestinal,
cardiovascular, neuroscience, respiratory, oncology, and
infection products.
24
Partner
American College of Physicians (ACP)
Established in 1915, the American College of Physicians
(ACP) is the nation’s largest medical specialty organization
and second largest physician group. Its mission is to enhance
the quality and effectiveness of health care by fostering
excellence and professionalism in the practice of medicine.
ACP membership includes about 119,000 members including
medical students. Members are physicians in general internal
medicine and related subspecialties, including cardiology,
gastroenterology, nephrology, endocrinology, hematology,
rheumatology, neurology, pulmonary disease, oncology,
infectious diseases, allergy and immunology, and geriatrics.
Internists treat the majority of adults in the United States.
For more information about
internal medicine physicians,
please visit:
www.doctorsforadults.com.
25

26
Credits
Sponsor
AstraZeneca LP
Partner
American College of Physicians
Patrick C. Alguire, M.D., F.A.C.P.
Director, Education and Career Development
Contributors to the Video
Harvey Licht, M.D., F.A.C.P.
Associate Professor of Medicine
Division of Gastroenterology
Temple University School of Medicine
Philadelphia, PA
Minhhuyen T. Nguyen, M.D.
Director, Clinical Gastroenterology
Fox Chase Cancer Center
Philadelphia, PA
Project Manager
Carol Brandenburg
Executive Producer
Conrad Productions
Guidebook Author
Stephen R. Braun
Medical Writer
Amherst, MA
Guidebook Designer
Cinda Debbink
Design Partners
www.dgdesignpartners.com
Special Thanks to:
Nathalie Dupree
Honorary Doctorate, Johnson and Wales University
Advanced Certificate, Cordon Bleu
Author, nine cookbooks (two James Beard Awards)
Host, more than 300 programs for The Food Network,
PBS and The Learning Channel