Published March 24, 2011
For most of us, a big holiday dinner or a night out on the town with friends sounds like a great idea.
But for the millions of Americans living with gastroesophageal reflux disease, or GERD, it sounds more like a recipe for disaster.
Characterized by symptoms of heartburn and regurgitation, GERD is a chronic condition where the acidic contents of the stomach flow back up into the esophagus. This constant backwash of stomach acid irritates the lining of the esophagus, and sufferers are left "feeling the burn."
There are simple changes that patients can make to their diet and lifestyle to help them manage the discomfort of their acid indigestion, according to Dr. Anish Sheth, a gastroenterologist and assistant professor of medicine at Yale University.
"It basically comes down to how frequently they're having symptoms and how much the symptoms are affecting their life," Sheth told FoxNews.com. "Avoiding caffeine, eliminating fatty or acidic foods, losing excess weight and quitting smoking are all things patients can do to control their acid reflux."
But while avoiding certain foods and changing habits may help people who deal with an occasional case of heartburn, these lifestyle modifications offer only temporary relief for patients suffering from more severe symptoms associated with GERD.
"If people are having symptoms on a daily basis or more than three times a week, we usually recommend they start medication," said Sheth.
But with so many medications available, how do you know which one is right for you?
Antacids. Popular over-the-counter medications like Tums, Maalox, Rolaids and Mylanta neutralize stomach acid and provide fast-acting relief in mild or isolated cases of acid reflux. Some antacids come in liquid form to coat the lining of the esophagus and help reduce the amount of acid in the stomach. But they won't aid in reducing inflammation of the esophagus associated with GERD.
"Most patients suffering from mild acid reflux will treat themselves with over-the-counter medications," Sheth said. "Antacids are better for immediate relief -- like after a big meal -- because their effectiveness is short-lived in nature and only lasts for as long as it's in the system."
Patients need to be conscious of the amount of antacids they are taking, because overuse can cause diarrhea, constipation and, in rare cases, an imbalance in electrolytes if the antacid contains calcium.
"You should see a doctor if your symptoms are not controlled by over-the-counter medicines because it could be a sign of a more serious condition," Sheth said.
Oral suspension medicines. These medications, like Pepto Bismol and Carafate, are sometimes used to treat heartburn and indigestion as well as nausea, diarrhea and ulcers in the throat, stomach and intestines.
"Carafate is a liquid suspension that essentially coats the inside of the esophagus. It's short-lived in its effectiveness because once the coating wears off it's not going to do much," Sheth said. "We really only prescribe it for people who have symptoms less than a couple times a week or month."
Anti-gas, anti-flatulence. Some patients experience pressure and bloating when they get heartburn.
For these symptoms, over-the-counter products like Phazyme, Gas-X and Beano can aid in relieving pressure, bloating, and gas in the digestive tract. These medications usually come in tablet form and work by breaking up gas bubbles, making it easier to eliminate.
H-2-receptor blockers. Previously available only with a prescription, H-2-receptor blockers such as Pepcid AC and Zantac are now sold over-the-counter.
"H-2-receptor blockers work by shutting off the production of acid in the stomach," Sheth said. "They are effective for mild reflux, they're relatively inexpensive and can be used casually by people who only have symptoms a couple times a month."
H-2-receptor blockers provide longer-lasting relief than antacids, but they do not take effect as quickly, so it is suggested that people take them 30 minutes before meals or before bed.
Proton Pump Inhibitors (PPIs). These medications, which include Prilosec, Prevacid and Nexium, block acid production and aid in healing damaged esophageal tissue, so they should be taken by people who are having more frequent, severe symptoms.
PPIs are usually taken under the care of a doctor to prevent acid reflux from recurring, but certain ones, like Prilosec, are now available over-the-counter.
"The standard of care for treating GERD and related digestive diseases has become proton pump inhibitors. And because they are so safe, these are the most common medicines," Sheth said.
The majority of people who go on a PPI will get better, Sheth said. But there are other medications that can be prescribed by a doctor in the event that they don't.
The bottom line
It's important for patients to pay attention to the frequency and severity of their symptoms, and to see a doctor if they suspect they may have GERD, because GERD can cause severe complications if left untreated.
Sheth said there are a number of red flags that may indicate complications, including trouble swallowing, unexplained weight loss, anemia, and drastic changes in symptoms.
"GERD can cause a narrowing of the esophagus that leads to trouble swallowing," Sheth said. "And in some patients, it causes a change in the lining of the esophagus called Barrett's esophagus -- a condition that can lead to cancer."