If you order pizza with a side of Tums or chase coffee with Maalox, you may think you know about GERD. But GERD is not heartburn; it is gastroesophageal reflux disease, the abnormal backflow of stomach acids into the esophagus.

This backflow, or reflux, occurs when the valve between the esophagus and the stomach (the lower esophageal sphincter) does not close tightly. Ideally, the LES opens for just a few seconds when you swallow. With GERD, the valve relaxes when it should not and for too long, forcing a one-way street to accommodate two-way traffic.

Several triggers relax the valve inappropriately. One is food: GERD dietary offenders include chocolate, coffee, alcohol, high-sugar foods, probably high-fat foods, onions and peppermint.

Some foods do not relax the valve but may cause heartburn for the GERD patient. These include spicy foods, citrus products and tomato products.

In addition to food, GERD has several possible instigators, such as nicotine, certain medications, pregnancy-related hormonal changes, a weak LES, hiatal hernia, slow digestion and an overfull stomach.

Red flags

The most common indicator of GERD is persistent heartburn, a hot feeling behind the breastbone. Reflux may produce a sour or bitter taste in the mouth and may also trigger excess saliva, known as water brash.

“If the acid refluxes up into the back of the throat it can cause hoarseness, asthma, vocal cord polyps and sinus problems,” says Dr. John Corless, gastroenterologist with Charleston Gastroenterology Specialists. “Many people who complain of phlegm and frequently clear their throat or cough because of allergies actually have GERD.”

GERD can occur without heartburn. The symptoms include chest pain, trouble swallowing, bad breath, dry cough, nausea (especially in the morning) and a hoarse voice in the morning. GERD may worsen asthma symptoms.

Risky business

“The fluid that backsplashes into your esophagus typically contains a high concentration of hydrochloric acid that is secreted by the stomach to help digest food,” says Corless. “The stomach is built to handle this acid, but the esophagus is not,” With mild GERD, the esophagus may erode or become inflamed. Severe GERD can cause esophageal ulcers, narrowing and bleeding. Other problems include persistent cough, asthma or pneumonia, structural changes of the lungs or voice box, irritation of the passage between the nasal airways and the pharynx, and tooth decay.

A word about Barrett’s esophagus: GERD can cause this condition, in which cells that line the esophagus are replaced by those similar to the ones founds in the stomach and intestine. Barrett’s esophagus can lead to cancer.

With or without Barrett’s esophagus, GERD increases cancer risk. “A study published in a 1999 New England Journal of Medicine showed that having more than one episode of heartburn or regurgitation per week is associated with an eight-fold increased risk of esophageal cancer (adenocarcinoma), while persistence of these symptoms over 20 years increased the cancer risk over 40-fold,” says Corless. “White males over the age of 50 seem to be at the highest risk.”

Purple pills and more

There is no cure for GERD, but symptoms can be managed.

“Long-term management of GERD starts with a common sense approach that includes avoidance of fatty foods, not overeating, weight loss if appropriate and eating supper earlier to allow the stomach to empty before lying down for the night,” says Corless. “Reduction or discontinuation of cigarette smoking and alcohol use can be quite helpful. Sometimes the simple avoidance of things like chocolate and mints can be very helpful in reducing heartburn.”

Many people with reflux self-medicate with over-the-counter remedies such as Tums, Rolaids and Maalox, according to Corless. Patients may find better relief with medications that reduce stomach acid and prevent backflow into the esophagus, including proton pump inhibitors (Nexium, Prevacid, Prilosec) or acid reducers (Pepcid AC, Zantac). Some of these are found over-the-counter, but more potent versions require prescriptions. When a single drug is ineffective, your doctor can prescribe a drug to keep acid moving downstream by promoting stomach emptying (Reglan, Zelnorm, Propulsid).

When lifestyle and pharmaceutical approaches do not suffice, surgery can tighten the lower esophagus and restore competence to the sphincter muscle there, says Corless.

Don’t ignore GERD symptoms or medicate without consulting your doctor. With proper care, you, pizza and coffee can coexist without chalky chaser sides (in moderation, of course).

Honor Hawkins is a freelance writer based in Charleston.

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