Gerd

Alan Jacob
Nutrition
April 13, 2011
1

GERD
(Gastroesophageal Reflux Disease)

Gastroesophageal Reflux Disease (GERD) is a gastric disorder which causes stomach acids
to back up into the esophagus, the tube leading from the mouth to the stomach. This causes pain,
which is also known as heartburn. GERD can disrupt sleep, and make eating difficult. It can also
lead to respiratory infections, ulcers and cancer.

The reflux action of Gastroesophageal reflux disease if a function of the weakening of the
lower esophageal sphincter (LES). The LES is a muscle located at the bottom of the esophagus
and acts as a shut off valve. When food is eaten, it passes through the esophagus and the LES,
then into the stomach. The LES then closes after the food enters the stomach, and keeps the
stomach contents from returning up the esophagus. GERD is the backup of stomach acid or bile
into the esophagus when the sphincter valve relaxes or weakens allowing acid to flow back up
into the esophagus. This causes the lining of the esophagus to be irritated and inflamed. Over
time it can erode the esophagus causing bleeding or breathing problems.

In infants, the LES may not be well formed, which causes the baby to spit up or vomit.
Infants & children who do not vomit or complain of heart-burn or a stomachache may have this
condition. There is the possibility that this material will be aspirated into the windpipe, which
can cause asthma, pneumonia, and possibly suffocation or sudden death! GERD
was thought to be implicated in sudden infant death syndrome (SIDS) however, studies
concluded it was not.
 Gerd
Alan Jacob
Nutrition
April 13, 2011
2

In older children, or adolescents, the LES weakens, and acids from the stomach enter
the esophagus, causing burning in the middle of the chest known as “heartburn”.
Everyone has experienced reflux at one time or another. Some only experience a vague
indigestion. Most people go to the doctor because they have trouble eating. They feel like
something keeps getting stuck in their throat when they eat.
This may be a serious condition called Dysphagia.

GERD affects one-third of the adult population (95 million) with 15 million
having symptoms everyday! It also affects 50% of all healthy, full term newborns!
It is the primary reason for most vomiting in infants during the first four months. (At which time
the vomiting should stop.) Frequent vomiting that continues after the first four months of life, or
is excessive at anytime usually indicates the presence of GERD. Constant crying with the back
arching usually accompanies the frequent vomiting. Almost 5% of infants continue with GERD
into adulthood. This number may be higher as more and more young children experience GERD
symptoms and are diagnosed with this condition. Children who have Hiatal hernia, cystic
fibrosis, neurological impairment or delay, or an immature esophagus and LES are at a higher
risk for GERD.
Children with GERD that are preschool age and older often have gas and abdominal pain
above the navel, with intermittent vomiting. They may also have chest pain or heartburn
symptoms that can last up to two hours and become worse after eating.
BENDING OR LYING DOWN MAKES THE HEARTBURN WORSE!
Children have different symptoms; they can gain or lose weight. Some eat more because
they are uncomfortable and a full stomach makes them fell better temporary. Some refuse to eat
and are picky about what they eat, and they eat very little even though they are hungry. Some
may have trouble swallowing: they choke or gag on food, so they may drink liquids constantly
because it soothes their esophagus and removes the burning sensation.
 Gerd
Alan Jacob
Nutrition
April 13, 2011
3

Other causes of GERD can be having too much acid in the stomach. Heredity can make
some families more prone than others. Neurological disorders that affect muscles in the body.
Diabetes, Allergies, rapid weight gain, medications can weaken the LES including calcium
channel blockers, (high blood pressure) theophyline (for asthma) antihistamines, and nitrates in
medications and different foods all can trigger GERD.

Risk factors that can increase your risk of GERD include:

• Obesity
• Hiatal hernia
• Pregnancy
• Smoking
• Dry mouth
• Asthma
• Diabetes
• Delayed stomach emptying
• Connective tissue disorders, such as scleroderma
• Zollinger - Eillison syndrome
• Caffeine
• Alcohol
• Chocolate
• Peppermint
• Eating large meals
• High fat foods
• Citrus foods (tomatoes, and tomato products increase acid in the stomach)
• Puberty (hormones seem to trigger acid reflux)
• Poor posture
 Gerd
Alan Jacob
Nutrition
April 13, 2011
4

Symptoms
• A burning sensation in your chest (heartburn), sometimes spreading to the throat, along
with a sour taste in your mouth.
• Chest pain
• Difficulty swallowing (Dysphagia)
• Dry cough
• Hoarseness or soar throat
• Regurgitation of food or sour liquid (acid reflux)
• Sensation of a lump in your throat

Respiratory symptoms are twice as likely in children with GERD then children without it.
Children often have frequent sore throats, sinus infections, bronchitis, and dry coughs. They
have a constantly runny nose or a hoarse, deep voice. They have wheezing or other asthma
symptoms. Sleep is often disturbed (coughing or choking when they lie down). Some
experience sleep apnea. Others have frequent ear infections or drool a lot. Some infants and
toddlers insist on being held upright and not laid down, sleeping in the parents’ arms. In extreme
cases the teeth will show signs of enamel erosion. Children with GERD have anemia because
there is an ulcer in the lining of the esophagus that has begun to bleed.

Diagnosis for GERD will be determined by the doctor after taking a thorough medical exam,
and history. The doctor will order a series of tests to gauge the extent of the damage done by the
GERD.
• Chest X-rays: To check for pneumonia or lung damage from aspiration.
• Upper GI Endoscopy: A camera looks at the esophagus, stomach, and the duodenum
for damage, and can take tissue samples.
 Gerd
Alan Jacob
Nutrition
April 13, 2011
5

• Esophageal Manometry: It measures how well the LES and motor function of the
esophagus are. A thin tube is inserted through the nose down the throat.
It is a 24 hour pH study that monitors how often and the length of a reflux. This test
can see if there is a connection between episodes of acid reflux and other symptoms
like a chronic cough, wheezing, or sleep apnea.
• Gastric Emptying Study - A child drinks a glass of milk mixed with a radioactive
chemical. Using a special camera, reflux can be seen with this test. This can determine whether
it was caused by GERD or by a milk allergy, which does not respond to acid suppressant
therapy.

Treatment for GERD has two main treatments.

• The first one is a lifestyle change. This means that patients should not:
1. Eat within three hours before going to bed.
2. Elevating the bed about six inches.
3. Eat smaller meals more frequently.
4. Avoid fatty foods.
5. Avoid caffeine.
6. Avoid mints and mint flavoring.
7. Avoid spicy foods.
8. Avoid citrus fruits.
9. Avoid anything with tomatoes.
10. Avoid carbonated beverages.
11. Avoid smoking.
12. Avoid alcohol.
13. Avoid tight fitting clothes.
14. Improve posture.
15. Maintain a healthy weight.
 Gerd
Alan Jacob
Nutrition
April 13, 2011
6

Infants are easier, hold baby upright about a half hour after breast/bottle feeding. Feed the
baby smaller portions more frequently, also thickening the formula with rice cereal or pre-
thickened formulas like Enfamil. (Decreases spit or vomit, but does not do anything for reflux).

• The second treatment is medication. The doctor may first recommend non-
prescription medications like antacids, like Gaviscon, Maalox, Mylanta, and Tums. (If antacids
are used everyday for more than three weeks, they produce diarrhea.) Histamine-2 receptor
blockers. (H2 blockers), such as Nizatidine (Axid), Ranitidine (Zantac), Famotidine (Pepcid),
Cimetidine (Tagamet).
• If these medications do not work the doctor will order a more powerful Proton-Pump
inhibitor (PPIs). Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid),
Rabeprazole (Aciphex), Pantoprazole (Protonix).
• Some doctors use promotility agents Metoclopramide (Reglan) and Bethanechol
(Duvoid), to tighten the LES and promote faster emptying of the stomach.

The last option when all else fails and a person’s GERD is very serious, the doctor will do
surgery. This is used only on a small number of people. Fundoplication is a surgical procedure
that puts pressure on the LES to keep acid from backing up. The doctor wraps part of the
stomach around the esophagus and sews it down. The procedure is done laparoscopically. This
procedure is not always successful and can have complications, and can come undone in 20-30%
of cases.

There are no proven alternative medicine therapies for GERD. Some options are:
• Herbal remedies – licorice, slippery elm, chamomile and marshmallow. (herbal
remedies can have serious side effects and may interfere with medications)
• Relaxation therapies – Techniques to calm stress and anxiety. (to reduce signs &
symptoms of GERD)
• Acupuncture – Involves inserting needles into your body. (Study reports it has helped
people with heartburn that persisted with medications)
 Gerd
Alan Jacob
Nutrition
April 13, 2011
7

The North American Society for Pediatric Gastroenterology and Nutrition drafted guidelines
for treating children and adolescents with GERD in 2001.

I am happy to say that my procedure worked out very well. St. John Hospital uses my
surgery as a training film for all of its future doctors. I had gone through every step I have
explained here, and since the surgery I have been reflux free for five years and counting!