Newsweek Lies:  Gut Reaction: Treating a Disease Called GERD

As the pitching ace of the Baltimore Orioles, Jim Palmer was used to gutting out physical problems. So when the future Hall-of-Famer started having bouts of intense heartburn, he gutted that out, too, living with the pain. After all, he figured, it was only heartburn.

It took Palmer 10 years before he learned that he had something far more serious than simple heartburn: He had a disease called GERD - gastroesophageal reflux disease. GERD is a condition in which strong stomach acids (and sometimes other substances such as pepsin and bile) involved in digestion back up into the esophagus (the gullet, or foodpipe, connecting the mouth to the stomach). This backup phenomenon, acid reflux, occurs when certain muscular capabilities of the esophagus or other protective mechanisms fail. It can produce a host of problems, but the signature symptom is heartburn, that burning in the chest and throat that is typically linked to indigestion (and sometimes mistaken for a heart attack).

Having frequent heartburn could mean you have GERD. About 50 percent of all noncardiac-related heart pain is caused by GERD. But most people don't realize that. Palmer's long-silent suffering was not unusual. Although some 44 million Americans have heartburn from acid reflux at some point in their lives, less than 17 percent ever see a physician. And about 21 million of them have full-blown GERD. In other words, millions of Americans suffer year after year from GERD, never knowing that their discomfort and pain come from a treatable disease. And untreated, it generally keeps getting worse.

"GERD is extremely common, but it should not be trivialized," says Seymour Katz, M.D., clinical professor of medicine at New York University School of Medicine and past president of the American College of Gastroenterology. "In about 20 percent of cases, it may become a chronic condition with serious consequences."

Untreated GERD can result in esophagitis (inflammation and ulceration of the esophagus) and Barrett's esophagus, a precancerous condition that affects the esophageal lining. Some research has shown that GERD is one of the major risk factors for adenocarcinoma, an increasingly common cancer in white males in the United States.

Even if the disease should start out with mild symptoms, its impact can be cumulative: GERD most often kicks into gear after the age of 40, Dr. Katz points out, "we think due to the constant exposure of the esophagus to acid over the years." As it worsens, heartburn episodes may become more severe, and sufferers may actually feel the advanced sensation of acids backing up in the esophagus or into the back of the throat. An overwhelming array of other symptoms may also develop - chronic regurgitation, belching, difficulty swallowing, hoarseness and laryngitis, coughing, even asthmatic episodes.

When the heartburn gets bad enough, crushing pain in the chest may mimic a heart attack. "We see patients who have been to their physician or an emergency room repeatedly, with both patient and physician guessing heart attack until a thorough evaluation proves otherwise," notes Reginald Bell, M.D., a surgeon in Englewood, Colo., who specializes in GERD.

Many patients have trouble sleeping. They awake coughing, choking, racked with heartburn. A survey of almost 10,000 Americans last year by the health-research company MEDTAP International, in Seattle, Wash., found that 74 percent of GERD patients report nocturnal symptoms. Generally this lowered their energy and interfered with their daily functioning. "Some people with GERD mistakenly eat too close to bedtime. When they do so, there is food in their stomach that stimulates acid. The acid, as well as their food, sometimes washes back up into the esophagus when they lie flat; it is then the acid that is causing the heartburn," says Dr. David A. Peura, Professor of Medicine and Associate Chief of Gastroenterology and Hepatology at the University of Virginia school of Medicine. "If someone's sleep is interrupted, he will wake up tired, cranky and be less productive at work."

Since food breakdown is a major factor in the disease, many with GERD also frequently feel excessive fullness after eating, or feel food stick to their gullet.

"All of this has a highly detrimental impact on life," observes Katz. "As symptoms worsen, quality of life worsens. A Scandinavian study found that compared with other common diseases, GERD patients have a worse quality of life than patients with hypertension, angina and heart failure. Only psychiatric patients did worse. The financial impact is huge, too - reduced productivity, time lost from work, in some people an inability to work at all."

But the key to avoiding all this is treatment - in other words, preventing the ailment from progressing to these dangerous points. Fortunately, knowledge and treatment of GERD has advanced to where the majority of patients can do very well - if the disease is discovered early enough.

Gastroenterologists, who specialize in digestive disorders, have definitive methodologies to determine the existence and extent of GERD. "If you regularly have the classical symptoms of burning and reflux after eating certain foods, we can pretty much say you have GERD, even before testing," explains David Fleischer, M.D., chairman of the Division of Gastroenterology and Hepatology at the Mayo Clinic in Scottsdale, Ariz. "If you have no worrisome signs suggesting serious complications - like trouble swallowing, weight loss or asthma - some physicians immediately put you on a high-dose regimen of an acid-inhibiting medicine called a proton pump inhibitor (PPI)," he says. "We do this as a kind of empirical testing; since these drugs are currently the best medicine for GERD, if they don't get the patient back to normal, we need to question the diagnosis."

The most common test after that is endoscopy: a slender and flexible, spaghetti-like fiber-optic tube called an endoscope is passed into the esophagus while the patient is mildly sedated. The tissues can be visualized through the endoscope to determine just what damage the esophagus has sustained.

As a first line of defense, changes in diet and lifestyle can help control the disease. For starters, patients are advised to eat smaller, more frequent meals and keep their weight down, since being overweight overburdens the esophagus and contributes to reflux. They are also instructed to avoid several offending foods, including fried, fatty or highly spicy items. Nicotine is taboo, as is anything that increases intra-abdominal pressure, from tight belts to heavy lifting or deep knee bends.

For some patients, controlling these lifestyle factors will be enough. Others require medical or surgical treatment. Over-the-counter antacids work for some, taken 30 to 60 minutes after eating and at bedtime, with pill form generally considered better than liquid form.

When the medications for GERD fail, or when patients ultimately decide that they don't want to take the drugs forever, surgery can fix the esophageal valve. Some newer endoscopic surgeries now offer alternatives to cutting -one uses radio-frequency waves to burn the inner lining of the esophagus, another literally "stitches" the esophagus more tightly shut.

"With all these therapies available and the rapid improvements being made in the field, 99 percent of GERD patients can live normally, with a high quality of life," concludes Dr. Fleischer. "If you suspect you may have GERD, see a doctor at once. Odds are, the problem will then be taken care of. It's eminently treatable."