GERD is commonly known as the “Acid reflux”. It is characterized by heartburn, regurgitation, and sometimes nighttime cough/hoarseness of voice/wheezing/retrosternal burning chest pain. 

First line treatment for this is lifestyle modifications such as: 

• Weight loss for patients with GERD who are overweight or obese
• Elevation of the head of the bed in individuals with nocturnal or laryngeal symptoms (eg, cough, hoarseness, throat clearing). This can be achieved either by putting six- to eight-inch blocks under the legs at the head of the bed or a Styrofoam wedge under the mattress. Refraining from assuming a supine position after meals and avoidance of meals two to three hours before bedtime also helps.
• Selective elimination of dietary triggers (caffeine, chocolate, spicy foods, food with high fat content, carbonated beverages, and peppermint) in patients who note correlation with GERD symptoms and an improvement in symptoms with elimination.
• Avoid tight-fitting garments to prevent increased pressure on the stomach
• Promote salivation with oral lozenges/chewing gum to neutralize refluxed acid and increase the rate of esophageal acid clearance
• Avoid tobacco and alcohol, as both reduce lower esophageal sphincter pressure and smoking also diminishes salivation
• Abdominal breathing exercises strengthen the antireflux barrier of the lower esophageal sphincter

Medications called proton-pump inhibitors (PPIs) are the first line medical therapy for GERD and GERD with extraesophageal manifestations. PPIs are started by taking one tablet, once daily. If once-daily PPI doesn’t work, it can be escalated to twice daily PPI for 6-8 weeks.  GERD symptoms refractory to empiric therapy with PPIs should get an upper GI endoscopy (EGD). If this is normal, but the patient continues to be symptomatic, then ambulatory esophageal pH monitoring or impedance pH testing can be done while the patient is taking a proton-pump inhibitor for symptom relief to see the symptom-reflux correlation. 

GERD patients with alarming symptoms of unintentional weight loss or anemia (low blood count) should immediately get an upper endoscopy to rule out cancer.

 Finally, your simple heartburn can be more than that; see your doctor today for appropriate care.

 Sagarika Ranga, MD, is accepting patients at White River Health Internal Medicine. To schedule an appointment, call 870-262-1530.