What You Should Know About GERD

By Dr. W. Gifford Jones

Do you suffer from heartburn, gas, stomach discomfort after eating and sometimes need to belch? Or do you ever feel that food has come back up leaving a bitter taste in your mouth? If so you may be suffering from a motility problem rather than excess stomach acid.

Following a meal, the upper sphincter, a tight ring of muscle separating the stomach from the esophagus (foodpipe) usually remains closed. Heartburn problems occur when the sphincter doesn't close or opens at the wrong time allowing the contents to splash up into the esophagus.

Stomach pain and discomfort also occur when the stomach can't push the food and stomach contents through the digestive tract. A stomach with poor motility allows its contents to remain too long, a condition known as delayed gastric emptying.

The results? Belching, bloating, gas, stomach fullness and pain. Doctors refer to this condition as non-ulcer dyspepsia or NUD. Sometimes the gastric juices shoot up into the esophagus causing heartburn and inflammation of the lining. Doctors refer to this condition as gastroesophageal reflux disease (GERD) when severe inflammation of the esophagus occurs.

One study showed that 39 percent of patients suffering from upper digestive problems had symptoms relating to poor motility. An additional 38 percent have heartburn along with other symptoms that implicate a motility problem.

The diagnosis of heartburn with motility related problems can sometimes be as easy as rolling off a log. Anyone experiencing belching and bloating probably has a motility problem. But it's not always the case. Heartburn can mimic angina and heart problems can imitate heartburn. So people who have more persistent stomach pain should never treat themselves. They should see their doctor.

Unfortunately even the physician can't always provide the answer. A Dutch study showed that cardiologists often reassured patients they did not have heart trouble. Yet they failed to diagnose GERD as a possible source of the pain.

What can you do to ease the symptoms of motility following a heavy meal? One that's often accompanied by belching, bloating and regurgitation of fluid? One that becomes more frequent, more severe and longer lasting?

First, it's necessary to change lifestyle and eating habits. Don't mimic the man in the T.V. ad. The one, who is in considerable distress and says, "I ate the whole thing!"

Remember too that all the jogging in the world won't make a weak upper sphincter stronger or tighten it up. The best solution is to leave something on the plate at meal time. Better still, eat smaller well-balanced meals.

Gastric juices, like water, don't flow uphill. So remain upright following a meal and forget about after dinner naps. It's for this reason that doctors suggest raising the head of the bed as many attacks of heartburn occur during the night.

There are a few more do's and dont's for which, your foodpipe and stomach will be grateful. Stay away from spicy, fatty or greasy foods. Decline onions, garlic, chocolate, after dinner mints and caffeine containing drinks.

These decrease the stomach's motility and affect the muscles of the upper sphincter. Similarly avoid gas-forming vegetables such as cabbage and beans.

Stop smoking. This will decrease stomach problems. If you can't quit cold-turkey use a nicotine patch to stop your craving.

But suppose lifestyle changes don't ease gastric distress? The doctor has also ruled out diseases such as peptic ulcer and malignancy. What else can be done?

If you have poor gastric motility, a weak sphincter or a sluggish stomach you can treat these problems. Doctors prescribe drugs such as Prepulsid which are "motility agents". It's an effective way to move stomach contents through the stomach because the medication improves stomach motility and strengthens the sphincter, thereby treating the underlying cause of the symptoms.

By moving the food and acid through your digestive system, Prepulsid helps ensure that the acid does not irritate the stomach and /or the lining of the esophagus. It treats and prevents the symptoms of poor motility-heartburn, post meal bloating, nausea and frequent belching.

A report in the Canadian Journal of Gastroenterology claims that Prepulsid increases LES pressure 20 to 50 percent in patients suffering from GERD. It also accelerates the emptying of stomach contents. This decreases the risk that partially digested food will remain in the stomach too long and irritate the esophagus.

Prepulsid is well tolerated with only a few patients complaining of diarrhea and stomach cramps. So when heartburn is due to motility related symptoms due to delayed gastric emptying, Prepulsid should quickly ease the symptoms. And more complete relief should be affected in 4 to 8 weeks.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod