Gastroesophageal Reflux Disorder (GERD)

Gastroesophageal reflux disorder (GERD) or more commonly referred to as ‘acid reflux’ disease is a painful and common disorder in adults of all ages, particularly in people 40 and over. The disorder is caused by the juices of the stomach backing up into the esophagus, causing a burning sensation and sometimes damaging the lining of the esophagus itself. The burning sensation is also referred to as ‘heart burn’, since it is often felt in about the same place the heart rests in the chest cavity.

Many of the digestive enzymes of the stomach, such as pepsin, work best at an extremely low pH, or in other words a very acidic environment. It is for this reason that ‘parietal’ cells of the stomach lining produce and pump large quantities of the chemical hydrochloric acid into the stomach. Stomach fluids are therefore highly acidic, reaching pH’s as low as 1, which is about ten times more acidic than common battery acid, and a million times more acidic than water. It is this acid that causes the discomfort and damage associated with acid reflux disease.

The disorder can develop for a number of reasons. There is a lot of evidence suggesting that a likelihood to develop the disease can be genetic. Also, any trauma or injury to the esophageal sphincter, the circular muscle responsible for keeping stomach fluids out of the esophagus, can lead to the disorder. Such injury can be caused by frequent vomiting, or by a hiatal hernia.

The bad news is that once you develop acid reflux disease, you are going to have it for life. The good news is there are a wide variety of excellent treatments for the disorder that are now available, some by prescription and some over the counter. There are also a number of measures people can take to reduce the symptoms of acid reflux in addition to the use of medication.

There are three basic medication types popularly used for acid reflux. The first and most famous being the ‘antacids’, which all use some kind of strong base such as calcium carbonate, or magnesium carbonate to neutralize the acid of the stomach. Though fast acting, these treatments only last a short period and are not recommended for use in treating reoccurring heart burn. Some examples of antacids include Tums, Rolaids, and Alka-Seltzer.

Like antacids, ‘acid reducers’ are available over the counter but they work by actually lowering the amount of acid produced by the stomach and are usually effective for a longer period of time. The more popular acid reducers include Zantac, and Pepcid AC.

Acid reducers are often enough to counter milder forms of acid reflux disorder, but more moderate forms of the disease may require a doctor prescribed ‘proton pump inhibitor’ (PPI). PPI’s also function by lowering the amount of acid produced by the stomach, though by a different mechanism than acid reducers. For this reason they can be safely be used in conjunction with acid reducers. Some PPI’s include Prilosec, Prevacid, and Aciphex. Prilosec has recently been made available over the counter, though its continued use should be only be done under the advice of a medical professional.