We've all Been There
You’ve just had the meal of a lifetime and you’re ready to slip into a food coma. You crawl into bed, snuggle up into your favorite pillow and are ready to snooze when suddenly, your esophagus is on fire. You feel like a dragon breathing fire every six seconds. Waves of burning pain move up and down your chest and now, sleep is the furthest thing from your mind. We’ve all been there at some point in our lives, but some will suffer more than others. You, my friend, have gastroesophageal reflux disease (GERD), better known as acid reflux.
You’re not alone – between 15 and 30 percent of Americans suffer from acid reflux (source). Sometimes it’s an isolated incident, brought on by foods that irritate the stomach. However for some people, GERD is a chronic condition that can make it difficult to get a good night’s sleep.
What is GERD?
Gastroesophageal reflux disease (GERD) is a chronic condition of the GI tract (digestive system) where stomach acid flows back up the tube that connects the mouth and stomach (the esophagus). When the stomach acid comes into contact with the lining of the esophagus, it can cause a lot of irritation. When this happens infrequently and after eating irritating foods, it’s referred to as acid reflux. If it happens to you more than twice a week, it’s more likely going to be GERD. Often, GERD can be managed with lifestyle changes and over-the-counter (OTC) medications. Sometimes, though, GERD may not respond to these treatments and may require stronger prescription medications or surgery.
Symptoms of GERD
Common signs and symptoms of GERD include:
- A burning feeling in your chest (also called heartburn) that happens after eating and gets worse when you lie down
- Feeling like you have something stuck in your throat
- Regurgitating (throwing up) food or sour tasting liquid
- Trouble swallowing
- Dry cough at night
- Trouble sleeping
It’s important to remember that only a doctor can diagnose GERD. If you are experiencing any kind of chest pain, you should seek immediate medical attention from your doctor or at the nearest hospital. Chest pain that is accompanied by trouble breathing, arm or jaw pain is a life-threatening emergency and should be evaluated right away.
What Causes GERD?
GERD can strike anyone at any time, no matter your age or ethnicity. However, there are a few groups that are more likely to develop it. You may be more likely to develop GERD if you are:
- Overweight or obese
- A smoker, or are exposed to secondhand smoke on a regular basis
- Taking certain medications, including painkillers or antidepressants
GERD is caused by frequent episodes of acid reflux. When you swallow food, there’s a little band of muscle (called a sphincter) at the bottom part of your esophagus that relaxes to allow the food and liquid into the stomach. After the esophagus is emptied, the sphincter closes. Acid reflux happens when the sphincter either closes when it shouldn’t or just becomes weaker, both of which allow stomach acid to backflow up into the esophagus. This causes irritation of the lining of the esophagus and often leads to inflammation. The stomach acid flowing back up into the esophagus is what causes the burning feeling in your chest.
Complications of GERD
Left untreated, GERD can cause a number of complications. These include:
- Barrett’s esophagus (a precursor to esophageal cancer that happens when stomach acid changes the makeup of the tissue that lines the esophagus)
- Ulcers (open sores in the esophagus that are caused by stomach acid wearing away the esophageal lining; can often bleed and be very painful when swallowing)
- Esophageal stricture (a narrowing of the esophagus that can make it very difficult for food to pass through)
- Eroding of teeth
- Bad breath
- Nausea and vomiting
Diagnosis and Treatment for GERD
GERD can be diagnosed through a few different tests, as well as a thorough medical history taken by your doctor. To confirm a diagnosis of GERD, you may have:
- Endoscopy: Also known as an upper endoscopy, this procedure is performed by inserting a thin, flexible tube through your mouth and down into your esophagus. The tube has a light and a camera on the end – with this, the doctor is able to look at the lining of your esophagus and even at the inside of your stomach. In addition to looking at everything, your doctor may be able to get tissue samples to test for inflammation or cancer cells.
- Esophageal manometry: This is a test that measures the rhythm of the contractions in your esophagus. It also is able to measure the force of each contraction. This information gives some insight into how effectively your esophagus is working.
- Upper GI X-ray: This special x-ray is taken after you drink a chalky liquid that coats the esophagus, giving the doctor a different view of your GI tract (the esophagus, stomach, and upper portion of your colon). Sometimes, you may be asked to swallow a pill made of barium – this can help diagnose an esophageal stricture (narrowing).
Common treatments for GERD include medications and lifestyle changes. Lifestyle changes that may improve GERD symptoms include:
- Quitting smoking or avoiding being around secondhand smoke
- Beginning a diet and exercise plan that is geared towards weight loss, or maintaining a healthy weight
- Not lying down immediately after meals
Medications that may improve or manage GERD symptoms include:
- Proton pump inhibitors (PPI): These medications act as acid blockers and provide an opportunity for the lining of the esophagus to heal. Examples of over-the-counter PPIs include Prevacid and Prilosec (omeprazole).
- Antacids: Products like Rolaids, Tums tablets, or Mylanta liquid can help to neutralize the acid and relieve symptoms immediately. However, they don’t fix the problem and often cause unwanted side effects like diarrhea.
- H-2 receptor blockers: These medications help reduce acid production and provide long-lasting relief of symptoms. Examples of these include Tagamet (cimetidine), Pepcid (famotidine), and Zantac (ranitidine).
- Medications to strengthen the esophageal sphincter: A medication called Baclofen can lessen the number of times your esophageal sphincter relaxes, which may improve your GERD symptoms. The downside, though, is the nausea and fatigue you may experience as side effects.
Tips for Sleeping With GERD
It may seem impossible to get a good night’s sleep when you suffer from acid reflux or GERD, but there’s hope yet. Here are some helpful tips to get you through the night:
Sleep with your head elevated. Sleeping with the head of your bed elevated 6-8 inches will help prevent stomach acid from flowing back up your esophagus. Try using an extra pillow or two, a wedge pillow, or try out a bed that has an electronically-powered adjustable head.
Don’t sleep on your back. Sleeping on your back, especially when you’re overweight, can put pressure on the stomach and can cause acid to flow back up into your esophagus. Obviously, you can’t control what position you’re in while you sleep – just try to be mindful of your position when you are awake. If you keep finding yourself on your side, try putting pillows on either side of you to remind you not to roll over.
Sleep on your left side. Sleeping on your left side has been scientifically proven to reduce symptoms of acid reflux. Sleeping on your right side can cause the lower esophageal sphincter to relax, allowing the backflow of acidic stomach contents back into the esophagus and therefore, heartburn.
Don’t go to bed right after eating. It’s a good idea to eat your last meal before bed approximately 3-4 hours before going to sleep. This allows your stomach to fully digest your meal and lessens the chances that you’ll have stomach contents reflux into your esophagus because your stomach is more likely to be empty. In addition to watching when you eat meals, watch what you’re eating. Lower fat, less acidic foods tend to be easier on the stomach and are easier to digest.
Lose weight. Obesity or being overweight is one of the biggest risk factors for acid reflux and GERD. By losing weight and staying active, you are not only reducing your chances of developing GERD, but you’re also taking steps to actively manage your symptoms.
The Bottom Line
Remember, if you’re experiencing acid reflux more than twice a week, it’s time to call your doctor to diagnose GERD and rule out any other causes. Chest pain is never normal, especially when it’s accompanied by shortness of breath, jaw or arm pain. If you are experiencing those symptoms, be sure to seek immediate medical attention from your doctor or the nearest emergency room.
GERD is an uncomfortable condition that affects millions of people each year. While the symptoms are not fun, they’re definitely manageable. And remember, with a few lifestyle adjustments and possibly medications, you’ll be able to manage your GERD symptoms and get that good night’s sleep you’ve been needing.