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How to prevent acid reflux from ruining your sleep.

Gastroesophageal reflux disease (GERD) is a condition in which the lower esophageal sphincter, a muscular valve that separates the esophagus from the stomach, becomes too relaxed or weak and I allows stomach acid to flow up into the esophagus, often causing considerable heartburn and other problems. GERD is a common problem, particularly among older adults. As we age, the ability of the esophagus to spontaneously function normally changes. Laxity in the diaphragm can also contribute to GERD. For many people, GERD can be worse at night.

Gastroenterologist Terri Getzug, MD, with the UCLA Health System, explains that nocturnal reflux (GERD episodes at night) can lead to coughing, asthma, esophagitis, aspiration, laryngitis, and Barrett's esophagus which is a pre-cancerous condition.

"The most common symptom of GERD is heartburn, which can increase when lying flat," she says. "When one lies flat there can be more reflux due to the absence of gravity and decreased clearance of the esophagus. Some patients have worse symptoms at night due to this mechanism."

Dr. Getzug adds that laxity in lower esophageal sphincter tone can also occur with obesity, specific foods, and from certain medications.

Avoiding GERD at night. Simple lifestyle measures can greatly impact nighttime reflux symptoms, Dr. Getzug says. "Some of these would include elevating the head of the bed four to six inches, not eating for three to four hours before going to bed, avoiding foods such as caffeine, chocolate, fatty or fried foods, rich foods, alcohol, and mint, which can all worsen reflux." she says. "Losing weight can also help greatly."

Alcohol may also trigger GERD episodes, but it's important to remember that your food triggers may differ from someone else who has GERD.

Smoking also has detrimental effects on the lower esophageal sphincter functioning effectively, so quitting cigarettes is vital.

There are medications that treat GERD. The best medicines are in a class of drugs called proton-pump inhibitors and are potent acid reducers. Other medicines, including H2-blockers and pro-motility agents, are also used. You should talk with your doctor about any over-the-counter antacids or other products you've tried, including those that help relieve symptoms and those that haven't worked at all.

Surgery for GERD. For serious GERD cases, surgery to reinforce the strength of the lower esophageal sphincter is an option. More and more, such procedures are done laproscopically, which requires only a few small incisions, rather than open surgery.

Many people with GERD also suffer from a hiatal hernia, which means that part of the stomach is sticking up through the diaphragm into the esophagus.

"Surgery usually treats a hiatal hernia and wraps the stomach (fundoplication) to minimize acid reflux in the esophagus," says Eric Esrailian, MD, MPH, a gastroenterologist at UCLA Health System. "It is often performed in patients who do not respond adequately to medicine, or are young and do not want to or cannot take medications long term."

If you have a small hiatal hernia, you may not have any symptoms, but a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. You may also be belching more than normal, and experience chest pain, difficultly swallowing, and nausea.

How do you know if it's GERD?

Occasional reflux is fairly common, but experiencing the burning sensation more often than twice a week is considered a red flag for GERD. Although the symptoms may be dismissed as simply heartburn, ignoring GERD can lead to complications, with adults over age 65 most at risk. One of the more serious complications of untreated GERD is esophageal cancer.

It's important to remember that GERD symptoms and triggers can vary from patient to patient. "There is no cookbook to follow for all patients," Dr. Esrailian says. "What are considered 'classic triggers' for some may not apply to others. Once your personal triggers are identified, avoidance or eating in moderation can help!"


* Try to avoid common GERD triggers such as smoking, spicy, fried and fatty foods, garlic, onions, alcohol, and caffeine.

* Don't bend over immediately after eating, and wait at least three hours before lying down.

* Control your weight--this is the most effective lifestyle measure for easing GERD symptoms.---Take your medications as directed and don't stop taking them without consulting your doctor.
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Publication:Healthy Years
Date:Dec 1, 2013
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