Feel the Burn?

Another cause might be a collective decline in the amount of H. pylori bacteria in our stomachs as more of us live in less crowded conditions than we did a generation or two back. H. pylori are passed from person to person and are the most frequent cause of stomach ulcers, but they also inhibit the stomach’s ability to make acid. Ganz says better collective hygiene also has led to fewer H. pylori in later generations. But the tradeoff for a decline in peptic ulcers has been the rapid spike in GERD.

Hiatal hernia is also frequently found in GERD sufferers. The upper part of the stomach invades the diaphragm’s turf, and it can trap acid close to the esophagus or interfere with the pressure necessary to keep the lower esophageal sphincter tightly closed.

Besides a burning sensation in the chest or the back of the throat, GERD symptoms can include hoarseness, chest pain, a dry cough, and difficulty swallowing. Attacks typically happen after a meal or when bending over or lying down. Common triggers include consuming citrus fruits, chocolate, caffeine, fatty foods, garlic or onions, spicy or tomato-based foods, and—of all things—mint flavorings. Although people are more likely to develop GERD as they get older, symptoms don’t necessarily worsen over time.

“People with the most harmful reflux sometimes have very mild symptoms and vice versa,” Ganz says. “Some people who develop Barrett’s esophagus have the least amount of symptoms, so any heartburn should be taken seriously.”

Too-Easy Fixes

GERD symptoms are usually enough for a diagnosis—no tests needed. And Ganz says that 20 to 30 percent of people with GERD can help themselves by doing what we all know we’re supposed to do: Quit smoking, eat more sensibly, and get more exercise. “You might not get rid of it completely, but it can make it significantly better,” he says. Waiting at least three hours between dinner and bedtime seems to help, as does raising the head of your bed six to eight inches. And those jokes people make about loosening their belts after a big meal? Letting yours out a notch or two really is good for relieving pressure on the abdomen and thereby the esophageal sphincter.

Many people can manage GERD with over-the-counter medications. Antacids like Rolaids or Tums combine magnesium, calcium, and aluminum with hydroxide or bicarbonate ions to neutralize stomach acid, while histamine2 blockers like Pepcid AC inhibit some of the stomach’s acid production. Prescription proton-pump inhibitors like Prilosec actually disable stomach cells from producing acid. Because prescription drugs take longer to provide relief, they’re often used together with over-the-counter meds.

The downside of easy treatment is that mild GERD symptoms can mask real damage to the esophagus. Doctors urge people to note the frequency as much as the intensity of symptoms. Having reflux two or more times a week might be cause for concern; daily reflux definitely is. “Our rule of thumb is, if someone has reflux on a daily basis or almost daily for more than year, whether they’re taking medications or not, they should get endoscoped to make sure they don’t have Barrett’s esophagus,” Ganz says.

Endoscopy of the upper gastrointestinal tract is the most common test doctors use if they are worried about Barrett’s. Your throat is numbed to stop the gag reflex so the doctor can slide a thin plastic tube equipped with a tiny camera into it. You can watch on a monitor as the camera scans the surface of the esophagus for abnormalities, such as scarring. If your doctor sees reddened tissue, that’s a likely indicator of Barrett’s esophagus, Ganz says, in which case your throat will be biopsied, also via endoscopy.