When it comes to gastroesophageal reflux disease, or GERD, the word “severe” is in the eye -- or chest, as it were -- of the beholder. There’s actually no specific medical diagnosis for “severe” as opposed to “mild” GERD, but any case of GERD that hasn’t responded to acid-neutralizing medications can be considered serious. At its worst, GERD can lead to difficulty swallowing, weight loss and severe abdominal pain -- symptoms that should be immediately discussed with a doctor. You can take certain actions yourself, however, to gain immediate relief.
GERD occurs when stomach acids leak back into the esophagus, causing irritation and inflammation of the esophageal lining. Protecting the esophagus from acidity allows the lining to heal. Over-the-counter antacids such as Tums or Rolaids are the fastest way to get short-term relief from a severe attack of GERD because they neutralize acid in the esophagus and stomach on contact. Liquid antacids usually work the fastest. While fast relief can be useful on occasion, antacids are not the answer when the problem is persistent, severe GERD.
Acid-blocking drugs known as proton pump inhibitors, or PPIs, reduce symptoms and help heal the esophagus by inhibiting stomach acid secretion. PPIs are considered the most effective medication for relieving GERD symptoms and healing inflammation of the esophagus. PPIs are available over the counter, but for severe GERD they are often prescribed at higher doses and for longer durations. They include familiar brand-name drugs like lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium).
An older group of acid blockers, the H2 inhibitors, are still sometimes used in particular situations. H2 blockers work within 30 to 90 minutes and can work for hours. For severe GERD, they are sometimes recommended for nighttime use as a supplement to PPIs. H2 blockers are also available over the counter under such generic names as famotidine (Pepcid), cimetidine (Tagamet) and ranitidine (Zantac).
Diet and Weight Loss
It used to be that certain foods were automatically considered off-limits because they were certain to aggravate GERD. These days, doctors are more likely to recommend that patients pay close attention to what they’re eating and take note of foods that trigger their symptoms and come to their own conclusions. However, although specific studies on individual foods and beverages are lacking, certain foods do have properties known to aggravate GERD. Foods to pay special attention to include fatty and fried foods, chocolate, raw onions, mint and alcohol. Excess body weight puts pressure on the valve known as the lower esophageal sphincter, or LES, causing structural weakness and hindering its ability to function. Your doctor may recommend that you lose weight, especially if you have experienced recent weight gain.
Changing Sleep Positions
Gravity has a big impact on GERD, which occurs when the band of muscles that function as an anti-reflux valve fails to form a tight seal. When you're lying flat, acidic liquids can more easily leak through the LES. Sleeping with your upper body inclined by 8 to 11 inches has been shown to reduce both the number of times acid may leak through the LES and the length of time acid stays in contact with the esophagus. Foam wedges made specifically for the purpose are sold commercially. The important thing is for your esophagus to be higher than your stomach so that digestive acids remain in the stomach.
Surgical Repair of the LES
If all else fails, surgery can be an effective remedy for severe GERD. The most common surgery for GERD is the Nissen fundoplication. A fundoplication involves first repairing any hiatal hernia, then coiling the upper part of the stomach around the lower end of the esophagus. This strengthens the LES, restoring its function as the “one-way valve” to prevent acid reflux.
Medical advisor: Jonathan E. Aviv, M.D., FACS