Updated May 22, 2006

GERD

Acronym for gastroesophageal reflux disease, a chronic condition in which the contents of the stomach back up into the esophagus, causing a variety of uncomfortable symptoms. GERD is somewhat more common in people with diabetes.

The esophagus carries food from the mouth to the stomach, which is highly acidic to help activate the enzymes that break down food during digestion. Between the stomach and the esophagus is a ring of muscle called the lower esophageal sphincter, which acts like a valve: It opens to allow food to move from the esophagus into the stomach, and closes again to prevent the contents of the stomach from backing up into the esophagus.

When the lower esophageal sphincter fails to close properly, gastroesophageal reflux can occur. Autonomic neuropathy, a complication of diabetes that affects automatic functions throughout the body, can cause gastroesophageal reflux by damaging the nerves that control the lower esophageal sphincter. When the acidic contents of the stomach back up into the esophagus, a variety of symptoms may result, including heartburn, belching, chest pain, hoarseness in the morning, difficulty swallowing or a feeling having food stuck in the throat, dry cough, and bad breath. If these symptoms occur more than twice a week or have been present for a while, a person may be diagnosed with GERD.

A number of factors may worsen GERD, including alcohol consumption, being overweight, pregnancy, and smoking. Certain foods may trigger reflux as well, including citrus fruits, chocolate, caffeine-containing drinks, fatty or fried foods, tomato-based foods, and spicy foods. Likewise, certain lifestyle changes may help alleviate GERD, including stopping smoking, avoiding alcohol, losing weight, eating smaller meals, and avoiding lying down for at least three hours after a meal. Another helpful measure is to raise the head of the bed 6 to 8 inches using blocks under the bedposts.

A number of types of drugs, including the following, may help as well:

• Antacids, such as Alka-Seltzer, Maalox, Pepto-Bismol, and Rolaids, which can treat mild GERD symptoms by neutralizing stomach acid with basic salts and ions. Side effects, however, may include constipation or diarrhea.
• Histamine-2 receptor blockers, or H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac), which are now available over the counter as well as by prescription. These drugs inhibit the production of stomach acid by preventing the chemical histamine from stimulating a pump in the stomach that releases hydrochloric acid. Over-the-counter H2 blockers should not be used for more than a few weeks at a time.
• Proton pump inhibitors, such as omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available only by prescription. These long-acting drugs are more powerful inhibitors of stomach acid production than the H2 blockers.

If symptoms persist in spite of lifestyle modifications and medication, surgery is sometimes used. The standard surgery for GERD is Nissen fundoplication, in which the upper part of the stomach is wrapped around the lower part of the esophagus to prevent the backflow of stomach contents into the esophagus. In some cases, fundoplication can be performed using laparoscopy, in which surgeons perform the procedure through tiny incisions using small instruments and a camera.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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