Decades of severe heartburn and other symptoms of gastroesophageal reflux disease (GERD), a very common condition in which stomach acid backs up into the esophagus, had worn Clara down. By the time he turned 80, he had long since stopped trying to manage the problem. He ate foods he knew would trigger his symptoms, didn’t take medications as directed, and skipped lifestyle changes his doctor recommended.
When Clara started having trouble swallowing, she attributed it to another GERD symptom and ignored it, too. But this time it meant something much worse: esophageal cancer, the sixth leading cause of cancer death worldwide.
Most cases of GERD do not lead to esophageal cancer, says a Harvard expert. But recurrent or persistent acid reflux should be evaluated and addressed, not only because untreated GERD can damage the esophagus, but because symptoms you think are “just GERD” may indicate other health problems, some of which can be life-threatening.
“It’s important to know what you’re dealing with, whether it’s GERD or something else,” says Dr. Elena Fradkov, a gastroenterologist at Harvard-affiliated Mount Auburn Hospital. “And if it’s something as scary as a heart attack, you don’t want to miss it.”
Similar conditions
Heartburn is perhaps the most widespread symptom of GERD. “But you may also have a sour or metallic taste in your mouth, hoarse voice, chest pain, dry cough, or postnasal drip,” says Dr. Fradkov.
These symptoms may overlap with those of several other conditions, including the following:
Hiatal hernia. A condition in which part of the stomach protrudes through the diaphragm (a sheet of muscle that separates the chest cavity from the abdomen), a hiatal hernia can trigger GERD or simply coexist with it, often without causing any symptoms, Dr. Fradkov notes. “Normally, the diaphragm is located where the esophagus and stomach meet,” he explains. “When there is a hiatal hernia, the upper part of the stomach looks almost like a toothpaste tube that has been squeezed in the middle.” This can cause symptoms associated with GERD.
Functional dyspepsia. This is a complicated name for chronic upset stomach, pain, or indigestion that doesn’t come from an identifiable cause. “There is no acid reflux into the esophagus,” says Dr. Fradkov. “But people who have it can have GERD symptoms anyway.”
Eosinophilic esophagitis. Eosinophils are a type of white blood cell involved in allergic reactions. When they accumulate in the esophagus, this allergic condition inflames the muscular tube, causing difficulty swallowing and other symptoms similar to those of GERD. “The main difference is that eosinophilic esophagitis usually involves much more classic problems with swallowing or food getting stuck,” he says, “while typical symptoms of GERD include burning, metallic taste in the mouth, hoarseness, or bad breath.”
Esophageal spasms. Certain medications, in addition to eating very cold or very hot foods, can cause involuntary contractions of the esophagus. Like GERD, these spasms can cause pain, difficulty swallowing, and the feeling that food is trapped in the chest.
Myocardial infarction. Heart attacks sometimes involve a burning sensation along with more typical chest pain. “You may think it’s just GERD, but if you’re also sweating, having trouble breathing, or have pain that extends to your back, you should go to the hospital,” says Dr. Fradkov.
Proactive strategies
Depending on your age and other health problems, diagnosing GERD may involve several tests, including an endoscopy, in which a doctor looks directly at the lining of the esophagus using a camera placed in a tube passed down the throat. “Sometimes we can see inflammation in the esophagus,” says Dr. Fradkov. “That will confirm a diagnosis of GERD or allow us to rule out other causes.”
If your symptoms are actually caused by GERD, your doctor may recommend prescription or over-the-counter medications. But the following lifestyle changes can usually help you control most or all of your symptoms, says Dr. Fradkov.
Avoid common triggers. Alcohol, coffee, chocolate, ketchup, carbonated drinks, mint, citrus fruits and juices, and fried, greasy, or acidic foods are all offenders.
Stretch your diet. Instead of three large meals a day, divide your intake into five or six smaller meals and eat more slowly.
Stay upright after meals. This helps gravity move food and drinks downward, rather than allowing stomach contents to flow back into the esophagus. Don’t eat two or three hours before bedtime and try elevating your upper body in bed with a foam wedge under the mattress.
Control your weight. Carrying extra pounds, especially in the abdomen, puts more pressure on the sphincter at the bottom of the esophagus that keeps food in the stomach. “It’s pure mechanics,” says Dr. Fradkov. “The more abdominal mass you have, the more it will push on your stomach and squeeze things up.”
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