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Gastroesophageal Reflux Disease (GERD), Silent Reflux and Respiratory SymptomsReflux During the process of digestion, food passes from the mouth to the esophagus and into the stomach through a muscle like structure known as the lower esophageal sphincter (LES). The purpose of the LES is to close the passage to the esophagus and keep food and acid in the stomach. If the LES does not close properly, stomach contents (including the acid) back up into the esophagus. This is called gastroesophageal reflux (GER). In certain cases, the refluxed stomach contents irritates the esophagus resulting in esophagitis or a disease called GERD. There are many reasons the LES may not function competently. The LES may not have formed properly or it has become weak or incompetent through irritation by stomach acid. Any activity that creates increased pressure changes in the stomach contributes to GERD by over stressing the LES making it open more easily. Coughing and acute asthma episodes create pressure changes with-in the chest which also contributes to similar pressure changes in the stomach and LES. It has been reported that as many as 45-70% of adults with asthma also have GERD. Certain medications (i.e.. Theophylline, prednisone, atrovent, and beta-2 agonist like albuterol, serevent) used in asthma treatment relax or irritate the LES or contribute to a delay in the emptying of the stomach. Many people with GERD are aware of symptoms such as: heartburn (burning feeling and/or fullness that rising from stomach into chest); mid chest pressure, belching or gassiness; or a sour or acidic taste in mouth. Typically, there is worsening of symptoms following a meal, when lying down, or with exercise or activities that cause an increase in pressure in the stomach or LES (i.e.… running, climbing stairs, jumping jacks, or sit-ups). In other cases, the symptoms of GERD are not as obvious and may be more difficult to diagnose. This type of GERD is sometimes referred to as Silent Reflux. Symptoms of silent reflux may include chronic or recurrent voice hoarseness, throat clearing, sinus disease, ear infections, or respiratory symptoms such as asthma or pneumonia. But there is no difference in the pathophysiology or the complications that can arise. The discomfort a person experience does not usually correlate to damage and severity of the disease. How is Reflux Diagnosised If GERD is suspected, your provider may try medications like a H2 blocker (i.e.…Tagament, Zantac, or Pepcid), or proton pump inhibitor (i.e.… Prevacid, Nexium, Prilosec, Protonix or Aciphex), as a therapeutic trial to see if this helps alleviate some of your symptoms. If testing is needed, some of the most common tests are pH monitoring, barium swallow, or upper endoscopy and/or esophageal biopsy. These and other specialized tests can be ordered by your primary care provider or a gastrointestinal specialist. However because reflux can have intermittent symptoms these tests can be normal. This just means that you were not having reflux symptoms during the test. How is Reflux Treated Elevate the head of bed on 6 to 8 inch blocks or bricks. Do not eat or drink large quantities 2 to 3 hours before going to bed. Do not lie down immediately after a meal. Avoid over filling of the stomach by eating smaller, more frequent meals (approximately 5-6 times a day). Eliminate caffeine, alcohol, carbonated beverages, chocolate, mint, fatty and/or fried foods, cheeses, eggs, butter, red meats, spicy foods, tomatoes, citrus fruits and any other foods that may trigger symptoms from your diet. Avoid smoking as it contributes to irritation of the LES, esophagus, and stomach. Avoid wearing tight clothing especially around the waist can increase reflux. Take liquid Maalox, Mylanta, Gaviscon, or Riopan 1 hour after meal/s as needed for symptoms. These medications may help symptoms but do not treat GERD. Additionally, these antacids interfere with absorption of other medications by coating the stomach. Therefore, they should not be taken within 1-2 hours or other oral medications (you may need to consult your provider for specific suggestions). Your provider may also prescribe a medication that reduces stomach acid. H2 Blockers, inhibit the uptake of acid produced. Usually are effective when taken before meals. Proton Pump Inhibitors (PPI), decrease acid production so there is less acid available to cause irritation. They are more effective than H2 blockers in the treatment of GERD. Typically, the PPI's should be taken 20-30 minutes before a meal. It is important to eat at this time as this actually "turns on" the PPI. Infant Feeding: Hold baby upright during feeding and for about 20-30 minutes after feeding. Feed baby slowly and burp him/her frequently (after each ounce or so). Thicken formula with rice cereal as instructed by your doctor. Average thickening needed is one tablespoon of rice cereal for every 2 ounces of formula. Do not place baby in infant seat or car seat for at least 60 minutes after feedings. Try smaller amounts of formula but more frequent feeding times, such as every two to three hours. Elevate the head of baby's crib 12-24 inches. Use towels blankets or pillows between the mattress and the spring to the desired height. Roll a towel or blanket and place it near the middle of the mattress to prevent your baby from slipping to the bottom of the crib. Place your child in a reflux harness if your doctor has ordered one. Child Feeding Tips: Avoid late night snacks Elevate the head of the bed Reduce fat and acidic food in diet and avoid caffeine Forward to Medications » « Back to Food Additives

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