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What is cancer of the colon and the rectum?
Why should I be concerned about cancer of the colon and the
rectum?
What is GERD?
I have never heard of GERD. Is it a new disease?
What are some symptoms of GERD?
How do people get GERD? What causes GERD?
How many people are afflicted with GERD?
Who is afflicted with GERD?
Do children get GERD?
What is the difference between GERD and GORD?
What is the difference between heartburn and GERD?
What is the difference between GERD and a hiatus hernia?
What is endoscopy and when is it used in GERD patients?
What are the complications of GERD?
What makes GERD symptoms worse?
Does eating spicy food cause GERD or make GERD worse?
What about GERD and smoking?
Do any medications make GERD worse?
What should people with GERD avoid?
Can GERD cause cancer?
Are there long-term consequences of GERD?
Is there a relationship between GERD and asthma?
Can GERD cause inflammation of the throat?
Can GERD be cured?
I think I have GERD. What should I do?
Cancer is a disease in which certain body cells don't function right,
divide very fast, and produce too much tissue that forms a tumor. The
colon and rectum are parts of the body's digestive system, which removes
nutrients from food and stores waste until it passes out of the body.
Together, the colon and rectum form a long, muscular tube called the large
intestine (also called the large bowel). Cancer that begins in the colon
is called colon cancer. Cancer that begins in the rectum is called rectal
cancer. Cancers affecting either of these organs also may be called
colorectal cancer.
Colorectal cancer affects an equal number of women and men each year,
and is most often found in people over the age of 50. Excluding skin
cancer, it is the third most diagnosed cancer for women, following breast
and lung cancers. And it is the second leading cause of cancer death in
the United States. Colorectal cancer is often called a "silent" disease
since symptoms don't always develop until it is difficult to cure. The
good news is that you can help prevent colorectal cancer, and it is mostly
curable when it is found early through regular screening tests.
1. What is GERD?
GERD stands for Gastroesophageal
Reflux Disease.
Gastroesophageal reflux describes a backflow of acid from the stomach into
the swallowing tube or esophagus. This acid can irritate and sometimes
damage the delicate lining on the inside of the esophagus. Almost everyone
experiences gastroesophageal reflux at some time. The usual symptom is
heartburn, an uncomfortable burning sensation behind the breastbone, most
commonly occurring after a meal. In some individuals this reflux is
frequent or severe enough to cause more significant problems, that is a
disease. Thus, gastroesophageal reflux disease is a clinical
condition that occurs when reflux of stomach acid into the esophagus is
severe enough to impact the patient’s life and/or damage the esophagus.
2. I have never heard of GERD. Is it a new disease?
No. GERD has probably been around as long as heartburn. The term is
relatively new (about 20 years), however, and has really come into common
usage over the past few years. GERD is often called "reflux," "reflux
esophagitis," or sometimes even "hiatus hernia" (although hiatus hernia is
a specific diagnosis that may or may not have anything to do with GERD).
GERD is the preferred term because it accurately describes the problem -
reflux of stomach acid up into the esophagus where it can produce symptoms
and sometimes damage. Many patients and health care professionals are not
familiar with GERD and its potential consequences, and thus may not have
heard the term previously.
3. What are some symptoms of GERD?
The four major symptoms of GERD are:
 | Heartburn (uncomfortable, rising, burning sensation behind the
breastbone).
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| Regurgitation of gastric acid or sour contents into the mouth.
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| Difficult and/or painful swallowing.
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| Chest pain. |
Heartburn is the most common symptom of GERD. In some patients it may
be accompanied by other GERD symptoms, such as regurgitation of gastric
contents into the mouth, chest pain and difficulty swallowing. Pulmonary
manifestations, such as asthma, coughing, or intermittent wheezing and
vocal cord inflammation with hoarseness, occur in some GERD patients.
In addition, acid can be regurgitated into the lungs in some GERD
patients, causing wheezing or cough. Acid refluxed into the throat can
cause sore throat. If acid reaches the mouth, it can dissolve enamel of
the teeth.
4. How do people get GERD? What causes GERD?
GERD is caused by reflux of stomach acid into the esophagus. In most
patients this is due to a transient relaxation of the “gate” or sphincter
that keeps the lower end of the esophagus closed when a person is not
swallowing food or liquids. This transient relaxation happens a few times
each day in people without GERD. Why it happens more frequently in GERD
patients isn’t known. The esophagus is not able to cope with acid as well
as the stomach and is easily injured. It's the acid refluxing into the
esophagus that produces the symptoms and potentially damages the
esophagus.
5. How many people are afflicted with GERD?
Recent statistics from the US Department of Health and Human Services
indicate that about seven (7) million people in the US alone suffer from
GERD.
(Source: Digestive Diseases in the United States: Epidemiology and
Impact, National Digestive Diseases Data Working Group, James E. Everhart,
MD, MPH, Editor, US Department of Health and Human Services, Public Health
Service, National Institutes of Health, NIH Publication No. 94-1447, May
1994)
6. Who is afflicted with GERD?
GERD afflicts people of every socioeconomic class, ethnic group and
age. However, the incidence does seem to increase quite dramatically above
the age of 40. Greater than 50 percent of those afflicted with GERD are
between the ages of 45-64 (both male and female).
7. Do children get GERD?
Yes. GERD is most common in adults over age 40 but virtually anyone
can get GERD, even infants.
8. What is the difference between GERD and GORD?
The British spelling of esophagus is oesophagus. Hence, GERD is GORD
in many European countries.
9. What is the difference between heartburn and GERD?
GERD is a disease and heartburn is its most common symptom. Heartburn
is defined as a rising, burning sensation behind the breastbone caused by
reflux of stomach acid into the esophagus. Nearly everyone has or will
experience heartburn on occasion. Frequent heartburn that disrupts one's
lifestyle suggests the diagnosis of GERD.
10. What is the difference between GERD and a hiatus hernia?
Hiatus hernia refers to dislocation of the stomach through the
"hiatus" of the diaphragm and into the chest. This is a common condition
that increases in frequency with age. It may or may not be associated with
GERD. When GERD is severe enough to be complicated by erosive esophagitis,
seen as breaks in the lining of the esophagus, a hiatus hernia is usually
present. However, most patients with a hiatus hernia do not have GERD.
11. What is endoscopy and when is it used in GERD patients?
Endoscopy is a diagnostic test wherein a thin, flexible tube is
swallowed by the patient to allow the physician to directly inspect the
lining of the upper gastrointestinal tract. This procedure can be used to
identify complications of GERD and to take small samples (biopsies) for
further analysis. GERD patients who have certain symptoms, such as
difficulty in swallowing or painful swallowing, should be considered for
endoscopy. Patients who fail to respond to therapy are also candidates for
endoscopy. Some physicians advocate endoscopy for all patients with
long-standing GERD in order to rule out Barrett's esophagus.
12. What are the complications of GERD?
Only a minority of patients develop complications of GERD. These
complications include breaks in the lining of the esophagus (esophageal
erosions), esophageal ulcer, and narrowing of the esophagus (esophageal
stricture). In some patients, the normal esophageal lining or epithelium
may be replaced with abnormal (Barrett's) epithelium. This condition
(Barrett's esophagus) has been linked to cancer of the esophagus and must
be carefully watched. Lung (pulmonary) aspiration, asthma and inflammation
of the vocal cords or throat may also be caused by GERD.
13. What makes GERD symptoms worse?
The major factor is meals. Meals stimulate the stomach to produce more
acid that can reflux up into the esophagus. In some patients, lying down
or taking certain medications can worsen acid reflux.
14. Does eating spicy food cause GERD or make GERD worse?
Spicy foods do not cause GERD, although they do seem to worsen GERD
symptoms in some people. Food (in general) can make GERD worse. This is
because food fills the stomach and induces more transient relaxations of
the lower esophageal sphincter. In addition, all meals stimulate
acid production in the stomach to aid digestion and can increase reflux
into the esophagus in GERD sufferers. Any very large meal might be
expected to produce heartburn in some people. The spicy food story is so
compelling, however, that GERD sufferers often relate a spicy (or greasy)
meal to their symptoms. Often they are told to avoid certain foods whether
or not these foods have anything to do with their symptoms. In this way,
many GERD sufferers end up on a very restricted diet or end up blaming
their symptoms on dietary indiscretion. If avoiding spicy foods and/or
other dietary advice helps, that's great. If it doesn't, GERD sufferers
shouldn't feel that they are doing something wrong. They should seek
medical advice on managing their disease.
15. What about GERD and smoking?
Smoking doesn't cause GERD and there is little evidence that smoking
significantly worsens GERD. Stopping smoking is a good idea anyway.
16. Do any medications make GERD worse?
Yes. Medicines that delay emptying of acid from the stomach or that
increase acid backup into the esophagus can worsen GERD. If you have, or
suspect you have, GERD and you require medication for other conditions,
you should make sure you inform your doctor about all medications you are
taking including prescription and over-the-counter medications.
17. What should people with GERD avoid?
GERD is a disease that is caused by gastric acid. However, certain
foods can trigger symptoms in some patients. Lying down after a meal,
wearing tight-fitting clothing, and even performing certain activities,
such as bending over, can also trigger symptoms in patients. A good way to
identify these "triggers" is to keep a diary of GERD symptoms noting when
they occur. If symptoms follow a pattern and occur after certain foods or
activities, these foods or activities should be avoided. A diary will also
help patients continue to enjoy those foods or activities that do not seem
to provoke symptoms, so that their lifestyle is not restricted
unnecessarily. Patients should review their symptoms with their doctor,
who can evaluate their condition and advise an appropriate treatment plan.
18. Can GERD cause cancer?
Severe, long-standing GERD can damage the esophagus and cause a
condition known as Barrett's esophagus wherein the normal lining of the
esophagus is replaced by a lining more like that of the stomach or
intestine. It is thought that this replacement may be an attempt by the
body to protect itself from further injury by acid. The risk of esophageal
cancer appears to increase significantly in patients with Barrett's
esophagus. The only way to diagnose Barrett's esophagus is by endoscopy.
Some studies suggest that intensive treatment of Barrett's esophagus can
reduce the amount of abnormal lining in the esophagus. It is not yet clear
whether such treatment will prevent esophageal cancer in GERD patients,
but this is under active investigation.
19. Are there long-term consequences of GERD?
Long-standing GERD can lead to damage of the esophagus. This damage
usually consists of breaks in the lining of the esophagus. In some cases
ulcers can develop. In some patients, such damage can result in scarring
and narrowing of the esophagus, making swallowing painful or difficult. A
condition called Barrett's esophagus is thought to result from
long-standing GERD in some patients. Barrett's esophagus is a risk factor
for the development of esophageal cancer. In some patients, acid backup
caused by GERD is thought to result in damage to the vocal cords or teeth
and may even cause asthma.
20. Is there relationship between GERD and asthma?
Many investigators believe that there is a link between asthma and
reflux of stomach acid up into the throat and then down into the lungs in
some patients. It appears that some patients who suffer from asthma might
benefit from treatment of GERD. This is a topic of active research at the
moment.
21. Can GERD cause inflammation of the throat?
In some patients, acid can reflux into the throat causing inflammation
of the back of the throat which can lead to pharyngitis, or into the vocal
cords, which can lead to laryngitis and hoarseness. Although there are
many other causes for sore throat and laryngitis, GERD should be suspected
in a patient with chronic sore throat or other GERD symptoms or when no
other cause can be found.
22. Can GERD be cured?
Unfortunately, GERD, in general, cannot be cured at present. In some
cases, it may be a temporary condition associated with a specific
aggravating factor such as pregnancy. In such cases, GERD will go away on
its own when the pregnancy has ended. In most cases GERD is a chronic
condition. However, it can be effectively managed with medications and
lifestyle modifications in almost everybody. In severe cases, surgery is
an option. Surgery does not cure the underlying problem, but wraps part of
the stomach around the lower end of the esophagus to help keep acid from
getting back up into the esophagus. A doctor can evaluate the condition
and advise on an appropriate treatment plan.
I think I have GERD. What should I do?
See your doctor. Your doctor can establish the diagnosis and work with
you to get you symptom-free. Primary care and physicians of many
specialties are becoming increasingly familiar with GERD.
Gastroenterologists and some gastrointestinal surgeons are usually very
familiar with GERD and its treatment.
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Barretts Esophagus - a
disorder in which the lining of the esophagus (the tube that
carries food from the throat to the stomach) is damaged because of
stomach acid that leaks back into and irritates the esophagus.
This leakage of acid is commonly known as "heartburn"
Colon: The large intestine, which absorbs water from
undigested material and stores it until it is expelled from the
body as stool.
Colonoscopy: An examination in which the internal lining of
the large intestine is visualized using a lighted, flexible,
fiberoptic scope.
Double Contrast Barium Enema: A test in. which x-rays of
the colon are taken after being given a special enema followed by
an injection of air. This outlines the colon and x-ray pictures
can be taken.
EGD - (Esophagogastro-duodenoscopy)
- an examination of the lining of the esophagus, stomach, and
upper duodenum with a small camera (flexible endoscope) which is
inserted down the throat.
Fecal Occult Blood Test: A test which checks the stool for
blood.
Hiatal Hernia - a
hernia in which an anatomical part (as the stomach) protrudes
through the esophageal hiatus of the diaphragm
Polyp: A growth of tissue. Not all polyps are cancer, but
most start out this way.
Sigmoidoscopy: An examination in which the lining of the
rectum and lower colon are visualized.
Bowel Preparation: Prior to an exam of the colon, it must
be clear of fecal matter. There are several methods to accomplish
this. Talk to your doctor to determine which one is right for you.
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