GERD or gastroesophageal reflux disease is ranked as the fourth most prevalent gastrointestinal disease. (1) The prevalence of symptoms increases linearly with age in women. (2) The overall incidence of heartburn, regurgitation, dysphasia, non-cardiac chest pain, cough and wheezing are similar for men and women.
However, research indicates the severity of symptoms is significantly more in women than in men. (3) The incidence in pregnancy exceeds 80 percent (4), with more than half of all pregnant women reporting symptoms, especially during the third trimester. (5)
What is GERD
GERD is a chronic digestive disease, which occurs when stomach contents, including food, stomach acid and occasionally bile, leak backwards from the stomach into the esophagus.
The lower esophageal sphincter, which is a circular band of muscle located at the very bottom of the esophagus, closes when you swallow. This action prevents food and digestive juices from refluxing into the esophagus. However, if the lower esophageal sphincter closes abnormally or weakens, stomach acid flows back into the esophagus causing irritation to the lining of the esophagus. (6)
Risk Factors
Women and men share common risk factors which contribute to developing this disease. A hiatal hernia, which occurs when the upper part of the stomach and the lower esophageal sphincter move above the diaphragm, increases the chance of acid reflux. Obesity, smoking and respiratory diseases, such as asthma and COP, increase the risk for acid reflux.
Pregnant women are particularly vulnerable to GERD, particularly during the third trimester as the growing uterus puts increasing pressure on the stomach. Sometimes, this forces stomach acid up into the esophagus. Hormones can cause the digestive system to slow down. Additionally, hormones cause the muscles which move food down the esophagus to slow down. (5)
Lifestyle Remedies
Changes in dietary habits can help reduce symptoms. For non-pregnant women, maintaining a healthy weight eliminates the excess pounds which put pressure on the abdomen. All women with GERD benefit from eating several small meals each day instead of three large meals.
Eat slowly and avoid common trigger foods, such as fatty or fried foods, tomato sauce and onions. Identify your personal trigger foods and avoid them. Alcohol and caffeine can make heartburn worse.
Avoid lying down right after eating. Wait at least three hours after eating before lying down or going to bed. Elevate the head of your bed placing wood or cement blocks under the feet of your bed. The head end should be raised by six to nine inches. If this is not possible, insert a wedge between the mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows is not effective.
Pregnant and non-pregnant women should avoid smoking. Smoking impedes the lower esophageal sphincter’s ability to function normally. (6)
Treatment Options
Treatment for the symptoms of GERD begins with non-prescription medications. These medications include antacids, which neutralize stomach acid, H-2 receptor blockers, which reduce acid production, and proton pump inhibitors, which block acid production and allow time for the damaged esophageal tissue to heal.
If symptoms persist, your physician will recommend prescription strength H-2 receptor blockers proton pump inhibitors. A prokinetic agent may also be prescribed. It is a medication that helps the stomach empty more rapidly and helps tighten the lower esophageal sphincter. (6)
A pregnant woman should not use H-2 receptor blockers, proton pump inhibitors or non-prescription medications without first consulting her physician. (5)
In cases where medications are ineffective or you want to avoid long-term medications use, invasive procedures such as surgery will be recommended.
Nissen fundoplication is a surgical procedure which reinforces the lower esophageal sphincter.
EndoCinch endoluminal gastroplication is a surgery that creates a barrier with suture material to prevent stomach acid from leaking backwards into the esophagus.
Stretta procedure is a procedure using electrode energy to create scar tissue and damage the nerves which respond to refluxed acid. (7)
Sources:
(1) Journal WATCH Specialties: GERD in Women, Oct. 25, 2011
http://womens-health.jwatch.org/cgi/content/full/2006/1116/1
(2) Scandinavian Journal of Gastroenterology @ PubMed.gov: Prevalence of Gastro-oesophageal Reflux Symptoms and the Influence of Age and Sex,
Nov. 2004, accessed Oct. 25, 2011
http://www.ncbi.nlm.nih.gov/pubmed/15545159?dopt=Abstract
(3) American Journal of Gastroenterology @ PubMed.gov: Features of Gastroesophageal Reflux in Women, Aug. 2004, accessed Oct. 25, 2011
http://www.ncbi.nlm.nih.gov/pubmed/15307857?dopt=Abstract
(4) Texas GERD Institute: Frequency of GERD in Women, Oct. 25, 2011
http://www.gerdcare.org/gerd-women.htm
(5) Texas GERD Institute: Pregnancy and GERD/Acid Reflux, Oct. 25, 2011
http://www.gerdcare.org/gerd-pregnancy.htm
(6) Mayo Clinic: GERD, Oct. 25, 2011
http://www.mayoclinic.com/health/gerd/DS00967
(7) Mayo Clinic: GERD/ Treatments and Drugs, Oct. 26, 2011
http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=treatments-and-drugs
Reviewed October 26, 2011
by Michele Blacksberg RN
Edited by Jody Smith