Gastroesophageal Reflux Disease

Approximately 20 percent of Americans complain of symptoms of gastroesophageal reflux disease (GERD). GERD is an injury to the lining of the esophagus or symptoms caused by too much stomach acid flowing back into the esophagus. In most cases, it occurs because a muscle between the stomach and esophagus fails to contract when it should, allowing gastric acid to move back into the esophagus. Severe GERD occurs when that muscle is weak.

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Symptoms

Symptoms of GERD include:

  • Heartburn
  • Regurgitation
  • Belching up a sour substance
  • Nausea, particularly in the morning
  • Globus, the sensation of something in the throat

Symptoms of severe or complicated GERD include:

  • Chest pain that feels like a heart attack. Patients with GERD and this type of chest pain should be checked for possible heart disease.
  • Blood in the stool is a warning that there is a significant problem requiring a doctor's care
  • Dysphagia, or difficulty in swallowing, suggests that the esophagus is blocked by a scar or growth. This symptom requires immediate attention by the physician
  • Asthma can be caused or made worse by gastroesophageal reflux
  • Persistent cough or throat clearing
  • Sore throat or hoarseness
  • Dental problems

 

Causes and Risk Factors

  • Certain drugs, like nitrates or calcium channel blockers
  • Diabetes
  • Scleroderma
  • Obesity
  • Pregnancy
  • Tobacco use
  • Use of alcohol, caffeine, carbonated beverages, chocolate, fatty foods and overly large meals

Untreated, GERD can also lead to more serious conditions like esophageal ulcer and/or stricture, Barrett's esophagus or esophageal cancer.

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Diagnosis

Detecting GERD early can prevent major complications. To ensure an accurate identification of GERD, doctors use the following procedures:

  • Upper GI endoscopy can identify an inflamed esophagus caused by GERD and complications. Biopsies can be done to see if there is inflammation.
  • pH testing can determine if too much stomach acid is moving backwards into the esophagus
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Treatments

GERD can be managed effectively with lifestyle modifications and medical treatment.

Lifestyle modifications:

  • Elevation of the head of the bed four to six inches
  • Avoiding alcohol, chocolate and caffeine
  • Avoiding overeating
  • Eating or drinking nothing two to three hours before bed
  • Avoiding greasy, fatty foods
  • Losing weight
  • Antacids to neutralize excess stomach acid

 

Medical treatments:

Medications that reduce acid production by the stomach, such as histamine 2 receptor blockers or proton pump inhibitors

Endoscopic stapling. This is a minimally invasive way to create a barrier in the stomach to reduce reflux in patients with mild to moderate GERD. It cannot be done if the patient has a large hiatal hernia.

Surgery to tighten the area where the stomach and esophagus meet. The most commonly done surgery is called the Nissen fundoplication. This surgery decreases the amount of gastroesophageal reflux. It can now be done as a minimally invasive surgery using laparoscopy.

These treatments may be used alone or in any combination, depending on the patient's specific needs.