Gastroesophageal reflux

Gastroesophageal Reflux Disease (GERD)

Feeling the Burn
It is estimated that more than one-third of Americans experience heartburn at least once per month, 20% at least weekly, and around 7% daily. If you are a frequent sufferer of heartburn, solutions are readily available. Have the problem checked out by your physician.

What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease, or GERD, is a condition in which stomach contents splash up into the esophagus (the narrow, muscular tube that carries food from the mouth to the stomach). The resulting symptoms are what many people commonly associate with heartburn, a burning sensation felt behind the breastbone and sometimes in the neck and throat.

Complications may occur when GERD is severe or continues over a long period of time. Constant irritation of the esophagus by stomach acid can lead to inflammation, ulcers, and bleeding. Anemia or low blood count may develop. Over time, scarring and narrowing of the esophagus can also develop, making it difficult to swallow foods and liquids. This narrowing is called a stricture. Some patients develop a condition called Barrett's esophagus, which is a serious change in the cells lining the esophagus. Barrett's esophagus may be a precursor to esophageal cancer.

The Mechanics of GERD

The esophagus is connected to the stomach by a muscular ring called the lower esophageal sphincter (LES). This muscle normally performs two major functions: It opens to allow food to pass into the stomach, and it closes to keep the stomach contents out of the esophagus. If this sphincter weakens or relaxes, the contents of the stomach splash back up into the esophagus, causing gastroesophageal reflux.

Symptoms of GERD

Frequent heartburn is the most common symptom. However, patients may also experience some of the following:

Sour or bitter taste
Bitter stomach fluid coming into the mouth, especially during sleep
Hoarseness
Repeatedly feeling a need to clear the throat
Difficulty swallowing food or liquid
Wheezing or coughing at night
Worsening of symptoms after eating, or when bending over or lying down

Causes of GERD

Certain diet and lifestyle choices can contribute to this condition:

Some types of foods increase acid production, and fatty foods increase the time food remains in the stomach.
Chocolate, peppermint, coffee, alcoholic beverages, and especially nicotine in cigarette smoke weaken or relax the LES.
Obesity places added pressure on the upper abdomen.
During pregnancy the LES weakens for unknown reasons.

Diagnosing GERD

Your physician may suspect GERD simply by taking your medical history. Beyond that, your doctor may order an x-ray examination of the esophagus and stomach. For this x-ray, the patient swallows a liquid containing barium. This makes it possible to see the reflux and a hiatal hernia on the x-ray.

Endoscopy is the most important test for patients with GERD. With the patient under sedation, the doctor examines the lining of the esophagus and stomach with a thin, lighted, flexible tube called an endoscope. This exam is helpful in determining how severe the disease is, how much tissue damage there is, and if there are any complications. Certain conditions, such as narrowing or stricture in the esophagus, can usually be corrected during this procedure. The procedure also gives the physician an opportunity to look for signs of Barrett's esophagus, and to perform a biopsy to see if precancerous changes have occurred.

There are other tests that are helpful. A pressure recording of the esophagus is called esophageal manometry. It measures the pressure in the lower sphincter and any abnormal muscle contractions in the main part of the esophagus. Also helpful is a 12- to 24-hour analysis of the acidity in the esophagus.

Treating GERD

Treatment of GERD is aimed at reducing reflux and damage to the lining of the esophagus. Treatment may include diet and lifestyle changes, medications, or surgery.

Diet and Lifestyle Changes

Initial treatment is with lifestyle changes. Patients with GERD are advised to follow these recommendations:

Avoid eating anything within three hours before bedtime.
Stop smoking. Nicotine in the blood weakens the LES.
Avoid fatty foods, milk, chocolate, spearmint, peppermint, caffeine, citrus fruits and juices, tomato products, pepper seasoning, and alcohol (especially red wine).
Decrease portions of food at mealtime, and avoid tight clothing or bending over after eating.
Review all medications with the physician. Certain drugs can weaken the LES, allowing acid irritation of the esophagus.
Elevate the head of the bed or mattress 6 to 8 inches. This helps to keep acid in the stomach by gravity when sleeping. Extra pillows by themselves are not very helpful.
Lose weight if overweight. This may relieve upward pressure on the stomach and LES.

Medications

Often, lifestyle changes are all that are needed to correct mild forms of GERD. When symptoms are bad or GERD is moderate to severe, the physician will prescribe medications that reduce stomach acid. There are a number of over-the-counter and prescription medications that are commonly used, some of which can neutralize stomach acid almost completely.

Surgery

Some patients with GERD may require surgery to strengthen the lower esophageal sphincter. This is usually done using laparoscopy, a newer type of minimally invasive surgical procedure that is performed with a tiny incision at the naval and a few needle points in the upper abdomen.

Usually, surgery is recommended if other forms of treatment are fail to resolve the condition. Surgery may also be considered for otherwise healthy patients when the disease is severe, or when patients don’t want to face the expense or lifestyle impact of long-term treatment with medications.

Gastroesophageal reflux