What
is GERD?
Gastroesophageal Reflux Disease (GERD) is the abnormal backflow (reflux)
of stomach contents such as acid, bile and food into the esophagus, causing burning and irritation.
This occurs when a weak lower esophageal sphincter (LES), a valve that controls the passage
of food from the esophagus to the stomach, does not close tightly enough or relaxes too
frequently during the course of the day or night. Several factors are associated with GERD
and include: a hiatal hernia, obesity, pregnancy, smoking or an overfull stomach. Under normal
circumstances, the stomach acid is removed from the esophagus by a process called peristalsis,
which uses squeezing movements to push the acid into the stomach. The valve closes, preventing
acid and bile from refluxing back into the esophagus. If the lower esophageal sphincter is
weak, this mechanism is disrupted and heartburn can occur.
What symptoms will I experience if I have GERD?
The major symptoms of GERD include:
Common:
- Persistent heartburn
- A
bitter or sour taste in your mouth as a result of the reflux
- Regurgitation
- Dyspepsia (pain or an uncomfortable feeling in the upper middle part of
the stomach)
- Bloating
Uncommon:
- Hoarseness
- Chronic cough
- Recurrent bronchitis/pneumonia
- Foul breath
- Tooth decay
How is it diagnosed?
If you have just begun to experience symptoms of GERD, your doctor will discuss the symptoms
you are experiencing and prescribe medication that is used to treat the symptoms of GERD.
If your symptoms improve with this medication, you will be closely followed.
There are circumstances, which may require further testing to determine the presence of
GERD. If any of the following are true, your doctor may have you undergo an upper gastrointestinal
endoscopy:
- You have had symptoms of GERD for more than two years.
- Your GERD symptoms do not respond
to medication.
- GERD symptoms return when use of medication is discontinued.
- History of Barrett’s
Esophagus or esophageal cancer.
- Other serious symptoms occur such as weight loss, vomiting
blood and swallowing problems, and history of Barrett’s esophagus.
If further evaluation is required, barium swallow and/or upper gastrointestinal endoscopy
are the most common diagnostic tests for GERD. A barium swallow involves ingestion of a barium-containing
liquid followed by x-ray study to help identify structural changes in the esophagus. Upper
gastro-intestinal endoscopy involves insertion of a thin, flexible tube with a camera through
the mouth into the esophagus to enable the physician to see the inside of the esophagus and
take biopsies as needed.
What is the treatment process for GERD?
There are two important factors
in treating GERD—treating the
symptoms and treating the problem.
There
are medications known as proton pump inhibitors that can reduce the production of gastric
acid. Prilosec©, Prevacid©, Nexium©, Protonix© and Aciphex© are
generally taken once or twice per day and may be a required treatment throughout your life.
Some patients may also find relief from over-the-counter medications such as Zantac©,
Pepcid©,
and Tagamet©,
which are taken as needed for those with occasional and predictable symptoms.
The symptoms of GERD may be reduced with a combination of diet/lifestyle modification
and medication. This requires the elimination of foods and behaviors, such as smoking that
cause reflux. Unfortunately, eliminating the necessary foods and completely controlling reflux
through diet modification is extremely difficult.
The problem in patients with GERD is a malfunctioning lower esophageal sphincter. This
valve controls the passage of food from the esophagus into the stomach. When it is weak or
continually is relaxing and opening, it allows food, acid, bile and other substances to pass
back into the esophagus causing GERD. There are several ways to treat the problem of a weak
lower esophageal sphincter.
Laparoscopic Nissen fundoplication
- This
is a surgery done to treat reflux. Five small incisions are made in the abdomen, where cameras
and surgical instruments are placed. The fundus of the stomach is wrapped around the lower
portion of the esophagus. This will create a new "valve" between
the esophagus and stomach to prevent reflux from occurring. In the majority of cases, medical
treatment alone is sufficient. Surgery is reserved for those patients who continually regurgitate
despite the reduction of acidity, have intolerance to medications used for treating GERD,
or respond well to these medications but are adverse to their continued use.
What happens if GERD goes untreated?
There are several problems that can occur if GERD goes untreated.
- Acid pathway: If
the lower esophageal sphincter continues to malfunction and the lower esophagus is chronically
exposed to acid, scarring of the esophagus can occur. This results in narrowing of the esophagus
with difficulty swallowing. Left unattended the esophagus will enlarge, and eating will be
very difficult and eventually may not be possible at all. There is a risk of developing cancer
in an esophagus chronically exposed to acid.
- Respiratory pathway: Chronic reflux may lead to respiratory and laryngeal
problems such as cough, asthma, hoarseness and sore throat..
Where can I learn more about GERD?
Where can I find a support group?
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