For More Info

Gastroesophageal Reflux Disease (GERD) is a condition of reflux of stomach acid into the esophagus. This causes symptoms that are commonly referred to as heartburn. GERD affects approximately 60 million people on a monthly basis and has become a billion dollar pharmaceutical industry. Fortunately, the amount of energy and research invested in studying GERD has resulted in newer and better medications to treat the symptoms.

Symptoms
Etiology
Diagnosis
Treatment Options
Surgery

SYMPTOMS
GERD is the feeling of burning, warmth, heat or pain that occurs in the upper abdomen. This pain may spread in waves upwards towards the throat and may be associated with a sour taste in the mouth. It often occurs after eating and is exacerbated by lying down or bending over. It can be relieved by sitting or standing up. The pain can last up to two hours. Chronic reflux can lead to a chronic cough or asthma.

Back to Top

ETIOLOGY
Normally, the lower esophageal sphincter in the distal esophagus acts to prevent stomach bile and acid from entering into the esophagus. Normal function of the esophagus relies on several factors: the esophageal muscular contractions (peristalsis) that normally clear food and liquid from the stomach; and the presence of a valve in the distal esophagus that lies within the abdomen. The length and the angle of this valve are critical in its ability to remain closed and prevent reflux. Finally, the presence of excess acid within the stomach can predispose a patient to reflux. When acid refluxes into the esophagus, it can damage the lining of the esophagus causing the symptoms of heartburn. Prolonged exposure to acid can cause the esophagus to undergo changes in its lining called Barrett's esophagus. Over a long period of time, these changes can put patients at an increased risk of cancer of the esophagus.

Back to Top

DIAGNOSIS
The clinical symptoms of heartburn are often enough to allow physicans to make the diagnosis. Patients can then be started on lifestyle altering treatment or medications without invasive testing. If these treatments are not effective, or if the symptoms are not clear cut, then further testing may be performed including an esophageogastroduodenoscopy (EGD). In this procedure, a small telescope is inserted through the mouth and guided to the esophagus and stomach. This allows a physician to look for damage to the esophagus as well as rule out other sources of abdominal pain. Additionally, a small probe can be placed in the esophagus to measure the amount of acid being refluxed into it.

Back to Top

TREATMENT OPTIONS
For many patients, GERD can be treated through lifestyle changes. This includes smoking cessation (which weakens the esophageal sphincter), weight loss (which decreases pressure on the abdomen), and diet changes. Foods that exacerbate reflux include:

• Citrus
• Caffeine
• Chocolate
• Peppermint
• Onions
• Alcohol

Additionally, such maneuvers as elevating the head of the bed and not eating for 2-3 hours before going to bed can help reduce the amount of reflux.

For patients that do not respond to these maneuvers, medical treatment can be very effective. These medications target reducing the amount of acid that the stomach produces and include Prilosec, Nexxium, Zantac and Tagamet. These medications can be used for periodic heartburn symptoms but often require daily use for prevention of symptoms. Unfortunately, long-term medical therapy is not always a good solution. The drugs are expensive and their long-term side effects are not known. Finally, medical treatment does not prevent the development of Barrett's esophagus and its associated risk of esophageal cancer.

Back to Top

SURGERY
Like medical treatment, surgery for GERD has also undergone a revolution of sorts. Laparoscopic Nissen fundiplication involves 4 to 5 small incisions and a laparoscope to recreate the sphincter of the esophagus. This is done in 1 to 2 hours and requires only a short hospital stay. More importantly, the repair is permanent and prevents the worsening of Barrett's esophagus.

For more information, click here.

Back to Top