GASTROESOPHAGEAL REFLUX DISEASE

 

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Causes, incidence, and risk factors

When you eat, food passes from the throat to the stomach through the esophagus (also called the food pipe or swallowing tube). Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.

If this sphincter muscle doesn’t close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms, or it can even damage the esophagus.

The risk factors for reflux include:

·    Alcohol (possibly)

·    Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)

·    Obesity

·    Pregnancy

·    Scleroderma

·    Smoking

 

Symptoms

More common symptoms are:

·    Feeling that food is stuck when swallowing (dysphagia)

·    Heartburn or a burning pain in the chest

·     Increased by bending, stooping, lying down, or eating

·     More likely or worse at night

·     Relieved by antacids

·    Nausea after eating

Less common symptoms are:

·    Bringing food back up (regurgitation)

·    Cough or wheezing

·    Hiccups

·    Hoarseness or change in voice

·    Sore throat

 

Signs and tests

You may not need any tests if your symptoms are not severe.

If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:

·    Upper endoscopy (EGD) is often used to find the cause and examine the esophagus for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.

·    Barium swallow (X-ray exam)

·    Continuous esophageal pH monitoring including the BRAVO Capsule

·    Esophageal manometry

 

Treatment

You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you. Making changes to your routine before you go to sleep may also help.

Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.

You may use over-the-counter antacids after meals and at bedtime, although they do not last very long.

Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach. These medications are the most potent medications we have to treat GERD and are the most effective. They have been used by millions of patients for more than 20 years are safe for long-term use. The best way to use the medications are to use the lowest effective dose to control symptoms.

Anti-reflux operations (fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and medications. Most patients still need medications within years of having surgery, therefore our physicians try to maximize the effectiveness of medications. Endoscopic procedures have been studied extensively, our physicians can discuss all options with you during your office visit.


Expectations (prognosis)

Most people respond to lifestyle changes and medications. However, many patients need to continue taking drugs to control their symptoms.

There has been a great deal of press in recent years about the longterm safety of PPIs. PPIs have not been proven to lead to any clear complications. They do not cause cancer. There have been associations with decreased bone mineral density after longterm use from decreased absorption of calcium from our diet. Post-menopausal women are at risk for osteoporosis and we recommend supplementation with calcium and vitamin D while on PPIs. Calcium citrate (Citracal and others) supplements are better absorbed while on PPIs.

To learn more about GERD: www.aboutgerd.org