Gastroesophageal Reflux Disease (GERD)

Definition & Symptoms

GERD is a severe, chronic acid reflux condition in which acidic stomach contents back up into your esophagus. The muscle connecting the stomach to the esophagus is weak or relaxes abnormally, allowing this abnormal movement. Although GERD is rarely life threatening, it can lead to internal bleeding, ulceration, strictures or esophageal cancer. Early detection can help prevent minor heartburn from becoming a major health issue. The hallmark symptoms of GERD are: 1. Heartburn: For many people, acid indigestion (known as heartburn) is more than an occasional annoyance after eating a greasy meal. Research shows that more than 60 million people suffer from this burning sensation that can extend from the breastbone to the neck and throat. Heartburn sufferers may also experience a sore throat, hoarseness, chronic cough, asthma or a feeling of a lump in the throat. Because there can be chest pain associated with GERD, heartburn sometimes is mistaken for heart attack. 2. Regurgitation: a sensation of acid backed up in the esophagus. Other common symptoms are: feeling that food may be trapped behind the breastbone, heartburn or a burning pain in the chest (under the breastbone), increased by bending, stooping, lying down, or eating, more likely or worse at night, relieved by antacids, nausea after eating

Risk factors

Risk factors for GERD include obesity, having a hiatal hernia, pregnancy, smoking, asthma, diabetes, delayed stomach emptying, and some connective tissue disorders.

Diagnostics

If your symptoms are severe, recurrent, or ongoing for more than one year, one or more tests may help diagnose reflux or any complications:

  • Esophagogastroduodenoscopy (EGD) is often used to 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. Biopsies can be taken for evaluation.
  • Barium swallow study
  • BRAVO pH system: A small capsule is temporarily attached to the esophageal wall and takes continuous pH measurements. Using these measurements, your physician can analyze and evaluate your symptoms.
  • Impedance pH monitoring
  • Esophageal manometry

Treatment

Treatment options include over the counter proton pump inhibitor drugs and H2 antagonists. Surgery or endoscopic therapy are options for patients whose symptoms do not go away with lifestyle changes and medication. Heartburn and other symptoms should improve after surgery, but some drugs may be needed for heartburn. Patients who have had GERD for many years may need an upper endoscopy to check for Barrett’s esophagus, which is a condition resulting from chronic acid exposure in the esophagus causing changes to the lining of the esophagus. Patients with Barrett’s esophagus are at an increased risk for developing esophageal cancer.

To help minimize heartburn symptoms:

  • Lose weight, if indicated.
  • Avoid spicy, fatty, or citrusy foods
  • Avoid bending over or exercising after eating.
  • Avoid wearing garments that are too tight around your waist
  • Avoid large meals before bedtime
  • Decrease stress
  • Avoid alcohol
  • Stop smoking to help the esophageal muscle work better.
  • Elevate the head of the bed by 4 to 6 inches, using cinder blocks or telephone books.
  • Eliminate midnight snacks.

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