What is Gastroesophageal Reflux Disease?
Gastroesophageal reflux occurs when contents within the stomach flow back into the esophagus. There is a valve (lower esophageal sphincter) located between the esophagus and stomach. When this valve doesn’t close properly, stomach contents enter the esophagus and reflux occurs.
What are the symptoms of Gastroesophageal Reflux?
The most common symptoms of gastroesophageal reflux are heartburn and/or acid regurgitation. Heartburn is a burning sensation felt behind the breast bone. This occurs from stomach contents irritating the normal lining of the esophagus. Acid regurgitation is the sensation of stomach fluid coming up through the esophagus and sometimes into the mouth.
Less common symptoms associated with gastroesophageal reflux include: unexplained chest pain, wheezing, sore throat and cough, among others.
What causes GERD?
Gastroesophageal reflux disease (GERD) occurs when there is an imbalance between the normal defense mechanisms of the esophagus and offensive factors such as acid and other digestive juices and enzymes in the stomach. Often with GERD, the barrier separating the stomach and the esophagus is impaired. This could be due to weakening of the lower esophageal sphincter or the presence of a hiatal hernia. Hiatal hernias are common, however, not all people with a hiatal hernia have reflux. One of the major causes of reflux is obesity. This is due to the increased pressure in the abdomen overcoming the barrier between the esophagus and stomach. Other contributing factors to GERD include: pregnancy, smoking, excess alcohol use, and several foods such as coffee, citrus drinks, tomato based products, chocolate, peppermint, and fatty foods.
How is GERD diagnosed?
Usually no additional testing is required before treatment when a patient is experiencing common symptoms of GERD such as heartburn and/or acid regurgitation. Additional testing may be necessary if symptoms do not respond to treatment or if other symptoms such as weight loss, difficulty swallowing or internal bleeding are present.
Upper endoscopy is a test in which a small tube with a light at the end is used to examine the esophagus, stomach and first portion of the small intestine. Sedation is given during the test to help you relax and lessen any discomfort you may feel. During an upper endoscopy, your doctor can see the lining of the esophagus and determine if any damage has been caused due to GERD. A biopsy of tissue may be done at that time as well. Obtaining a biopsy will not cause you any pain or discomfort.
Another test, known as Bravo® pH monitoring, measures acid in the esophagus. This is done by attaching a small sensor to the esophageal mucosa during the time of endoscopy. The sensor transmits information to a small recorder worn on your belt.
X-ray testing is not useful in the initial evaluation of individuals with symptoms of GERD.
How is GERD treated?
Sometimes reflux symptoms disappear if dietary or lifestyle excesses are reduced or eliminated. Avoiding or limiting these items may reduce your discomfort:
- citrus drinks or foods
- tomato-based products
- carbonated beverages
- fatty or spicy foods
- eating within three hours of bedtime
- excess alcohol consumption
- excess weight gain
Some people find it helpful to raise the head of the bed at night.
If symptoms persist , over-the-counter antacids may decrease discomfort. Antacids have a limited role in treating reflux disease because they only work for a short time. Histamine H2 receptor antagonists (cimetidine, ranitidine, and famotidine) decrease acid production in the stomach and work well for treating mild reflux symptoms. These medications are safe, have very few side effects, and are available over-the-counter at reduced dosing, or at a higher dose by prescription.
Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, and rabeprazole) are all highly effective in treating reflux symptoms by blocking the final step of acid production in the stomach. They are typically taken once or twice daily prior to meals. Proton pump inhibitors are the most effective medical treatment for frequent reflux symptoms.
Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of GERD. Metoclopramide is currently the only available drug in this category available on the market and has been found to have little benefit and many side effects.
For patients with well documented GERD and cannot tolerate medications or continue to have regurgitation as a primary symptom, surgery should be considered. A comprehensive evaluation should be completed prior to having surgery. Fundoplication is the surgery to treat reflux. During this procedure, any hiatal hernias are eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done by laparoscope, avoiding a full incision of the stomach. The surgery is complex and it is important to seek a skilled surgeon who have experience in performing this procedure. The surgeon will discuss all risks and benefits of the procedure with you.
When should I see my doctor?
If you have symptoms of unexplained weight loss, trouble swallowing or internal bleeding in addition to heartburn and/or acid regurgitation, you should see your doctor immediately. You should also see your doctor if you have symptoms that persist even after making lifestyle changes and if you use over-the-counter medications regularly to reduce reflux symptoms. Your doctor can work with you to determine the best course of treatment for you.