What Is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease, commonly called GERD, is a condition in which stomach acid and other stomach contents flow backward (reflux) into the esophagus, the tube that connects your mouth to your stomach. While occasional reflux is normal, GERD occurs when reflux happens frequently enough to cause bothersome symptoms or damage to the lining of the esophagus.

The lower esophageal sphincter, a ring of muscle at the bottom of the esophagus, normally acts as a one-way valve, opening to let food into the stomach and closing to keep stomach contents from flowing back up. In GERD, this valve does not work properly, allowing acid and other stomach contents to wash back into the esophagus.

Symptoms

• Heartburn: A burning sensation that rises from the upper belly toward the neck. This is the most common symptom of GERD.
• Regurgitation: The effortless return of stomach contents up toward the mouth, often with a sour or bitter taste.
• Chest pain: GERD can cause chest pain and should be evaluated if the heart has been found to be normal by a cardiologist. Always seek emergency care if you are unsure whether chest pain is from your heart or your esophagus.
• Other GERD related symptoms can include a lump in the throat (globus), chronic cough, asthma, throat clearing, hoarseness, sore throat, or voice changes. These  “atypical” symptoms can be caused by many conditions other than GERD, so it is important to also see other specialists such as ENT or pulmonology (lung) as appropriate.
• Warning signs that need prompt medical attention: If you experience difficulty swallowing, unintentional weight loss, vomiting blood, or black/tarry stools, contact us at Salem Gastro for an evaluation. These may indicate a more serious problem.

 

Evaluation

Not everyone with heartburn needs testing. Your doctor may recommend treatment based on your symptoms alone. However, further evaluation may be needed in certain situations.

When testing may be recommended:

• You have warning signs (see above)
• Your symptoms do not improve after 4–8 weeks of treatment
• You have atypical symptoms (see above)
• You have multiple risk factors for Barrett’s esophagus, a precancerous change related to acid exposure. Read more here (Note to Steve: please link this to our Barrett’s article)

Common tests:

• Upper endoscopy (EGD): A thin, flexible tube with a camera is passed through the mouth to examine the esophagus and stomach. This can detect inflammation (esophagitis), scarring / narrowing (strictures), Barrett’s esophagus, or a hiatal hernia where part of the stomach sits up in the chest and increases reflux.
• pH monitoring: A small sensor is placed in the esophagus (either on a thin wire through the nose or a wireless capsule attached to the esophageal wall) to measure acid exposure over 24–96 hours. This is the most accurate way to confirm whether acid reflux is occurring.
• Esophageal manometry: A test that measures how well the muscles of the esophagus squeeze and move food downward. This is typically done before considering surgery.

Lifestyle Treatment

Lifestyle changes are an important part of managing GERD and can make a real difference in symptoms.

• Elevate the head of your bed with a wedge pillow
• Avoid eating within 3-4 hours of bedtime to allow the stomach to empty fully and prevent reflux
• Quit smoking: smokers who quit for one year had a 44% improvement in GERD symptoms.
• Limit alcohol and caffeine which relax the lower esophageal sphincter
• Weight loss: losing weight decreases the pressure in your belly, which prevents stomach contents from being forced upwards
• Identify and avoid your personal food triggers. Common triggers include spicy foods, high-fat meals, chocolate, onions, and tomato-based products. There is no need to avoid food you feel fine eating.
• Avoid tight-fitting clothing around the waist.

Medical Treatment

Most people with GERD can be effectively managed with medications. Your doctor will choose the right approach based on the severity and frequency of your symptoms.  Symptoms that come and go can frequently be managed using over the counter antacids or famotidine.

Patients needing long term acid suppression are frequently offered proton pump inhibitors (PPIs), such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), rabeprazole (Aciphex), or lansoprazole (Prevacid).  These medicines need to be taken on an empty stomach before meals for best absorption.

You may have heard concerns about long-term PPI use. High quality studies have shown only a slightly increased risk of certain gut infections and decreased absorption of certain minerals. Other reported associations such as dementia aren’t thought to be real side effects of PPIs, but rather associations with the fact that overall sicker patients are more likely to be taking PPIs.  In the right patients, the benefits of avoiding long term acid-related complications like strictures or esophageal cancer significantly outweigh PPI risks.  Your doctor can help you weigh the benefits and risks for your specific situation.

Surgical Treatment

Surgery is an option for people with confirmed GERD who prefer not to take long-term medications, who have severe symptoms despite medications, or have large hiatal hernias.

• Fundoplication (Nissen or partial wrap): The most commonly performed antireflux surgery. The top of the stomach is wrapped around the lower esophagus to strengthen the valve. Achieves symptom relief in up to 92% of patients and high satisfaction rates (over 90%) at 10 years. Possible side effects include difficulty swallowing and gas-bloat (a feeling of trapped gas).
• Roux-en-Y gastric bypass: May be recommended for patients with GERD who also have morbid obesity. This procedure is very effective at eliminating reflux. Note: Sleeve gastrectomy (another weight-loss surgery) can actually worsen GERD.

Important: Before surgery is considered, GERD should be confirmed with objective testing (endoscopy, pH monitoring), and esophageal motility should be evaluated.

Complications

When GERD is not adequately controlled over time, it can lead to several complications:

• Esophageal stricture: long-term acid-related inflammation can cause scar tissue to form, narrowing the esophagus. This causes difficulty swallowing, especially solid foods.  Strictures are treated with endoscopic balloon dilation (stretching) combined with long-term PPI therapy to prevent recurrence.
• Barrett’s esophagus and esophageal cancer: long-term acid exposure can cause abnormal intestinal type cells to grow in the lower esophagus. Barrett’s esophagus is a precancerous condition and needs regular surveillance endoscopies to check for further concerning changes, as well as long term PPI therapy to prevent cancer.

 

Here at Salem Gastro we provide comprehensive GERD care to restore your quality of live and prevent dangerous long term complications.