GASTROESOPHAGEAL REFLUX DISEASE (GERD)

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Gastroesophageal reflux disease is a digestive disorder where liquefied stomach content persistently and frequently flows back up (refluxes) into the esophagus.

• The refluxed liquid contains acid and pepsin that are produced by the stomach. The acid can inflame and damage the lining of the esophagus.
• Many people experience gastroesophageal reflux (GER) from time to time. In patients with GERD, however, the acid reflux occurs at least twice a week or at least once a week. In other words, GERD is the long-term, regular occurrence of GER.
• Research has also found that in people with GERD, the refluxed liquid contains more acid that remains in the esophagus longer and the acid refluxes to a higher level in the esophagus than in normal individuals.
• If left untreated, GERD can worsen and turn into other conditions such as esophagitis, Barret’s esophagus, and respiratory problems including asthma, pneumonia, and laryngitis.

CAUSES

GERD is caused by a persistent acid reflux.

In normal digestion, the lower esophageal sphincter – which is a circular band of muscle around the esophagus opens to allow food and liquid to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus.

When the sphincter weakens or relaxes inappropriately, stomach content can flow back into the esophagus. This persistent and regular reflux of acid irritates the esophagus lining, causing it to become inflamed.

The following conditions that can increase a person risk of GERD:

• Obesity because of increased pressure on the abdomen
• Pregnancy
• A hiatal hernia
• Connective tissue disorders
• Low or prolonged emptying of the stomach

The following factors can aggravate acid reflux:

• The use of certain medications such as antihistamines, antidepressants
• Smoking
• Eating late at night or large meals
• Eating fatty or fried foods

SYMPTOMS

 

• Chest pain
• Acidic taste in the mouth
• Regurgitation and heartburn
• Coughing
• Nausea
• Difficulty swallowing

DIAGNOSIS AND TREATMENT

Diagnosis may be made based on a physical examination and history of your signs and symptoms.

There are several possible tests to diagnose GERD, including:

• Upper gastrointestinal endoscopy where a thin, flexible tube equipped with a light and camera is passed down the patient’s throat to examine the inside of your esophagus and stomach.
• Esophageal manometry test to measure rhythmic muscle contractions in the esophagus during swallowing.
• Esophageal pH and impedance monitoring test to measures the amount of acid in the esophagus while the body is in different states such as eating or sleeping.
• X-ray of the upper digestive system, where X-rays are taken after the patient takes a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows the doctor to visualize your esophagus, stomach, and upper intestine and shows up certain physical abnormalities that might cause GERD.

TREATMENT

GERD will often be treated with lifestyle modifications and over-the-counter medications before attempting other lines of treatment.

If no changes are experienced within a few weeks, prescription medications or surgery may be recommended.

The primary medications used are

• Antacids to neutralize stomach acid.
• Medications are known as H-2- receptors blockers such as cimetidine (Tagamet), famotidine (Pepcid) to reduce acid production
• Medications that block acid production and heal the esophagus. These medications are known as proton pump inhibitors.

If medications don’t help, surgery may be recommended. Surgery such as:

Fundoplication where the surgeon wraps the top of the stomach around the esophagus to tighten the muscle and prevent reflux

For those with severe symptoms that do not respond to other treatments, the LINX device is used. The LINX device was approved by the FDA in 2012 and consists of a series of metal beads with magnetic cores that are placed surgically around the lower sphincter.