Gastroesophageal Reflux Disease (GERD)
What is GERD?
Gastroesophageal reflux disease (GERD) is a disease where the contents of the stomach move upwards into the esophagus. At times this phenomenon happens in everyone and is considered normal. When it happens frequently or causes symptoms, it is considered abnormal and is referred to as GERD.
Why does reflux happen?
The connection between the esophagus and stomach is a round muscular band known as the lower esophageal sphincter. This sphincter is designed to hold pressure at the esophagus and stomach connection and prevent reflux of stomach materials, namely acid. For a variety of reasons, the sphincter can become “lazy” and allow frequent stomach content reflux. “Laziness” can occur due to medications, age, smoking, and hiatal hernia.
What are the symptoms of GERD?
Symptoms of GERD are most commonly heartburn and regurgitation. Heartburn is different for each person, but commonly described as a burning or painful feeling in the low chest. Regurgitation usually refers to the sensation of food or fluid moving up into the chest or even back of the throat. Other symptoms associated with GERD include difficulty swallowing, sore throat, hoarse voice, chest pain, chronic chough or choking, and frequent sinus or ear infections.
How do I know if I have GERD?
Your physician generally makes the diagnosis of GERD based on your symptoms. Other examinations that aid in the diagnosis of difficult or complicated cases include upper GI endoscopy, 24-hour pH monitoring (this involves a tube into your esophagus via your nose that measures reflux of acid into the esophagus), barium swallow tests/upper GI series, and esophageal manometry (another tube into the esophagus via the nose that measures esophageal squeezes).
What is the treatment?
There are a variety of medications that can be used to manage GERD symptoms. Simple therapies such as TUMS, Rolaids or Mylanta can be very helpful. Over-the-counter medications that help decrease acid include ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) or omeprazole (Prilosec OTC). The strongest drugs available for acid suppression must be prescribed by your doctor and include Prevacid, Nexium, Protonix, and Aciphex. This class of medication acts to block acid secretion within the stomach. These have been extremely successful medications and are very well tolerated.
Other novel approaches to treatment of GERD exist. Surgical antireflux procedures are successful and well tolerated. Your physician can help you to decide if you are a good candidate for such an intervention.
Complications of GERD
Unfortunately, complications of acid reflux do sometimes occur. One of the most common problems associated with GERD is narrowing of the lower esophagus, called a stricture or ring. Strictures can form in patients both with and without regular symptoms of GERD! Strictures cause difficulty with swallowing and often must be stretched via upper GI endoscopy. Barrett’s esophagus is another complication, defined as an alteration of the tissue lining of the lower esophagus due to chronic acid damage. Barrett’s is a pre-cancerous condition diagnosed by upper GI endoscopy and needs to be watched regularly by your Gastroenterologist. Some lung issues such as asthma and pneumonias can be associated with frequent regurgitation of stomach contents into the mouth and ultimately lungs.
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