Gastroesophageal Reflux Disease

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Gastroesophageal reflux disease, or GERD, is caused when some of the stomach’s contents, including acid, flow back up into the esophagus, the tube through which food is carried from the mouth to the stomach. Many recognize the condition simply as heartburn – a burning sensation in the neck and chest – and something most people will experience on occasion. But when reflux occurs frequently and severely enough to compromise quality of life, it could be GERD.

GERD is caused by a weakened sphincter at the base of the esophagus. When healthy, the sphincter opens to allow food in and then closes to prevent food and stomach acids from escaping. If the sphincter is weakened or unnecessarily relaxed, the stomach’s contents can flow up into the esophagus. Some doctors believe such weakening could result from a hiatal hernia, when the upper part of the stomach bulges into the chest through a hole.

GERD affects at least 20% of U.S. adults. If chronic, it can lead to Barrett’s esophagus, a less-common but serious condition that can lead to esophageal cancer.

It’s very likely two people with GERD will experience different symptoms, and those signs are wide-ranging. Those who regularly experience the following should see a doctor.

  • Chronic sore throat and/or cough
  • Hoarseness
  • Frequent burping
  • Sour or bitter taste in the mouth; bad breath
  • Chest pain
  • Pain when swallowing and a feeling that eaten food sticks in the throat
  • Nausea and/or vomiting
  • Inflammation of the gums
  • Erosion of tooth enamel

The most reliable way to diagnose GERD is through a physical exam that includes a review of the patient’s symptoms and behaviors.

To confirm a diagnosis, your physician may recommend one or more of the following:

  • Upper endoscopy: The physician inserts a thin, flexible tube (endoscope) equipped with a tiny camera into the patient’s throat to examine the esophagus, stomach, and possibly upper small intestine (duodenum). This procedure may detect inflammation or other complications.
  • Ambulatory acid (pH) probe test: The use of a monitor to identify when and for how long stomach acid regurgitates. The monitor, placed within the esophagus, connects to a small computer that the patient wears around the waist or on a strap over the shoulder.
  • Esophageal manometry: A pressure recorder is inserted into the esophagus and measures contractions as the patient swallows. Esophageal manometry also measures the coordination and strength of esophageal muscles.
  • X-ray/imaging: An image of the upper digestive system is taken after the patient drinks a chalky liquid that coats the lining of the digestive tract, creating a silhouette.

In most cases, patients diagnosed with GERD are advised to first try lifestyle modifications such as dietary changes, weight loss, and avoiding nicotine and alcohol. If symptoms persist, the doctor might recommend medication or surgery.

Medications include antacids, H2 receptor blockers (to reduce acid production), and proton pump inhibitors (stronger acid blockers).

Other procedures

  • Fundoplication: The surgeon wraps the top of the stomach around the lower esophageal sphincter to tighten the muscle and prevent reflux.
  • Transoral incisionless fundoplication (TIF): The surgeon tightens the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners.
  • LINX device: A ring of tiny magnetic beads is applied to where the stomach and esophagus meet, causing a magnetic attraction strong enough to close off acid from escape, but weak enough that food can pass down.

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