Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD), or acid reflux, is a more severe form of gastroesophageal reflux (GER), which occurs when the liquid content of the stomach regurgitates or refluxes into the esophagus. The acidic content of the liquid causes inflammation and damage to the lining of the esophagus. Reflux occurs in most people, but only tends to cause GERD when there is more acid in the liquid.
The cause of GERD that develops in some people is unknown. Abnormalities with the lower esophageal sphincter, which allows the liquid to pass back up to the esophagus, can cause the condition. Swallowing disorders and abnormally slow emptying of the stomach can also increase the chance of developing GERD. Other risk factors for developing GERD include obesity, pregnancy and smoking. Symptoms can be triggered by spicy foods, caffeine or alcohol.
The primary symptom of GERD is heartburn, which occurs as the liquid travels through the esophagus and stimulates the nerve fibers. Heartburn is felt as a burning pain in the middle of the chest. It can stretch from the abdomen to the neck and can even extend into the back. Heartburn from acid reflux occurs most often after eating or while lying down, when reflux is more likely to occur. Regurgitation, nausea and trouble swallowing are also common symptoms of GERD. More severe cases of GERD can lead to ulcers, asthma and narrowing of the esophageal inner cavity.
GERD is usually diagnosed by a treatment trial. Since heartburn is the identifiable symptom, your doctor may prescribe medication to suppress the production of acid in the stomach. If heartburn is relieved or greatly reduced, the diagnosis of GERD is confirmed. The problem with this method is that the symptoms may actually be a result of other conditions, such as an ulcer. Proper diagnostic testing may be done and can include:
A thin tube with a camera is swallowed and fed to the esophagus, which can be visually examined for inflammation, lesions or breaks in the lining which lead to a confirmed diagnosis of GERD.
Esophageal Acid Testing
A catheter is inserted through the nose and into the esophagus with an acid sensor on the end. The tube is connected to a recorder at the waist which records episodes of reflux from the sensor over a 24 hour period. Since most people have mild amounts of acid reflux, the results of this test are not always accurate and must be confirmed by GERD symptoms or response to treatment. This test can also be used to determine why treatment is ineffective or if GERD has been diagnosed incorrectly.
Esophageal Motility Testing
This test determines how well the muscles of the esophagus are working by inserting a catheter through the nose and into the esophagus with a sensor to measure the pressure of the muscles when they contract.
Gastric Emptying Studies
This study determines how quickly and efficiently food is emptied from the stomach. The patient eats a meal labeled with a radioactive substance and a sensor is then placed over the stomach to measure how quickly the substance empties from the stomach.
Biopsies, X-rays and examination of the throat and larynx are also useful in diagnosing GERD or ruling out other possible conditions.
While GERD is a chronic condition that cannot be cured, there are plenty of treatment options to reduce the severity and frequency of symptoms. Life changes are one of the simplest yet effective treatment methods for GERD. Some of these changes include:
- Keep the upper body slightly elevated while sleeping to utilize the effects of gravity and keep refluxdown.
- Eat smaller meals and avoid foods known to promote reflux such as chocolate, peppermint and alcohol.
- Avoid lying down for 3 hours after a meal.
- Stop smoking.
Medications are also helpful in reducing acid production or relieving the muscles that empty your stomach. These medications include antacids, foaming agents, H2 blockers. proton pump inhibitors and pro-motility drugs. Surgery may be recommended for patients that do not respond to medication and other mild treatment. Surgery for GERD is known as fundoplication, but is commonly known as reflux surgery. This procedure can repair any complications from a hiatal hernia, make an artificial lower esophageal sphincter or tighten an opening in thediaphragm.
Many cases of GERD can be treated by the patient through life changes and over-the-counter medications. However, it is still important to see your doctor for recommended treatment and to prevent any complications of GERD.