Conditions

Gastroesophageal Reflux Disease (GERD)

• Definition
• Causes
• Risk Factors
• Symptoms

• Diagnosis
• Treatment
• Prevention

Definition:

Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The stomach lining has natural protective mechanisms against acid, but the lining of the esophagus does not share these resistant features.

Causes:

Normally a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES) prevents reflux of the acid. With we swallow, the LES relaxes, allowing food to pass into the stomach. It then tightens to prevent flow in the opposite direction. With GERD, the sphincter fails to adequately tighten, allowing acid to flow back, or reflux, and ultimately damage the lining of the esophagus.
GERD is very common, with as many as 10% of adults experiencing symptoms on a daily to weekly basis. The condition can be worsened by the presence of an abnormal enlargement in the opening in the diaphragm muscle through which the esophagus passes from chest to abdomen. This enlarged opening, called a hiatal hernia, allows the stomach to rise up into the chest, increasing reflux problems.

Risk factors:

Untreated severe GERD can result in ulcers and scarring of the esophagus, with problems swallowing (dysphagia), asthma symptoms, and even tooth decay. Constant irritation of the esophagus lining can cause it to undergo a degenerative change called Barrett’s esophagitis. The danger here is that a small, but real, percentage of patients with Barrett’s esophagitis will undergo malignant transformation into esophagus cancer. There may be no warning signs or symptoms of this, other than those associated with GERD, until cancer is already established. Thus, persistent or severe reflux symptoms should be evaluated and medical care sought.

Symptoms:

Heartburn, the primary symptom of GERD, describes the sensation of stomach acid irritating the esophagus. It is usually felt as a burning pain in the center of the chest that can extend from the upper abdomen up into the base of the neck. Caffeine, alcohol and tobacco, as well as lying down or bending over can make it worse. In the most severe cases, acid washes up into the back of the throat, food is regurgitated, and airway symptoms such as asthma and wheezing can result.

Diagnosis:

For patients with severe GERD, where a surgical solution may be eventually considered, a referral will likely be made to a gastroenterologist. Diagnostic tests to document and/or verify GERD will usually include upper endoscopy, also called esophagogastroduodenscopy, or EGD. This allows direct visualization of the lining of the esophagus and stomach, and can document the presence of inflammation (esophagitis), ulcers, scarring, and the presence of Barrett’s esophagitis. The presence of a hiatal hernia as well, can frequently be diagnosed. It is an essential step in the preoperative evaluation for surgery. Barium swallow x-rays may also be utilized to determine the presence of a hiatal hernia or other esophagus abnormalities. The gastroenterologist may also perform a 24-hour pH probe study, where an acid detecting probe is placed in the lower esophagus to determine the degree of acid insult over a 24-hour period. If surgery is a strong consideration, then a final test called esophageal manometry, will test the muscle function of the esophagus as well as the competency of the lower esophageal sphincter (LES). In patients with severe GERD, where the diagnostic testing is felt to be convincing, referral on to a general surgeon may be considered for a surgical evaluation and possible operative repair.

Treatment:

Most patients with mild GERD are usually well managed with a combination of antacids, acid reducing medicines such as Tagamet, Pepcid, and/or strong acid blocking agents like Prilosec. Frequent or persistent GERD symptoms should be brought to the attention of your physician for evaluation.

Prevention:

There is no know way to prevent GERD. However, caffeine, alcohol and tobacco, as well as lying down or bending over can make it worse.

References: