Gastroesophageal Reflux Disease (GERD) Q&A
What is GERD?
GERD is a disease that develops when the valve, or sphincter, between the esophagus and the stomach (called the lower esophageal sphincter, or LES) malfunctions due to weakness or damage, allowing stomach acid to regularly move backward, or reflux, up the esophagus. “Acid reflux” simply describes this process of acid moving (refluxing) backward up into the esophagus from the stomach.
A common finding in patients with GERD is a hiatal hernia. A hiatal hernia is the protrusion of the upper part of the stomach up into the chest through the diaphragm (a thin, flat muscle, separating the lungs from the abdomen). When a portion of the stomach is stuck above the diaphragm, acid from the stomach can leak into the esophagus and cause GERD symptoms.
What are the Symptoms of GERD?
One most common symptoms of GERD is heartburn. Heartburn is a burning sensation felt behind the breastbone and sometimes behind the neck and throat. Heartburn is caused by stomach acid refluxing into the esophagus.
Other symptoms include:
What are Some Possible Complications of GERD?
Possible complications from GERD arise if the condition is severe or long-standing. Constant irritation of the esophagus by stomach acid can lead to inflammation, ulcers, and bleeding. Anemia (low red blood cell count) can develop as a result of chronic bleeding. Scarring and narrowing of the esophagus (formation of a stricture) can also develop with chronic acid exposure, making it difficult to swallow foods and liquids. Over time, repeated exposure to stomach acids can cause Barrett’s esophagus, in which the tissue lining the esophagus undergoes cellular changes and morphs into tissue similar to that of the intestine.
How is GERD diagnosed?
The first step to a diagnosis of GERD relies on a description of symptoms as well as a medical history. Based on this information, patients are sometimes tried on trial courses of acid-suppressing medications, which come in two forms: proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). If medicinal therapy is helpful, this strongly indicates that the patient has GERD.
Various procedures and forms of testing can also be performed. An endoscopy is the investigative procedure of choice for evaluating the esophagus and the LES. If a hiatal hernia exists, it can be visualized at this time. If inflammation or ulceration in the esophagus is detected, this is a very good indication that significant reflux is occurring.
Other testing sometimes used to diagnose GERD includes a barium swallow, which is simply an x-ray taken after the ingestion of liquid barium contrast and barium soaked food to determine if there is an abnormality of the esophagus or of its motility. Esophageal manometry similarly detects motility abnormalities of the esophagus by placing a tube through the nose into the esophagus and measuring the strength of the LES. Finally, the acidity of the esophagus can be recorded during a 24 pH study, in which reported episodes of esophageal pain or discomfort and visualized episodes of acid reflux are recorded and correlated.
How is GERD Treated?
Treatment strategies for GERD include lifestyle changes and medications. Very occasionally, minimally-invasive surgery is recommended to correct a damaged LES or a large hiatal hernia.
The same lifestyle change or medication does not work for everyone, and it is often a matter of persistence to find what works best for you. Lifestyle changes that are often helpful include: avoiding eating anything within three hours before bedtime, avoiding nicotine, avoiding trigger foods that worsen symptoms, elevating your head 6-8 inches when sleeping, and losing weight if overweight.
When lifestyle changes are not adequate to resolve your symptoms, medication is considered. It is important to consult with a doctor before beginning treatment with acid-suppressing medications so you are fully aware of the risks, benefits, and side effects of long-term use of these medications.