Gastroesophageal Reflux (GERD)


Gastroesophageal reflux disease (GERD) is a condition where the stomach contents (food or liquid) rise up from the stomach into the esophagus, a tube that carries food from the mouth to the stomach.

Normally, the stomach contents do not enter the esophagus due to the constricted lower esophageal sphincter (LES). However, in patients with GERD, stomach content travels back into the esophagus because of a weak or relaxed LES. Lower esophageal sphincter is a ring of muscle fibers that surrounds the lower-most end of the esophagus where it joins the stomach. LES acts like a valve between the esophagus and stomach, preventing food from moving backward into the esophagus.

Heartburn is usually the main symptom - a burning-type of pain in the lower part of the mid-chest, behind the breast bone. Other symptoms, such as a bitter or sour taste in the mouth, trouble in swallowing, nausea, dry cough or wheezing, regurgitation of food (bringing food back up into the mouth), hoarseness or change in voice, and chest pain, may be experienced.

The exact cause of what weakens or relaxes the LES in GERD is not known; however, certain factors including obesity, smoking, pregnancy and possibly alcohol may contribute to GERD. Common foods that can worsen reflux symptoms include spicy foods, onions, chocolates, caffeine containing drinks, mint flavorings, tomato-based foods and citrus fruits. Certain medications can also worsen the reflux.

There are several tests that can be performed to diagnose GERD and they include:

  • Endoscopy: This test allows the doctor to examine the inside of your esophagus, stomach and portions of the intestine, with an instrument called an endoscope, a thin flexible lighted tube.
  • Barium X-rays: These are diagnostic X-rays in which barium is used to diagnose abnormalities of the digestive tract. You are asked to drink a liquid that contains barium. The barium coats the walls of the esophagus and stomach and makes the abnormalities visible more clearly. Then, X-rays are taken to see if there are strictures, ulcers, hiatal hernias, erosions or other abnormalities.
  • Twenty four-hour pH monitoring: In this procedure, a tube will be inserted through the nose into the esophagus and positioned above the LES. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into esophagus. A recorder, strap-like device that can be worn on your wrist, will be connected to record the pH of the acid content. The tube will be left in place for 24 hours. You can go back home and perform your regular activities, and record the pH of the acid content when you experience the symptoms. On the next day, the recorder will be connected to a computer and the data will be analyzed.
  • pH Capsule: It is a new method of measuring acid exposure in the esophagus. A small wireless capsule is introduced into the esophagus by a tube through the nose or mouth. The tube is removed after the capsule is attached to the lining of the esophagus. The pH sensor transmits signals to a computer that collects the data on the acid exposure over 24 hours. The capsule falls off the esophagus with time and is passed out in the stool.
  • Impedance study: This test is similar to the pH test, but requires two probes: one is placed in the stomach and the other just above the stomach. The dual sensor helps to detect both acidic and alkaline reflux.

Antacids are over-the-counter medicines that provide temporary relief to heartburn or indigestion by neutralizing acid in the stomach. Other medications, such as proton pump inhibitors and H2 antagonists, may be prescribed to reduce the production of acid in the stomach.

Surgery may be an option if your symptoms are not relieved with medications. Nissen’s fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the end of your esophagus and esophageal sphincter, and sutured in place. This surgery strengthens the sphincter and helps prevent stomach acid and food from flowing back into the esophagus.

Endoluminal gastroplication or endoscopic fundoplication techniques require the use of an endoscope with a sewing device attached to the end, known as EndoCinch device. This instrument places stitches in the stomach below the LES to create a plate, which helps reduce the pressure against the LES and help strengthen the muscle.

Chronic GERD left untreated can cause serious complications such as inflammation of the esophagus, esophageal ulcer, narrowing of the esophagus, chronic cough, and reflux of liquid into the lungs (pulmonary aspiration). Some people develop Barrett’s esophagus, which is characterized by changes in the esophageal lining, which can lead to esophageal cancer.

The general measures that you can take to reduce reflux are:

  • Avoid eating before going to bed as this may decrease the acid production.
  • Eat smaller and more frequent meals.
  • Lose weight if you are overweight.
  • Elevate the head of the bed.
  • Eliminate the foods that increase reflux.
  • Avoid smoking and use of alcohol.
  • Check with your physician regarding the side effects of prescription medications.