Madhukar Kaw, M.D.
Gastroesophageal reflux disease (GERD) more commonly referred to as acid reflux or acid regurgitation occurs when the ring of muscles at the bottom of the esophagus opens or does not close properly and stomach contents rise up into the esophagus. The acidity associated with GERD is the result of digestive juices—that rise up with the food into the esophagus (the tube that carries food from the mouth to the stomach).
Acid reflux, is the burning or acid taste one gets at the back of the mouth. The burning sensation experienced in the chest or throat occurs when refluxed stomach acid touches the lining of the esophagus. Occasional gastroesophageal reflux is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.
Symptoms of GERD
The main symptom associated with GERD in adults is frequent heartburn, also referred to as acid indigestion. This burning sensation occurs in the lower mid-chest region, behind the breast bone and in the mid-abdomen. Children under 12 experience GERD without symptoms of heartburn. Most may experience a dry cough, asthma symptoms, or trouble swallowing.
Causes of GERD
While research is underway to determine the cause of GERD, our current state of knowledge shows that in people with GERD, the sphincter muscles are not in sync with the esophagus, it relaxes while the rest of the esophagus is working. Hiatal hernias are also indicated as a cause of GERD. When a hiatal hernia is present, acid reflux can occur more easily. Hiatal hernias can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.
Other factors that are associated with the onset of GERD include:
Obesity, pregnancy, smoking, foods such as: citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavorings, spicy foods, tomato-based foods, like spaghetti sauce, salsa, chili, and pizza.
Treatment of acid reflux
For people who have not been able to get relief from GERD after using antacids or other over-the-counter reflux medications for more than 2 weeks, your primary care physician may refer you to a gastroenterologist. Along with lifestyle changes, GERD sufferers may be treated with medication or surgery. Recommended lifestyle changes for adults with GERD include: the cessation of smoking, avoiding foods or beverages that exacerbate GERD symptoms, weight loss, eating small frequent meal, avoid lying down for 3 hours after a meal, raising the head of the bed 6-8 inches by securing wood blocks under the bedposts.
Medications for treating GERD may include the use of H2 blockers such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac), decrease acid production in combination with antacids. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production Doctors may also prescribestronger medication such as: proton pump inhibitors such as:omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium).
Some patients get relief from the prokinetic class of drugs which help strengthen the muscles of the esophagus and speed up stomach emptying. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Options beyond Medication & Lifestyle Changes
If your symptoms do not improve with lifestyle changes or medications, you may need additional tests. A Barium swallow radiograph utilizes x-rays to identify abnormalities such as a hiatal hernia or an anatomical problem in the esophagus. An upper endoscopy is more accurate than the barium swallow radiograph in identifying injury to the esophagus from acidity resulting from GERD. In this procedure tissue samples may be removed to identify damage to the esophagus caused by acid reflux versus infections or abnormal growths in the esophagus producing symptoms of GERD. pH monitoring is another study used by gastroenterologists to determine when and how acid enters the esophagus. This study is useful for identifying wheezing and coughing episodes triggered by reflux.
Many non surgical procedures are available for management of acid reflux. Transoral incisionless fundoplication (TIF) is one of the innovative procedure which provides durable relief of acid reflux without incision.
Surgery is recommended as the final option to treat GERD, after all other treatment options have not yielded effective results. Nissen fundoplication is the surgical treatment of GERD. Since the Nissen fundoplication may be performed using a laparoscope, it is a relatively non-invasive procedure and when performed by experienced surgeons, laparoscopic fundoplication is safe and effective for people of all ages.
Effects of Untreated GERD
Untreated, GERD has serious complications. Refluxed stomach acids damage the lining of the esophagus and can cause bleeding or ulcers or inflammation of the esophagus. Scars from the damaged tissue can lead to narrowing of the esophagus, making swallowing difficult. Some patients develop Barrett’s esophagus, a condition in which cells in the esophageal lining take on an abnormal shape and color. Over a period of time, these cells become cancerous resulting in esophageal cancer, which is often fatal. Thus, it is vital that people with GERD be evaluated and treated by a competent gastroenterologist to ensure that the symptoms are treated effectively.