Gastroesophageal Reflux
Gastroesophageal Reflux Disease (GERD) occurs when the normal barrier between your stomach and esophagus fails. This barrier is a muscular ring called the Lower Esophageal Sphincter (LES). Think of the LES as a valve; when it doesn't close tightly, stomach acid flows back up into the esophagus (reflux).
A condition called a hiatus hernia, where part of the stomach pushes up into the chest, significantly weakens this LES valve and is a major cause of severe GERD.
The severity of GERD can range widely: from mild, occasional heartburn with no damage to the esophagus, all the way up to serious complications like ulcerations, bleeding, strictures (narrowing of the esophagus), and difficulty swallowing (dysphagia).
Serious Long-Term Risk:
If GERD is prolonged, it can cause changes in the lining of the esophagus called Barrett’s esophagus. This change is a significant risk factor for developing esophageal dysplasia and, eventually, esophageal cancer.
What Are the Symptoms?
The classic symptoms that bring people to the doctor include:
- Retrosternal burning pain: This is the common feeling of heartburn felt behind the breastbone.
- Dysphagia: Difficulty or discomfort when swallowing food.
- Odynophagia: Pain experienced specifically during swallowing.
- Upper GI bleed: Bleeding in the upper digestive tract.
How It's Diagnosed?
- Classic Symptoms: If a patient has the textbook symptoms of GERD, the diagnosis is usually straightforward, and no immediate extensive testing is needed.
- Severe Symptoms: If symptoms are severe (like dysphagia or bleeding), an endoscopy is required. This allows the doctor to look directly at the esophagus to confirm the diagnosis and rule out other potential causes.
- Other Tests: Additional tests that may be used include a Barium swallow (X-ray showing the esophagus), 24-hour pH testing (to measure acid exposure), and manometry (to measure the strength of the LES).
Treatment Options:
Treatment usually involves a stepped approach, starting with simple changes:
Lifestyle Modification:
Making certain changes can greatly help control acid reflux:
- Stop smoking and limit alcohol.
- Avoid tight clothing that puts pressure on the abdomen.
- Elevate the head of your bed (gravity helps keep acid down).
- Lose weight if you are overweight.
- Avoid late-night snacks close to bedtime.
- Limit intake of tea, coffee, cola, and citrus fruits, as they can trigger acid production.
Medications:
- PPIs (Proton Pump Inhibitors) and prokinetic agents are very effective at controlling symptoms. PPIs significantly reduce the amount of acid the stomach produces.
Surgery (Fundoplication)
Surgery may be an option, particularly a procedure called fundoplication, which physically corrects the underlying defect by reinforcing the LES valve.
Surgery is typically indicated for patients who:
- Are doing well on PPI medication but want a permanent solution to avoid long-term medication use.
- Are young patients who frequently develop strictures (narrowing) of the esophagus.