What is GERD?
Gastroesophageal reflux disease represents the abnormal passage of stomach contents (including acid) Into the esophagus.
When this happens some patients experience heartburn, which is a burning in the mid abdomen–sometimes radiating up the chest. In addition to heartburn, patients may also experience regurgitation of stomach contents into their mouth or lungs (called aspiration), swallowing problems, chest pain, sinus symptoms, hoarseness, worsening reactive airways disease/asthma, and loss of dental enamel.
Too much acid or Plumbing?
At the heart of GERD is a plumbing problem–not an excess of acid. There is a valve at the bottom of the esophagus called the lower esophageal sphincter. When this valve abnormally relaxes, it allows stomach contents including acid to backflow into the esophagus. Patients with acid reflux do not have too much acid–their acid is just getting to the wrong place.
What causes acid reflux?
There are many contributors to acid reflux. These include being overweight, smoking, eating excessively large meals, and certain foods parentheses excessive caffeine, and alcohol. Some patient also have a hiatal hernia, where the top part of the stomach bulges through the diaphragm into the chest–this bulge or “herniation” inhibits the lower esophageal sphincter from doing its job of preventing backflow of stomach contents.
Why do we care?
- GERD causes symptoms and lifestyle disruption.
- Complications may occur, including development of tissue injury called Barrett’s that can turn into esophagus cancer. Also common is a tissue injury which narrows the esophagus (esophageal stricture) and can lead to swallowing problems.
The two treatments.
The two ways acid reflux is treated are medical therapy and surgical therapy.
Medical therapy works to improve the risk factors causing acid reflux. In other words patients are encouraged to lose weight, decrease caffeine and alcohol intake, eat small meals and avoid late night meals. Patients with night time symptoms may benefit from elevating the head of the bed with 6-8 inch blocks. Medications to reduce production of stomach acid include histamine blockers such as Zantac and Pepcid and proton pump inhibitors including Prilosec/omeprazole, Nexium, Prevacid, Pantoprazole, and others. Although proton pump inhibitors are much better at inhibiting stomach acid and treating GERD, they also have some side effects. These include long-term potential for bone weakening called osteoporosis. There is also a small risk of development of kidney damage. There has also been a widely reported potential correlation between proton pump inhibitors and cognitive decline such as Alzheimer’s. These side effects are weighed against the benefit derived from treatment–symptoms control and prevention of complications.
Surgical therapy involves an outpatient (usually laparoscopic) procedure to snug the junction between the esophagus and stomach to allow the sphincter valve to work better. Benefits include being able to go off medication in many cases. Potential risks include anesthesia risks, basic surgical risks, and development of bloating and swallowing problems after surgery. Age, medical comorbidities, and anatomical factors come into play and deciding whether medical therapy or surgical therapy is best for you.
Do I need an Endoscopy (Esophago-Gastro-Duodenoscopy)
An endoscopy may be performed to evaluate for tissue injury (Barrett’s), swallowing problems (a stretch or “dilation” may be performed to treat a stricture), esophagus cancer, and anatomical abnormalities such as a hiatal hernia which may contribute to acid reflux. During the EGD, the esophagus, stomach, and duodenum are closely examined for any other contributing factors to the patient’s symptoms.
Dr. Christopher J. Goulet