Gastroesophageal Reflux Disease (GERD)

Causes

The esophagus is the muscular tube that carries food from the throat to the stomach. At the bottom of the esophagus is a ring of muscle called the lower esophageal sphincter (LES). The LES opens to let food and liquid enter the stomach and then closes to prevent stomach contents from flowing back into the esophagus. GERD can occur if the LES becomes weak or does not work properly.

Another condition that can cause or worsen GERD is hiatal hernia, which weakens the LES. A hiatal hernia is a condition where a portion of the upper stomach migrates into the chest cavity. Over time, the hernia can become very large. In serious cases, the entire stomach can migrate into the chest.

Symptoms

People with GERD often experience heartburn—a burning sensation in the center of the chest—at least two or three times a week. Although heartburn may be the most noticeable symptom of GERD, there are several other symptoms:

• Regurgitation of food or fluid into the mouth
• Stomach pain
• Problems swallowing or food getting stuck
• Painful swallowing
• Continual hoarseness or sore throat
• Long-term cough
• An acidic taste in your mouth
• Feeling like you have a lump in your throat
• Worsening dental problems
• Frequent lung or sinus infections
• Waking up to a choking sensation.

Taking over-the-counter or prescription drugs for GERD may relieve the symptoms of heartburn associated with this disorder, but these medications do not solve the real problem—reflux of stomach contents into the esophagus.

Diagnosis

Norton Thoracic Institute (NTI) is a leader in diagnosing and treating GERD. Early diagnosis and treatment can prevent or reduce injury to the esophagus. If you have signs of GERD, the esophageal experts at NTI may use some of the following tests to evaluate your condition:

• Endoscopy, the use of a small, flexible tube with a light and camera to examine and obtain samples, if needed, from your esophagus, stomach, and small intestine
• 24-hour pH study to determine how much stomach acid is reaching your esophagus
• Manometry to measure the muscle contractions of your esophagus and determine how well your LES is working
• Barium studies, x-rays taken while you drink a thick white liquid.

Treatment

The specialists at Norton Thoracic Institute recommend the following lifestyle and diet changes as the first line of defense against GERD:

• Lose weight.
• Avoid foods and drinks that trigger reflux. These vary from person to person, but common triggers include chocolate, alcohol, caffeine, peppermint, and fatty foods.
• Eat your last meal of the day at least two hours before bedtime.
• Raise the head of your bed six to eight inches by placing a foam wedge (available at medical supply stores) under your mattress, or by getting an adjustable bed.

For many people, these changes will limit the backwash of stomach contents into the esophagus at night, which is when the greatest damage occurs.

If you continue to experience reflux despite lifestyle and diet changes, your doctor may recommend one or more of the following:

• Over-the-counter antacids (TUMS, Maalox, Rolaids, Mylanta) to relieve the discomfort of occasional heartburn. You should take these on an as-needed basis.
• Proton pump inhibitors (AcipHex, Dexilant, Nexium, Prevacid, Prilosec, Protonix). A six-week-long trial of PPIs may be prescribed for appropriate patients. If symptoms return, the NTI medical team will assess whether the medication should be continued or whether surgery might be a better option. PPIs relieve heartburn but do not treat the underlying reflux; as a result, a patient taking a PPI may unknowingly continue to experience reflux and damage to the esophagus. Patients taking PPIs for extended periods must watch for other symptoms of reflux (listed above) and have their condition checked regularly by their doctor.
• Laparoscopic fundoplication surgery to strengthen the LES and diaphragm, and prevent reflux. The surgeon can also repair a hiatal hernia during this procedure.
• LINX Reflux Management System, the use of a small, flexible band of magnets implanted around the weak esophageal sphincter to prevent reflux. When you swallow, the beads are forced apart temporarily to allow food and liquid to pass into the stomach. This minimally invasive procedure usually takes less than an hour to perform. 

Prevention

You can take steps to control GERD.

• Lose weight.
• Raise the head of your bed six to eight inches with a foam wedge under your mattress (available at medical supply stores).
• Avoid the foods that trigger your reflux—these may include excessive caffeine, chocolate, alcohol, peppermint, and fatty foods.
• Quit smoking.
• Eat your last meal of the day at least two hours before bedtime.
• Avoid wearing tight-fitting clothing that can compress your stomach.
• Chew gums or use lozenges that increase saliva production and help clear stomach contents from the esophagus.

The LESS GERD TRIAL for Adults Living with Severe Reflux

Most individuals with GERD are successfully treated with acid blocking medications such as proton pump inhibitors (PPI). However, nearly 30% of individuals on PPI medication continue to suffer from symptoms. If you or a loved one between the ages of 22 and 75 suffers from chronic reflux, take PPI medication, and continue to suffer from reflux symptoms, consider participating in the LESS GERD TRIAL. Click here to learn more about the LESS GERD TRIAL.

Learn More About GERD Services at Norton Thoracic Institute

To learn more about our services, call (602) 406-4000.