Reflux occurs when stomach contents and acid flow back up into the esophagus causing irritation in the throat. Usually stomach acid is confined to the stomach. But in some cases when a small valve called the lower esophageal sphincter (LES) malfunctions, it allows acid to seep back up into the esophagus.
There are any number of causes for GERD, including eating certain foods that trigger heartburn (chocolate, peppermint, garlic, tomatoes, citrus fruits, etc.); ingesting alcohol and caffeine; eating too much; being overweight; and lying down after a meal.
Certain medications (antidepressants, beta blockers) and some medical conditions (esophageal varices and strictures) also may cause GERD. Usually stomach acid is confined to the stomach. But in some cases when a small valve called the lower esophageal sphincter (LES) malfunctions, it allows acid to seep back up into the esophagus. Reflux disease also is more common in patients with hiatal hernia, in which a portion of the stomach protrudes up into the esophagus.
GERD is a common medical disorder affecting more than 17 million adults and children. Women who are pregnant also have higher rates of GERD.
Your physician will first want to rule out cardiac chest pain as the cause of your symptoms. In many cases, your gastroenterologist will be able to tell, based on the symptoms you describe, whether or not you have GERD. He or she also will have you undergo one or more procedures to help diagnose your condition and determine if there is any damage to the esophageal lining from reflux.
These procedures include an upper GI or esophagogastroduodenoscopy (EGD), a barium x-ray, esophageal pH monitoring, and esophageal manometry.
In many patients, mild symptoms of reflux disease are treated effectively with over-the-counter medications, such as antacids that neutralize the effects of stomach acid. However, when these drugs no longer work other medications, including prescription-strength H2 blockers and proton pump inhibitors, may be prescribed that reduce gastric (stomach) acid production.
Lifestyle changes also significantly - and positively - affect GERD symptoms. These measures include:
- Losing weight
- Stopping smoking
- Restricting caffeine and alcohol use
- Eliminating fried, fatty foods from the diet as well as other foods that trigger heartburn
- Eating smaller portions
- Not lying down after eating
- Raising the head of the bed
Patients who have longstanding reflux of stomach acid into the esophagus will be evaluated for Barrett's esophagus, a precancerous condition in which the cellular lining of the esophagus has changed due to the irritating effects of GERD.
In some cases, surgery is recommended when medications are no longer tolerated or effective. Surgery also may be indicated to repair the esophagus to help reduce or eliminate GERD symptoms. These conditions include hiatal hernia, when the top of the stomach protrudes up into the lower esophagus; esophageal strictures, which is narrowing of the esophagus; and procedures to strengthen the lower esophageal sphincter (LES) muscle that sits between the top of the stomach and the lower esophagus.
One such LES surgical technique, the Hill repair, was perfected by Virginia Mason Surgeon Lucius Hill, MD. Today, the Hill repair is the preferred surgical treatment for GERD and is performed most often laparoscopically.
In the laparoscopic approach, three or four small incisions, about ¼ to ½ inches in diameter are made in the abdomen. Small surgical instruments and a miniature camera are then inserted through these "ports." The surgeon performs surgery while viewing images of the esophagus on a video monitor.
Because the Hill repair is more technically difficult, surgeons may choose the more common Nissen fundoplication procedure, which involves wrapping the top of the stomach around the lower esophagus, which eliminates symptoms of GERD. This procedure also can be performed laparoscopically.
Most patients find successful reduction of GERD symptoms with medical therapy. But sometimes the medications no longer work or are not well tolerated. In these cases, surgery may be recommended to tighten the lower esophageal sphincter (LES) or to repair areas of the esophagus. Your gastroenterologist and surgeon will talk to you about the type of surgery best suited to your needs.
In most cases you will always take medications to control symptoms of GERD, unless you have had surgery to tighten the lower esophageal sphincter. This surgical procedure prevents stomach acid from entering the lower esophagus.
Long-standing GERD can lead to a precancerous condition called Barrett's esophagus, in which cellular changes have taken place in the lower esophageal lining. This condition can progress further into low- or high-grade dysplasia, and then to esophageal cancer. For this reason, patients diagnosed with Barrett's esophagus are monitored regularly with endoscopic surveillance and biopsy.