The esophagus is the food pipe that carries food and liquid from the mouth to the stomach. A specialized muscle, known as the lower esophageal sphincter (LES), is located at the end of the esophagus. This LES relaxes only to let food and liquids to pass into the stomach and maintains certain pressure, to prevent stomach acid and digested food from moving back into the esophagus.
However, the LES can easily be overcome by a number of factors, the most common being eating a large meal. Other agents that weaken the LES muscle and allow reflux of stomach juices are: Nicotine (cigarettes), fried or fatty foods, caffeinated products such as chocolate, coffee, coke, citrus fruits and juices, peppermints and certain medications such s theophylline.
In hiatal hernia (a part of the stomach gets pulled up into the chest through the diaphragm muscle), LES pressure is overcome causing gasteoesophageal reflux. Persistent reflux results in tissue damage to the esophagus causing esophagitis. A hiatus hernia exists when part of the stomach protrudes through the diaphragm muscle into the chest. When the hernia is fixed in this position, stomach acid and food do not drain out of it quickly and the LES pressure is overcome. This results in tissue damage to the esophagus. A fixed hiatus hernia, therefore, is an important factor in causing esophagitis.
Heart burn is a common symptom of GERD. Almost everyone has experienced heartburn. About 25 million American adults suffer daily from heartburn. It is that burning sensation felt behind the breastbone and sometimes in the neck and throat. Patients may also experience some of the following: sour or bitter taste, hoarseness, repeatedly feeling a need to clear the throat, difficulty swallowing food or liquid, wheezing or coughing at night, worsening of symptoms after eating, or when bending over or lying down.
Complications occur when GERD is severe or long-standing. Constant irritation of the esophagus by stomach acid can lead to inflammation, ulcers, and bleeding. Anemia or low blood count may develop. Over time, scarring and narrowing of the esophagus can also develop, making it difficult to swallow foods and liquids. This narrowing is called a stricture. Some patients develop a condition called Barrett’s esophagus, which is a serious change in the cells lining the esophagus. Barrett’s esophagus may be a forerunner of esophageal cancer.
The diagnosis can usually be suspected by the physician, simply by taking the medical history which is the initial step for GERD treatment. Beyond that, the physician may order an x-ray examination of the esophagus and stomach. This makes it possible to see the reflux and a hiatal hernia on the x-ray. Upper endoscopy is the most important test for patients with GERD. This is helpful in determining how severe the disease is, how much tissue damage there is, and if there are any complications. Certain conditions, such as narrowing or stricture in the esophagus, can usually be corrected during this procedure. During an endoscopy, the physician can also look for signs of Barrett’s esophagus, and perform a biopsy to see if precancerous changes have occurred.
There are other tests that are helpful. A pressure recording of the esophagus is called esophageal manometry. It measures the pressure in the LES and any abnormal muscle contractions in the main part of the esophagus. Finally, a 12 to 24 hour recording of the acidity in the esophagus is often helpful.
Treatment for GERD includes life style modification such as avoid eating anything within three hours before bedtime, avoid smoking and tobacco products, reduce consumption of fatty foods, coffee, chocolate, mints, caffeinated and carbonated drinks, citrus juices and alcohol. Eating smaller meals and avoiding tight clothing helps. Elevating the head of the bed or mattress helps to keep acid in the stomach but not practical. Weight loss may relieve upward pressure on the stomach and LES.
A certain category of medications called proton pump inhibitors are the main tool used to markedly reduce stomach acid and considered as best GERD treatment. These include Prilosec or Zegerid (omeprazole), Prevacid (lansoprazole), AcipHex (rabeprazole), Protonix (pantoprazole) and Nexium (esomeprazole) taken once or twice a day. All of these are equally effective despite some deceptive advertising. Other acid reducing drugs such as Zantac, Pepcid, Axid, and Tagamet are also available. Reglan (metoclopramide) is a drug that can strengthen the LES.
Certain patients with GERD may need surgery as latest treatment for GERD that strengthen the LES. This type of surgery is called fundoplication. It is now done by laparoscopy.
If you are facing any of the symptoms of GERD, consult our board certified physician in Riverdale NJ.
