Gastroesphageal Reflux Disease

What is Gastroesphageal Reflux Disease (GERD)?
This condition is also referred to as “heartburn” or acid regurgitation. Your stomach contains strong acids that may not always stay in your stomach. When you experience gastroesphageal reflux, acid is backed up, or refluxed, into your esophagus. Your esophagus was not made to handle these acids, and therefore will produce a burning feeling that is commonly referred to as acid indigestion. You may also feel a strange taste in the back of your mouth. Acid reflux is the problem; heartburn is the symptom of the problem.

Gastroesophageal reflux is a common problem that many Americans face. If it happens often (e.g. more than twice a week) then you may be diagnosed with a chronic condition called Gastroesphageal Reflux Disease (GERD).

What are the symptoms of GERD?
The most common symptom that everyone with acid reflux will experience is heartburn. Heartburn is that “burning sensation” feeling that is typically felt in the middle of your chest all the way up to your throat.

Other common symptoms of acid reflux include:
  • Dry coughing
  • Wheezing
  • Asthma
  • Nausea & Vomiting
  • Sore throat – can lead to laryngitis, which is a swollen voice box
  • Trouble with swallowing
  • Enamel erosion caused by the acid eating away at your teeth
  • Bad breath
  • Abdominal pain
What causes GERD?
Gastroesphageal reflux can be intermittent or chronic (i.e. constant or frequently). In intermittent cases, certain foods or drinks cause acid reflux. Foods that take a while to digest cause your stomach to produce more acid to help break your food down. Such foods include high fat meats and fried, fatty foods such as pizza.

Foods that are high in acidity are also triggers of acid reflux. These include oranges, lemons, tomatoes, and marinara sauce. Certain beverages have also been identified in causing increased episodes of acid reflux and they include alcohol, coffee, and tea. Dairy products are also known to cause episodes of acid reflux for some individuals.

Certain beverages have been identified in increased episodes of acid reflux and they include alcohol, coffee, and tea.

Dairy products are also known to cause episodes of acid reflux for some.

In chronic cases, typically a patient’s lower-esophageal sphincter (LES) is the problem. This involuntary muscle is responsible for keeping your stomach acids where they belong – in the stomach. When it becomes weakened or laxed, it will be easier for acid to shoot up or reflux into your esophagus.

In some cases, patients have a hiatal hernia. This is a condition in which the upper part of your stomach shifts upwards past the diaphragm, allowing acid to reflux into your esophagus. It’s worth noting that even though people may suffer from a hiatal hernia, they may not feel any symptoms.

There are other factors that play a role in gastroesphageal reflux. If you are pregnant, obese, or a smoker, then you have a higher chance of developing GERD. Certain medications can also contribute to gastroesphageal reflux such as painkillers and specific antidepressants.

Eating late in the evening or just before sleeping can help stomach contents overcome the LES muscle, which can produce episodes of acid reflux. These episodes typically occur at night and can cause nighttime coughing or asthma.

How is GERD diagnosed?
Dr. Khorrami will ask you questions pertaining to your lifestyle and may use certain tests to aid in the diagnosis. Such tests include:
    Esophageal pH monitoring
    This test is very accurate in diagnosing acid reflux as it measures the acid levels in your esophagus as you eat and sleep. This test is most useful when combined with a carefully kept diary of when, what, and how much food the person eats and GERD symptoms that result. The test can document correlations between symptoms and certain foods or times of day.

    Upper GI series
    This test allows Dr. Khorrami to evaluate the upper part of your digestive system including your stomach and esophagus to look for any abnormalities.

    Upper Endoscopy
    This is a procedure that involves a small flexible tube with a camera to view your esophagus and stomach. After the person receives sedation, Dr. Khorrami carefully feeds an endoscope through the mouth and down the esophagus, then into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. Dr. Khorrami uses the endoscope to take a biopsy, a procedure that involves taking a small piece of esophageal tissue.

    Esophageal manometry
    Esophageal manometry measures muscle contractions in the esophagus. Dr. Khorrami may order this office procedure when considering a person for anti-reflux surgery. A person may receive an anesthetic spray on the back of the throat. The gastroenterologist then passes a soft, thin tube through the person’s nose into the stomach. The person swallows as the gastroenterologist guides the tube slowly back into the esophagus. A computer measures and records the pressure of the muscle contractions in different parts of the esophagus.
How is GERD treated?
Patients with chronic acid reflux problems (GERD) will find relief through lifestyle changes and medications. Surgery is only recommended in cases where a patient is not responding well to lifestyle changes or prescribed medications.

Lifestyle changes include losing weight, avoiding known “triggers” of acid reflux, wearing clothes that are not tight, sleeping slightly upright by raising the head of your bed, and quitting smoking.

There are many medications that are used to treat GERD and they include:
    Antacids are effective in intermittent cases of reflux to relieve heartburn. They can be purchased over-the-counter. Common antacids include Tums, Rolaids, Mylanta, and Alka-Seltzer.

    H2 blockers
    Histamine 2 blockers, or "H2 blockers", are medications that work by lowering your stomach acid production and provide longer relief than antacids. Common H2 blockers include Zantac, Pepcid AC, and Tagamet.

    Proton pump inhibitors, or "PPIs", are the strongest acid blocking medications and are more effective than both H2 blockers and antacids in treating acid reflux for long-term results.

    This medication reduces acid reflux by helping the stomach empty its contents faster, but may come with undesirable side effects.

    There are a few special surgeries that are performed when your body does not respond well to lifestyle changes or medications. They include fundoplication endoscopic sewing, and radiofrequency ablation.

    Fundoplication is a surgery in which the top of your stomach is sewn around the esophagus to add pressure to the lower end, which reduces the chance of acid reflux occurring. Endoscopic sewing aims at tightening the LES muscle in a similar way as surgical fundoplication. Radiofrequency ablation aims at tightening the LES by creating heat lesions.
What are the long-term complications of GERD?
If you continue to let stomach acid eat away at the lining of your esophagus, then you risk developing esophagitis, Barrett’s esophagus, strictures, or problems with your respiratory system.

Esophagitis is when your esophagus becomes irritated and inflamed. Your esophagus will bleed and in some cases you may develop an ulcer.

Barrett’s esophagus occurs when the lining of your esophagus starts resembling the lining of your intestines. Barrett’s esophagus has a very small chance of developing into esophageal cancer.

An esophageal stricture is when your esophagus narrows, leading to trouble with swallowing.

It is important to gain control of your GERD symptoms to prevent more serious conditions from occurring.

Eating, Diet, and Nutrition
You can reduce or prevent episodes of GERD from occurring by avoiding foods that trigger your symptoms. You may also reduce symptoms by eating five or six smaller meals a day, instead of three large meals. Staying active and maintaining a healthy weight may also reduce your GERD symptoms.

Discuss Your Options with Dr. Khorrami
Dr. Khorrami has been in practice since 1996 as a double-board certified gastroenterologist, has experienced a variety of patient cases, and is well equipped to solve your digestive problems. It’s important to control your stomach acid in order prevent more serious diseases from developing. Get in touch to learn more about gastroesophageal reflux and how you can fix and prevent it.

Source contains material from the National Digestive Diseases Information Clearinghouse (NDDIC).


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About Dr. Khorrami

Dr. Payman Khorrami is a UCLA graduate, has been in practice since 1996, and is double board certified. Undergraduate Education at University of California, Berkeley, Medical School at University of California, San Francisco, Internal Medicine Training at University of California, San Diego Read Full Bio