Gastroesophageal Reflux Disease (GERD)
“Fifty percent of people at some point in their lifetime experience symptoms of reflux, and 10 to 15 percent of the population have significant reflux disease.”
Dr. Christopher Hurley
Gastroesophageal reflux disease occurs when stomach acid flows into the esophagus. In many cases, it is because the lower esophageal sphincter, the muscle between the esophagus and stomach, relaxes. The patient can experience ulcers and inflammation in the esophagus. If left untreated, it could lead to Barrett’s esophagus, a precursor to esophageal cancer.
GERD symptoms include difficulty swallowing, frequent heartburn and indigestion. Less common symptoms include chronic cough, frequent throat-clearing, feeling of a lump in the throat, excessive mucus in the throat and chest pain unrelated to the heart.
An esophagogastroduodenoscopy (EGD) is an endoscopy that can diagnose GERD by examining the lining of the esophagus, stomach and a part of the small intestine. An additional tool, a barium X-ray, can determine if reflux activity is happening. Sometimes the patient may be asked to undergo a 24-hour pH impedance test to measure the amount of acid reaching the esophagus. This is done on an outpatient basis.
The first treatment approach aims to reduce the amount of acid; the patient will need to change his or her diet. Next, physicians may turn to medication, such as H2 blockers and proton pump inhibitors (PPIs). PPIs include esomeprazole, lansoprazole and omeprazole, and are safe to use long term.
However, surgery may be recommended because the problem lies with the weakened lower esophageal sphincter and a hiatal hernia, where the stomach is pushed up through the diaphragm to the esophagus. A Nissen fundoplication surgery fixes both of these issues. The upper curve of the stomach is wrapped around the esophagus and sewn into place. The esophagus then passes through a small tunnel of the stomach muscle. As a result, the sphincter is strengthened which stops the flow of acid.