ACID REFLUX (GERD)

What is GERD?

GERD is a chronic digestive disorder where stomach acid or bile flows back into the esophagus due to a weak lower esophageal sphincter (LES). This backflow, or reflux, can irritate the lining of the esophagus and cause various symptoms. While heartburn is common in GERD, other symptoms can also occur, making it more than just a heartburn condition.

Factors Contributing to GERD:

• Obesity
• Diet (certain foods and beverages)
• Age
• Smoking
• Medications (e.g., nitrates, antihistamines, NSAIDs)
  
  
  

Symptoms of GERD:

GERD presents with a wide range of symptoms beyond heartburn. Symptoms can include:

• Regurgitation
• Hoarseness / Voice Changes
• Epigastric Pain (upper stomach discomfort)
• Chest Pain
• Cough or Sore Throat
• Difficulty Swallowing or feeling of choking
• Weight Loss
• Bitter / Bile Taste
• Asthma-like Symptoms
• Recurrent Pneumonia, Bronchitis
• Dental Problems (due to acid damage)
• Bad Breath
• Excessive Belching
• “Lump” Sensation in the Throat
• Nausea or Vomiting
  
  
  

Impact on Patients’ Lives:

• Poor Quality of Sleep: Reflux symptoms can disrupt rest.
• Reduced Work Productivity: Symptoms can interfere with daily tasks.
• Dietary Compromises: To avoid symptoms, patients often modify their diet significantly.
• Long-term Concerns: Patients may worry about the long-term effects of GERD or the need for lifelong medication use.
  
  
  

Diagnostic Tests for GERD:

1. Upper Endoscopy (EGD): Visualizes the esophagus and stomach to check for damage or complications.
2. Barium Esophagram (Upper GI Series): A special X-ray to assess swallowing and esophageal function.
3. Esophageal Manometry: Measures the pressure and muscle contractions in the esophagus.
4. pH Monitoring: Measures acid levels in the esophagus over 24 hours.
   
   
   

Treatment Options for GERD:

• Lifestyle Changes:
  • Avoid Trigger Foods: Certain foods can aggravate symptoms.
  • Weight Loss: Reducing excess weight can decrease pressure on the stomach.
  • Quit Smoking: Smoking weakens the LES, worsening reflux.
  • Meal Timing: Avoid eating less than three hours before bed to reduce nighttime reflux.
    
    

• Diet Modifications:
  • Avoid spicy foods, caffeine, fatty foods, tomato-based foods, chocolate, alcohol, and carbonated beverages that can worsen GERD.
    
    

• Pillow/Bed Elevation:
  • Elevating the head of the bed by 6-8 inches can prevent acid from backing up into the esophagus during sleep.
    
    

• Medications for GERD:
  • Proton Pump Inhibitors (PPIs): Reduce stomach acid production. Examples: Nexium, Prevacid, Prilosec, Aciphex, Dexilant.
  • H2 Blockers: Reduce acid production but are less potent than PPIs. Examples: Pepcid, Tagamet, Zantac.
  • Antacids: Neutralize stomach acid to provide quick relief. Examples: Tums, Rolaids, Mylanta, Pepto-Bismol.
    
    

• Surgical Options for GERD:
  • Fundoplication: A surgical procedure that strengthens the LES by wrapping the upper part of the stomach around the lower esophagus to prevent reflux.
  • TIF (Transoral Incisionless Fundoplication): A less invasive procedure to repair the LES and prevent reflux without incisions.
    
    
    

GERD Summary:

GERD is a chronic condition that involves much more than just heartburn. Without treatment, it can lead to serious complications such as:

• • Esophagitis (inflammation of the esophagus)
  • Strictures (narrowing of the esophagus)
  • Barrett’s Esophagus (a precancerous condition)
  • Esophageal Cancer
    
    
    

While medications can relieve symptoms, they do not cure the underlying cause of GERD, prevent reflux, or eliminate the need for long-term treatment. Managing GERD often requires a combination of lifestyle changes, medications, and in some cases, surgery.

It is important to work closely with your healthcare provider to develop a treatment plan that addresses your symptoms and reduces the risk of complications.