Gastroesophageal Reflux Disease
- reflux esophagitis
Gastroesophageal reflux disease (GERD) is a condition in which stomach contents, particularly acid, splash up into the esophagus. The esophagus is a narrow, muscular tube that carries food from the mouth to the stomach.
What is going on in the body?
The esophagus is separated from the stomach by a muscular ring called the esophageal sphincter. Normally, this muscle opens to allow food to pass into the stomach, then closes to keep the acidic stomach contents from backing up into the esophagus. If this sphincter weakens or relaxes, the contents of the stomach splash back up into the esophagus. This splashing is known as gastroesophageal reflux. The esophagus is hurt by the repeated burning of the misplaced acid.
What are the causes and risks of the disease?
GERD can be caused by a weak or abnormally functioning esophageal sphincter. A hiatal hernia may be associated with GERD. Hiatal hernia is a condition in which the stomach pushes up into the diaphragm muscle. When this happens, the esophageal sphincter does not work properly and does not create enough pressure to close the opening between the esophagus and stomach. As a result, the fluid can easily leak back into the esophagus.
Factors that make GERD worse include the following:
- being overweight or obese
- a stomach that doesn't empty normally (called gastroparesis)
- being pregnant
- drinking alcohol or caffeine
- drinking carbonated beverages or fruit juice
- eating chocolate or peppermint
- eating fatty or spicy foods
- eating large meals
- lying down or bending over after a meal
- medications, such as inhalers for lung disease that contain anticholinergics or beta-agonists, calcium channel blockers, diazepam, estrogens, narcotics, prgesterone, or theophylline
- smoking or using smokeless tobacco products
What can be done to prevent the disease?
Usually there is no way to prevent gastroesophageal reflux unless it has come about because of weight gain. Once it develops, symptoms can be minimized with the treatments outlined below.
How is the disease diagnosed?
The diagnosis of GERD begins with a medical history and physical examination. Usually the combination of symptoms reviewed above lead to an accurate diagnosis. The healthcare provider may order an esophagoscopy. A thin tube with a light and camera attached to it is passed down into the esophagus. This allows a doctor to look at the inside lining of the esophagus directly through the endoscope.
Small monitors can be dropped into the stomach to monitor the acid level in the esophagus (by measuring pH). Long term symptoms or so-called "alarm" symptoms from GERD (vomiting, weight loss, age greater than 55 years, blood loss or anemia, and trouble swallowing) necessitate endoscopy and biopsy of the esophagus. Some people with GERD develop irritation of the esophagus that may lead to change in the lining called "Barrett's esophagus," a potentially precancerous condition.
Long Term Effects
What are the long-term effects of the disease?
Most GERD sufferers have frequent, severe heartburn. This tears down and damages the cell wall lining of the esophagus. Without treatment, GERD can lead to the following conditions:
- Barrett's esophagus, a precancerous change in the cells lining the esophagus
- esophageal cancer
- esophageal stricture or narrowing from scarring of the esophagus that interferes with eating
- esophageal ulcers, which damage the lining further
- esophagitis, or inflammation of the esophagitis with or without bleeding
What are the risks to others?
GERD is not contagious and poses no risk to others. Some families have a tendency towards Barrett's esophagus when they have GERD.
What are the treatments for the disease?
People with GERD can minimize symptoms by taking the following steps:
- Not eating food within three hours of bedtime.
- Avoiding fatty or spicy foods, especially in the evening.
- Not smoking or using smokeless tobacco products.
- Limiting or stopping caffeine intake.
- Limiting or stopping intake of alcohol
- Managing weight to avoid obesity.
- Sleeping with the head of the bed elevated.
- Staying upright after eating.
- Taking medications for osteoporosis (the bisphophonates) in the morning with a lot of water and not lying down for 30 minutes afterward.
Some of the common medical and surgical treatments for GERD include the following:
- proton-pump inhibitors (PPIs), such as esomeprazole (i.e., Nexium), omeprazole (i.e., Prilosec), lansoprazole (i.e., Prevacid), or rabeprazole (i.e., Aciphex)
- H2 blockers, such as cimetidine (i.e., Tagamet), nizatidine (i.e., Axid), ranitidine (i.e., Zantac), and famotidine (i.e., Fluxid) are all used much less often since proton pump inhibitors were introduced
- gastrointestinal (GI) stimulants that empty the stomach faster, such as metoclopramide (i.e., Reglan) are used infrequently
- fundoplication or other surgical procedures that strengthen the esophageal sphincter
A surgical procedure known as dilation may be done with an endoscope to correct an esophageal stricture (scar tissue resulting from acid and blocking the esophagus). The healthcare provider passes a series of dilators down the esophagus. The dilators gently stretch the narrowed opening apart.
What are the side effects of the treatments?
Medications used to treat GERD (especially the PPIs) have few significant side effects. Surgery can be complicated by bleeding, infection, and an adverse reaction to the anesthetic.
What happens after treatment for the disease?
The medical treatment of GERD is usually lifelong and may include repeated so-called surveillance endoscopies with biopsies to avoid complications such as Barrett's esophagus, cancer, or stricture. Surgery can sometimes cure symptoms of GERD.
How is the disease monitored?
Any new or worsening symptoms should be reported to the healthcare provider, especially alarm symptoms in people who have GERD.