Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD), or acid reflux, occurs when the liquid content of the stomach regurgitates or refluxes into the esophagus. The acidic content of the liquid causes inflammation and damage to the lining of the esophagus.

What causes GERD?

The cause of GERD that develops in some people is unknown. A hiatal hernia can cause GERD because it does not allow the diaphragm to keep the acid from rising. Swallowing disorders and abnormally slow emptying of the stomach can also increase the chance of developing GERD. Other risk factors for developing GERD include obesity, pregnancy and smoking. Symptoms can be triggered by spicy foods, caffeine or alcohol.

What are the symptoms of GERD?

The primary symptom of GERD is heartburn, which occurs when acid from the stomach refluxes into the esophagus. Heartburn is felt as a burning pain in the middle of the chest. It can stretch from the abdomen to the neck and can even extend into the back. Heartburn from acid reflux occurs most often after eating or while lying down, when reflux is more likely to occur. Regurgitation, nausea and trouble swallowing are also common symptoms of GERD, while severe cases can cause ulcers, asthma and narrowing of the esophagus.

How is GERD diagnosed?

GERD is usually diagnosed by a treatment trial. Since heartburn is the identifiable symptom, your doctor may prescribe medication to suppress the production of acid in the stomach. If heartburn is relieved or greatly reduced, the diagnosis of GERD is confirmed. The problem with this method is that the symptoms may actually be a result of other conditions, such as an ulcer. Proper diagnostic testing may be done and can include:

Endoscopy - A thin tube with a camera is swallowed and fed to the esophagus, which can be visually examined for inflammation, lesions or breaks in the lining which lead to a confirmed diagnosis of GERD.

Esophageal acid testing – Acid levels within the stomach are measured through the advanced Bravo™ pH Monitoring System, which involves a small capsule that attaches the wall of the esophagus and transmits data to a receiver worn by the patient. There is no catheter involved with this procedure, relieving the discomfort associated with traditional acid testing.

Esophageal motility testing - This test determines how well the muscles of the esophagus are working by inserting a catheter through the nose and into the esophagus with a sensor to measure the pressure of the muscles when they contract.

Upper Gastrointestinal (UGI) Series – This test involves a series of X-rays that detect abnormalities within the GI tract after the patient drinks a mixture of barium and water. This solution travels through the tract and makes the organs easier to see as several X-ray pictures are taken.

How is GERD treated?

While GERD is a chronic condition that cannot be cured, there are plenty of treatment options to reduce the severity and frequency of symptoms. Life changes are one of the simplest yet effective treatment methods for GERD. Some of these changes include:

Keep the upper body slightly elevated while sleeping to utilize the effects of gravity and keep reflux down.
Eat smaller meals and avoid foods known to promote reflux such as chocolate, peppermint and alcohol.
Avoid lying down for 3 hours after a meal.
Stop smoking.

Medications are also helpful in reducing acid production or relieving the muscles that empty your stomach. These medications include antacids, H2 blockers and proton pump inhibitors. Surgery may be recommended for patients that do not respond to medication and other mild treatment. Surgery for GERD involves a procedure called fundoplication, but is commonly known as reflux surgery. This procedure can be performed laparoscopically and is successful in repairing any complications from a hiatal hernia, making an artificial lower esophageal sphincter or tightening an opening in the diaphragm.

Gastric Volvulus?

Gastric volvulus involves the stomach twisting upon itself, usually as a result of hiatal hernia or other defects in the diaphragm. This rare condition causes severe abdominal pain, retching and the inability to swallow food.

This condition can be diagnosed through an X-ray, CT scan or through endoscopy. Once diagnosed, most cases of gastric volvulus should be treated as an emergency, and surgery is performed to try to relieve the obstruction in the stomach. This is done laparoscopically.