Gastroesophageal reflux disease, or GERD, as it is often referred to by health professionals, is a widespread problem in the Western world. According to the October 16, 2008 issue of the "New England Journal of Medicine," approximately 14 to 20 percent of adults in the U.S. are affected.
How It Occurs
The esophagus is a tube that connects the mouth to the stomach. Food or drink, once swallowed, travels down the esophagus and on entering the stomach, is broken down by acid. Acid is prevented from flowing or refluxing back into the esophagus by the lower esophageal sphincter, or LES, a thick band of muscle that encircles the lower esophagus. Anything that lowers the pressure of the LES and causes it to relax can cause acid to reflux back into the esophagus and cause irritation, leading to symptoms of gastroesophageal reflux.
When symptoms occur more than twice a week, the condition is termed gastroesophageal reflux disease or GERD.
Causes
Substances that lower LES pressure include coffee, alcohol, chocolate, spicy food, fried food, medications and smoking. Other causes of GERD include hiatal hernia, obesity and pregnancy.
Symptoms
Common symptoms of acid gastroesophageal reflux include heartburn, a burning sensation in the chest, felt after eating or drinking; regurgitation, in which the patient spits up swallowed food or fluid and difficulty swallowing, also referred to as dysphagia. Less common symptoms include coughing, hoarseness and chest pain similar to a heart attack.
Diagnosis
When typical symptoms of GERD are present, the patient may be treated with medication without the need for diagnostic tests. When unusual symptoms are present, or if the patient does not respond to medication, an endoscopy is usually carried out. This involves the insertion of a thin tube into the esophagus where the area can viewed by means of a tiny camera and biopsies can be taken. A biopsy involves the removal of a small core of tissue and examination under the microscope by a pathologist.
Medical Treatment
Most cases of GERD can be treated effectively with both lifestyle changes and medication. Lifestyle modifications include weight loss, avoidance of triggering substances, elevating the head of the bed with pillows, avoiding lying down immediately after meals and eating small, frequent meals.
Medications include over-the-counter antacids, such as Maalox, which neutralize the acid contents of the stomach; histamine-receptor blockers, such as ranitidine, sold as Zantac, which reduce acid production and proton-pump inhibitors, such a lansoprazole, sold as Prevacid, which block the secretion of acid in the stomach.
Surgical Treatment
In those cases where lifestyle modifications and medications are ineffective, or when the prospect of taking long-term medication is unacceptable to the patient, surgery may be an option.
The procedure is known as Nissen fundoplication and involves wrapping the upper portion of the stomach around the lower esophagus, forming a sphincter-like band.
It is important to weigh the benefits of surgery against the risks, as this procedure is itself associated with complications, including the need for repeat surgery, increased flatulence and increased bowel symptoms.
Complications
It is important to adequately treat GERD. If untreated, GERD may lead to esophagitis, where the esophagus becomes inflamed due to the damage inflicted by the acid from the stomach. Esophagitis may eventually lead to Barrett esophagus, a serious precancerous condition that may progress to cancer.
