GERD (Gastroesophageal reflux disease)

Gastroesophageal reflux disease (GERD) is diagnosed in people who persistently suffer the effects of stomach contents rising up into the esophagus (the tube that carries food from the mouth to the stomach).

At the point where the esophagus meets the stomach, a ring-like muscle called the lower esophageal sphincter (LES) acts like a valve that opens to allow food to pass through and closes to keep stomach contents out. When the LES opens spontaneously, for varying periods of time, or does not close properly, stomach contents including digestive juices (called acids) flow back (reflux) into the esophagus causing irritation. This is known as gastroesophageal reflux (GER).

GER is a common occurrence that can cause a burning sensation in the chest or throat when refluxed stomach acid touches the lining of the esophagus. This is called heartburn or acid indigestion. Lifestyle changes and over-the-counter medications usually manage GER.

When GER persistently occurs more than twice per week, it is considered GERD. GERD can eventually lead to more serious health problems including erosion of the esophagus. People of all ages can have GERD.

Symptoms

The main symptom of GERD in adults is frequent heartburn - a burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. The burning sensation may spread to the throat and there may also be regurgitation of food or sour liquid (acid reflux).

Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing. There may also be a sensation of a lump in the throat, a sore throat or hoarseness.

Immediate medical attention should be sought if you experience chest pain, especially when accompanied by other signs and symptoms such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack.

If you are experiencing symptoms of GERD or find yourself turning to over-the-counter medications for heartburn more than twice per week, see your primary care physician or gastroenterologist for a complete diagnosis.

Prevention

The reason some people develop GERD is still unclear, but some risk factors exist. These include obesity, the presence of a hiatal hernia, pregnancy and smoking.

Common foods that can worsen reflux symptoms include citrus fruits, chocolate, drinks with caffeine or alcohol, fried or fatty foods, garlic and onions, mint flavorings, spicy foods and tomato-based foods like spaghetti sauce or chili.

Treatment

Lifestyle changes

Treatment of GERD can begin with lifestyle changes that include quitting smoking, losing weight if needed and avoiding foods and beverages that worsen symptoms. Eating small, frequent meals, wearing loose-fitting clothing and avoiding lying down for three hours after a meal may help. Raising the head of your bed 6-8 inches may also help.

Medication

Over-the counter medications that neutralize stomach acid, reduce acid production or block acid production and heal the esophagus are usually the first step in treating GERD. If these don't seem to be helping after a few weeks, prescription-strength medications may be tried. A combination of medications may be tried to increase effectiveness.

Surgery

When lifestyle changes and medication do not control GERD, surgery may be an option. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

The standard surgical treatment for GERD is called fundoplication. A specific type of this procedure, called Nissen fundoplication, is usually performed. During the procedure, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux and repair a hiatal hernia if one is present.

Today, the Nissen fundoplication may be performed using a minimally-invasive or laparoscopic approach. A laparoscope is an instrument that is inserted through tiny incisions in the abdomen. The doctor then uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, the laparoscopic procedure is safe and effective in people of all ages, including infants.

As opposed to open surgery which requires a large incision and several days in the hospital, laparoscopic surgery requires a shorter hospital stay, usually only a day or two. There is less pain after surgery because there is no large incision to heal. Most people are able to get back to their normal routine in about two to three weeks instead of the four to six weeks of recovery open surgery requires.

Surgical procedures to treat GERD can sometimes also be performed using endoscopic techniques. An endoscope is a flexible tube with a small camera that is inserted down the patient's throat. These techniques involve putting stitches in the LES to create pleats that help strengthen the muscle or using electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps toughen the muscle. The longterm effects of these procedures are unknown.

The information provided on these educational pages is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. And, if experiencing a medical emergency call 9-1-1.

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