Gastroesophageal Reflux Disease (GERD)

Digestive Diseases

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Gastroesophageal reflux disease (GERD) develops when the valve (also known as a "sphincter") that separates the esophagus and the stomach opens spontaneously or does not properly close. As a result, stomach acids flow back up into the esophagus. This causes a burning sensation in the throat or chest and may lead to serious health problems.

Acid reflux irritates the esophagus and, over time, can lead to a narrowing and/or ulceration of the esophagus, Barrett's esophagus, and a slightly increased risk of esophageal cancer.

Symptoms

Symptoms include heartburn, which is a sense of burning in the chest behind the breastbone or in the abdomen especially when bending or lying down. GERD also may cause regurgitation of food, trouble swallowing, hoarseness, coughing, wheezing, sore throat, and asthma.

Risk Factors

Risk factors for GERD include obesity, hiatal hernia, smoking, pregnancy, and diabetes. Eating large meals, lying down right after eating, spicy foods, alcohol, chocolate, caffeine, tomato sauce, onions, and carbonated beverages may worsen GERD.

Diagnosis

GERD is initially diagnosed by symptoms and a patient's response to a class of drugs called proton pump inhibitors, which reduce the stomach's production of acid.

Complicated cases of GERD may require endoscopy, in which a thin, flexible tube equipped with a light and camera is inserted through the mouth and into the throat to view the esophagus and stomach and determine if there is inflammation or an ulcer. A tissue sample can be taken to test for Barrett's esophagus, a precancerous condition in which cells in the esophagus become abnormal.

Treatment

Physicians will usually begin by prescribing long-acting, prescription-strength proton pump inhibitors to suppress the production of stomach acid. Other medications used include H2-receptor blockers, which also reduce acid production, and prokinetic drugs, which help the stomach empty faster and may tighten the lower esophageal sphincter – the muscular valve between the esophagus and stomach.

People who do not respond to medication may require a surgery called fundoplication, which involves making a small incision in the abdomen and tightening the lower esophageal sphincter with sutures to prevent reflux.