GERD

When you have GERD (chronic acid reflux) your stomach acid persistently flows back up into your mouth through your esophagus. You may experience heartburn, acid indigestion, trouble swallowing, feeling of food caught in your throat and other problems.

Causes #

Factors that can lead to this include:

• Too much pressure on the abdomen - Some pregnant women experience heartburn almost daily because of this increased pressure.

• Particular types of food (for example, dairy, spicy or fried foods) and eating habits.

• Medications that include medicines for asthma, high blood pressure and allergies, as well as painkillers, sedatives and anti-depressants.

• A hiatal hernia - The upper part of the stomach bulges into the diaphragm, getting in the way of normal intake of food.

Symptoms #

• Heartburn.

• Regurgitation (food comes back into your mouth from the esophagus).

• The feeling of food caught in your throat.

• Coughing.

• Chest pain.

• Problem swallowing.

• Vomiting.

• Sore throat and hoarseness.

Infants and children can experience similar symptoms of GERD, as well as:

• Frequent small vomiting episodes.

• Excessive crying, not wanting to eat (in babies and infants).

• Other respiratory (breathing) difficulties.

• Frequent sour taste of acid, especially when lying down.

• Hoarse throat.

• Feeling of choking that may wake the child up.

• Bad breath.

• Difficulty sleeping after eating, especially in infants.

Diagnosis #

GERD diagnosis include the following

• Upper gastrointestinal GI endoscopy and biopsy: Your provider feeds an endoscope (a long tube with a light attached) through your mouth and throat to look at the lining of your upper GI tract (esophagus and stomach and duodenum). The provider also cuts out a small bit of tissue (biopsy) to examine for GERD or other problems.

• Upper GI series: X-rays of your upper GI tract show any problems related to GERD. You drink barium, a liquid that moves through your tract as the X-ray tech takes pictures.

• Esophageal pH and impedance monitoring and Bravo wireless esophageal pH monitoring: These tests both measure the pH levels in your esophagus. Your provider inserts a thin tube through your nose or mouth into your stomach. Then you are sent home with a monitor that measures and records your pH as you go about your normal eating and sleeping. You’ll wear the esophageal pH and impedance monitor for 24 hours while the Bravo system is worn for 48 hours.

• Esophageal manometry: A manometry tests the functionality of lower esophageal sphincter and esophageal muscles to move food normally from the esophagus to the stomach. Your provider inserts a small flexible tube with sensors into your nose. These sensors measure the strength of your sphincter, muscles and spasms as you swallow.

Prevention #

• Achieve and maintain a healthy weight.

• Eat small, frequent meals rather than huge amounts a few times a day.

• Reduce fat by decreasing the amount of butter, oils, salad dressings, gravy, fatty meats and full-fat dairy products such as sour cream, cheese and whole milk.

• Sit upright while eating and stay upright (sitting or standing) for 45 to 60 minutes afterward.

• Avoid eating before bedtime. Wait at least three hours after eating to go to bed.

• Try not to wear clothes that are tight in the belly area. They can squeeze your stomach and push acid up into the esophagus.

• When sleeping, raise the head of the bed 6 to 8 inches, using wooden blocks under the bedposts. Extra pillows don’t work.

• Stop smoking.

• Your healthcare provider may prescribe acid-reducing medications. Be sure to take them as directed.

• Cut out possible trigger foods.

Treatment #

The most common GERD medications:

• Antacids (provide quick relief by neutralizing stomach acids) include Tums, Rolaids, Mylanta, Riopan and Maalox.

• H-2 receptor blockers (which decrease acid production) include Tagamet, Pepcid AC, Axid AR and Zantac.

• Proton pump inhibitors (stronger acid blockers that also help heal damaged esophagus tissue) include Prevacid, Prilosec, Zegerid, Nexium, Protonix, AcipHex and Dexilant.

• Baclofen is a prescription drug used to reduce the relaxation of the lower esophageal sphincter which allows acid backwash.

GERD is usually controlled with medications and lifestyle changes (like eating habits). If these don’t work, or if you can’t take medications for an extended period, surgery may be a solution.

Laparoscopic antireflux surgery (or Nissen fundoplication) is the standard surgical treatment #

It’s a minimally invasive procedure that fixes your acid reflux by creating a new valve mechanism at the bottom of your esophagus. The surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so food won’t reflux back into the esophagus.

LINX device implantation is another minimally invasive surgery #

A LINX device is a ring of tiny magnets that are strong enough to keep the junction between the stomach and esophagus closed to refluxing acid but weak enough to allow food to pass through.