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The media is full of mentions of gastroesophageal reflux disease, or GERD, but many people are unfamiliar with the specifics of this condition. When food is swallowed, it passes down the esophagus into the stomach. At the lower end of the espohagus is a muscular valve called the lower esophageal sphincter. This muscular sphincter allows food to pass into the stomach from the esophagus and helps prevent food and stomach contents from flowing backward into the esophagus. Sometimes this sphincter does not close as well as it should, and/or it opens a little too often. When this happens, acid and contents from the stomach flow back into the esophagus. Although most of us experience this from time-to-time, when it happens on a regular basis (weekly or daily), we refer to this as gastroesophageal reflux disease. This causes "heartburn" - that burning sensation in the throat and chest that is frequently associated with a bitter, acidic taste in the mouth. But there are other symptoms of chronic reflux disease. These include frequent belching, a chronic dry cough, chronic sore throat, hoarseness, bad breath, gum inflammation, erosion of tooth enamel, and chest pain. It should be noted that not everyone with GERD will have heartburn. And there are many other causes for these same symptoms.
Is GERD merely an annoyance, or is it serious? Actually, it is both. While GERD can interfere with sleeping, eating, and just feeling well, it can also lead to much more serious problems if left untreated. GERD can lead to esophagitis, esophageal bleeding, strictures and esophageal cancer. When acid from the stomach comes into repeated contact with the esohagus, this causes irritation and inflammation of the esophagus. Over time, the lining of the esophagus can begin to erode, bleed and form ulcers. Chronic exposure to acid from the stomach can also lead to changes in structure of the cells lining the esophagus. This in turn can lead to a specific type of esophageal cancer.
The definite cause is unknown, but we do know things that make people prone to GERD and may worsen symptoms. Smoking and alcohol use both increase acid production as well as decrease the functioning of the esophageal sphincter. Obesity and poor posture will decrease the tone of the esophageal sphincter. Diet plays an important factor as well. Fatty and fried foods, onions, spicy foods, caffeine, and acidic foods such as citrus fruit and tomatoes, will all increase the acidity of the stomach contents. Eating large portions and eating late at night prior to going to bed will increase the pressure on the lower esophageal sphincter. And certain medical conditions may predispose people to GERD. These include hiatal hernias, pregnancy and diabetes. Some medications may exacerbate symptoms, such as calcium channel blockers (a type of blood pressure/ heart medication), theophylline, nitrates and antihistamines. Benefits of these medications must be weighed against potential risks.
Typically, diagnosis is made by symptoms alone. However, for various reasons, your physician may want to order certain tests to evaluate the esophagus. During an upper endoscopy a thin, flexible tube is passed (under light sedation) down the esophagus. The tube has a light and camera attached that can visualize the esophagus and photograph it. This method also has the capability of allowing the physician to take biopsies of certain problem areas that are identified. An upper GI series, or barium swallow, is a special x-ray where the patient drinks a chalky liquid that coats the esophagus and stomach. This special coating allows the stomach and esophagus to be seen more easily on x-ray and will typically "outline" certain areas of concern. There are other tests that can monitor the acid level of the stomach and the strength of the esophageal sphincter. Some individuals may require none of these tests, while others, depending on severity of illness, length of illness, and other predisposing risk factors, may need more testing.
Treatment is aimed at reducing symptoms, the amount of stomach acid present in the esophagus, and at preventing damage to the esophagus. This can be accomplished through the use of medications, diet changes and lifestyle modifications (such as stopping smoking, weight loss, wearing less tight-fitting clothes, and reducing stress). Surgery is never used as first line therapy, but it can be useful for people who do not respond to other methods of treatment. It is designed to "tighten up" the lower esophageal sphincter, and is successful in the vast majority of people. If you think that you may be experiencing reflux symptoms on a frequent basis, please discuss this with your doctor. Early and adequate treatment may be able to prevent serious complications in the future.
