Gastroesophageal Reflux Disease (GERD)

Over 60 million Americans have gastroesophageal reflux disease, or GERD. GERD is a condition in which the acidic juices in the stomach splash back into the esophagus (acid reflux) and irritate the esophageal lining.

Normally, swallowed food travels through the mouth, down the esophagus, and through the bottom of the esophagus called the lower esophageal sphincter (LES) into the stomach. The LES acts as a one-way valve so that food may enter into the stomach but not come back up. GERD occurs when the LES is too relaxed and does not prevent stomach acid and food from backing up into the esophagus. Unlike the stomach’s lining, the esophagus is not protected from stomach acid. Contact may irritate the esophageal tissue, leading to GERD symptoms.

What are GERD symptoms?

  • Heartburn
  • Acid regurgitation, or the sensation that acid and food contents within the stomach is backing up into the esophagus and at times, even into the mouth, causing a bitter or sour taste
  • Hoarse or scratchy voice
  • Coughing
  • Certain types of asthma
  • Sinus problems
  • Tooth enamel erosions
  • Difficulty swallowing or food becoming stuck in the esophagus

Are there complications from long-term GERD?

The main gastrointestinal complications related to long-term GERD include:

  • Barrett’s esophagus is a precancerous condition in which normal tissue lining the esophagus changes to resemble tissue lining the intestine. Individuals with Barrett’s esophagus should undergo regular endoscopies for cancer screening.
  • Swallowing problems often include painful swallowing and/or the sensation of liquid or solid food getting stuck in or passing slowly through the esophagus.

How is GERD diagnosed?

San Bernardino Gastroenterology Associates uses a variety of tests to diagnose GERD:

  • Upper endoscopy or EGD (esophagogastroduodenoscopy): A small lighted tube is passed through the mouth into the esophagus, stomach, and first portion of the small intestine. This allows the doctor to examine the lining of the upper GI tract, where a tissue sample may be taken if needed.
  • Barium swallow and/or an Upper GI X-ray: A patient drinks barium, which coats the esophagus, stomach, and first portion of the small intestine. An x-ray then lets the doctor examine the lining and structures of these areas. Sometimes a special x-ray video may be used to record the action of swallowing.
  • A Bravo capsule (a small sensor) is placed in the lower esophagus via EGD or through the mouth. The device records acid events over a 48-hour period, measuring how often acid backs up into the esophagus and how long it stays there. Alternatively, patients may undergo a pH monitoring test in which a thin tube is placed through the nose and into the esophagus. The tube remains in place recording information for 24 hours.
  • Manometry: A thin tube is placed through the nose into the esophagus for a short period of time, during which the patient is instructed to swallow, drink, and/or cough. Sensors in the tube measure esophagus pressure to show the strength and coordination of a swallow.

How is GERD treated?

Before any other GERD treatments, your GI doctor will likely recommend lifestyle changes.

LIFESTYLE CHANGES

  • Avoid fatty foods, chocolate, caffeine, spicy foods, and peppermint, which aggravate reflux.
  • Avoid alcohol, caffeinated drinks, and tobacco.
  • Lose weight, as being overweight increases your risk for reflux.
  • Sleep with the head of the bed elevated to prevent the acid in your stomach from flowing up into the esophagus.
  • Don't lie down for 3 hours after eating.
  • Take all medicines with plenty of water.

If these are unsuccessful, other treatment options include medications, endoscopic esophagus treatment, and surgery.

MEDICATIONS:

  • Proton pump inhibitors that reduce the production of stomach acid
  • Antacids to neutralize stomach acid
  • H2 blockers that lessen the release of stomach acid

SURGERY:

Surgery may be an option for those do not see results with lifestyle changes or medication, or as an alternative for those looking to eliminate or reduce medication.

  • Nissen Fundoplication: A procedure to treat GERD and hiatal hernia, during which the upper portion of the stomach is wrapped around the lower portion of the esophagus (the esophageal sphincter, or LES) to reinforce the LES and prevent reflux.
  • LINX device: The LINX System is a small flexible band of interlinked magnetic beads placed around the LES during surgery. This band is designed so that swallowing temporarily breaks the magnetic bond, allowing food and liquid to pass normally into the stomach. Immediately after, the magnetic attraction between the beads closes the LES, restoring the body's natural barrier to reflux.