Gastroesophageal Reflux Disease (GERD)
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you contact your doctor about your specific condition.
Gastroesophageal reflux disease (GERD) is a condition in which there is excessive flow of the contents of the stomach up into the esophagus. The esophagus is the tube but carries food from the back of the mouth down into the stomach, which is the hollow organ where the meal is stored, ground up into a liquid, and begins to be digested. There is a valve between the esophagus and stomach called the lower esophageal sphincter (LES). When this valve does not work properly, gastroesophageal reflux disease occurs.
Symptoms of Gastroesophageal Reflux Disease
The most common sensations caused by gastroesophageal reflux disease (GERD) are heartburn (a burning sensation in the chest) and regurgitation (a sensation of material coming up into the chest and throat, or even the mouth). Gastroesophageal reflux may also cause a sore or full feeling in the throat, hoarseness, cough, asthma, wheezing, chest pain, bad breath, a full feeling in the chest, or nausea. The large portion of the population has occasional heartburn or regurgitation. It is only when these symptoms are frequent and/or very bothersome that a doctor needs to be seen.
Causes of Gastroesophageal Reflux Disease
The immediate cause of gastroesophageal reflux disease (GERD) is impaired function of the valve between the stomach and the esophagus, the lower esophageal sphincter (LES), which normally prevents acid from backing up from the stomach. The valve does not work well when its muscle is weak or relaxes too frequently or when there is a hiatal hernia. Factors that contribute to gastroesophageal reflux disease (GERD) are obesity, tight garments, pregnancy, alcohol use, smoking, eating soon before going to sleep, certain medications, and consumption of food such as chocolate, fatty or fried foods, peppermint, or carbonated beverages. Some people are also sensitive to acidic foods such as citrus drinks, tomato-containing foods, or coffee.
A hiatal hernia is a condition in which part of the stomach, which normally is located in the abdomen, bulges above the diaphragm muscle into the chest. The diaphragm is a large sheet of muscle that separates the chest from the abdomen and is involved in breathing. There is a small gap in the diaphragm through which the esophagus passes from the chest into the abdomen. If this gap, called the hiatus, is too large, it allows the stomach to bulge above the diaphragm into the chest. When a hiatal hernia is present, it may weaken the function of the valve (lower esophageal sphincter) between the stomach and the esophagus and cause gastroesophageal reflux to occur. Hiatal hernias are very common and do not always cause gastroesophageal reflux (GERD). The hiatal hernia itself is usually not treated; the gastroesophageal reflux is what needs to be treated.
Diagnosis of Gastroesophageal Reflux Disease
Special diagnostic tests are not always necessary prior to starting treatment for gastroesophageal reflux disease (GERD), especially if there are typical symptoms such as heartburn or regurgitation. However, a doctor should be seen and tests should be done if the symptoms do not respond well to home treatments, if they are very frequent or severe, if medicine as needed for more than 2 weeks at a time, or if there are additional symptoms such as weight loss, difficulty swallowing, internal bleeding, or chest pain when swallowing food. If diagnostic testing is needed, then an upper GI endoscopy (EGD) is often the first test that is performed; it allows the doctor to detect any injury or pre-cancerous changes (Barrett’s esophagus) in the inner lining of the esophagus due to GERD. Ambulatory esophageal reflux pH monitoring is also sometimes done to evaluate gastroesophageal reflux disease (GERD). Ambulatory esophageal reflux pH monitoring measures the presence of acid or fluid flowing into the esophagus and its association with symptoms. In patients with chest pain that could be due to heart disease (especially if the pain is related to exertion, difficulty breathing, or heavy sweating), an evaluation by a cardiologist is the first priority.
Gerd Treatment in NYC
Avoiding dietary and lifestyle habits that contribute to gastroesophageal reflux disease (GERD) may help:
- fatty or fried foods
- spicy foods
- large meals
- excess weight gain
- carbonated beverages
- citrus drinks
- tomato-based foods
- eating within 3 hours of bedtime
Elevating the head of the bed so that the chest is higher than the abdomen may help gastroesophageal reflux disease (GERD). You can put 4-6 inch wood blocks under the legs at the head of the bed or obtain a large foam wedge to accomplish this.
Medications for gastroesophageal reflux disease (GERD) can help; Dr. Harary with offices in NYC can prescribe these. Over-the-counter antacids neutralize the acid in the stomach and esophagus; they can be helpful for immediate relief of discomfort, but they only work for a short time. Histamine H2 receptor blockers, such as ranitidine (Zantac and others), famotidine (Pepcid and others), cimetidine (Tagamet), and nizatidine (Axid) decrease acid production in the stomach. These medications help mild reflux symptoms and have few side effects. Lower doses are available over-the-counter, and higher doses require a doctor's prescription. They often need to be taken 2-3 times per day.
The most powerful medications for gastroesophageal reflux disease (GERD) are the proton pump inhibitors (omeprazole, lansoprazole, rabeprazole, pantoprazole, deslansoprazole, and esomeprazole, which go under the brand names of Prilosec, Prevacid, Zegerid, AcipHex, Protonix, Dexilant, and Nexium). These drugs block the production of acid in the stomach; they are taken once or twice a day, less than one hour before a meal. They are quite effective, safe, and have few side effects. There may be an increased risk of side effects if used at high doses or for a long time (more than one year), so decreasing the dose or using milder medications should be attempted once symptoms are controlled or if the higher dose is not helping. If you are stopping or decreasing use of the drug, it should be done under the supervision of your doctor.
Surgery for gastroesophageal reflux disease (GERD) is usually not necessary, but can be considered for patients who cannot tolerate medications or who have persistent regurgitation or throat symptoms. If symptoms do not respond to medical treatment, a thorough evaluation, including ambulatory esophageal reflux pH monitoring, should be performed to identify why the treatment has not worked and to make sure that GERD and not other conditions are actually the cause of the symptoms. Only if it is clear that reflux is the cause of the symptoms should surgery be considered. With the surgery, called fundoplication, the hiatal hernia, if it is present, is repaired, and the upper part of the stomach is wrapped around the lower end of the esophagus to create a stronger barrier to acid reflux. The operation is usually done using a laparoscope, a thin instrument that allows a much smaller incision and easier recovery than open surgery. It is quite effective, but can sometimes cause difficulty with swallowing or bloating. Only very experienced surgeons should do this operation.
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