Gastroesophageal Reflux Disease (GERD)
By Mike Baker, MD, Associates in Gastroenterology, Colorado Springs LIVING WELL Magazine
Gastroesophageal reflux (i.e., stomach contents moving retrograde back into the esophagus) is a normal physiologic process that occurs multiple times throughout the day. These episodes are typically short lived, do not cause symptoms and occur after meals. In contrast, GERD occurs when there is a breakdown of the body’s normal “anti-reflux” mechanisms leading to abnormal amounts of reflux. This increase in reflux can lead to symptoms such as heartburn or damage to the lining of the esophagus. Researchers believe that between 10 and 20% of the population in the U.S. have weekly symptoms of heartburn making GERD one of the most common reasons people seek outpatient medical attention. Additionally, the impairment of quality of life due to GERD has been reported to be similar to that of arthritis, high blood pressure and even heart failure.
What are the symptoms?
The most common symptom of GERD is heartburn, which is generally described as a burning sensation in the center of the chest that can spread to the throat. Patients may also describe an acid taste in the back of their throat. Less common symptoms include non-burning chest pain, stomach pain, sore throat, cough and hoarseness. If the reflux has caused damage to the lining of the esophagus patients may even describe difficulty swallowing, food getting “stuck” or painful swallowing.
When should I seek consultation from a gastroenterologist?
Most patients with GERD are managed by their PCP and have improvement or resolution of their symptoms with simple lifestyle modifications and/or medications. Any patient with typical symptoms of GERD (chest burning, acid regurgitation, etc.) who does not improve with treatment, should be evaluated by a gastroenterologist. Additionally, any patient experiencing difficulty/painful swallowing, vomiting blood, unexplained weight loss, chest pain and choking should report these to your PCP. Lastly, it is my feeling that any patient with long standing reflux (>10 years) should be seen by a gastroenterologist to determine the need for an EGD.
How is the diagnosis made?
The diagnosis of GERD is based on presenting symptoms and response of these symptoms to treatment. If a patient presents with typical symptoms and responds to therapy there is no need to perform any further testing. If a patient presents with any of the symptoms previously mentioned, does not respond to therapy, or has atypical symptoms, then further evaluation is warranted. Generally the first test performed would be an esophagogastroduodenoscopy (EGD) to look at the lining of the esophagus and stomach and take tissue samples if needed. Additional studies that may need to be performed are the 24-hour pH study and the esophageal manometry study. A 24-hour pH study is the most direct way to truly measure the amount of stomach acid refluxing back into to the esophagus. This is a helpful study in patients who do not have resolution of their symptoms despite maximal medical management.
How is GERD treated?
The type of treatment depends on the severity of symptoms. Typically, patients with very mild disease will respond to lifestyle modifications: weight loss, raising the head of the bed 6 to 8 inches, tobacco cessation, avoidance of reflux inducing foods (caffeine, chocolate, alcohol, peppermint), and avoid large late meals. Patients with more severe symptoms, or those who do not respond to lifestyle modifications, will require treatment with medications. Patients with intermittent symptoms may be controlled with otc H2 blockers. If symptoms are persistent then I will recommend a stronger type of medication known as a proton pump inhibitor. Surgical treatment is generally reserved for people who have failed maximal doses of medications and have a large hiatal hernia.
What are the potential complications?
Most patients with GERD do not go on to develop any serious complications, especially if the GERD is adequately treated. The type of esophageal cancer associated with GERD is believed to be the result of chronic irritation of the lining of the esophagus leading to a change in the type of cells lining the esophagus. Over time these “new” cells can mutate and lead to the development of esophageal cancer. Additional complications that can arise from chronic GERD include ulcers, lung and throat problems and esophageal strictures, which are narrowings that can cause a blockage.
Gastroesophageal disease (GERD) is a common medical condition in the U.S. This disease leads to significant healthcare costs and has the potential to cause serious medical complications. Recognizing symptoms and obtaining proper evaluation and treatment is important to prevent complications and improve quality of life for those patients suffering from GERD.
Mike Baker is a physician with Associates in Gastroenterology and can be reached at 719-635-7321. For more information visit www.agcosprings.com.