Gastroesophageal Reflux Disease (GERD)

DEFINITION

Gastroesophageal reflux disease (GERD) is one of the most prevalent diseases of the gastrointestinal tract; prompting more than 1.8 million outpatient clinic visits per year.  Approximately 44% of Americans report GERD at least once a month.  The Center for Digestive Disorders at The GW Medical Faculty Associates offers comprehensive management of GERD, including the latest technology in diagnosis and therapy.

What causes GERD?
The esophagus has natural barriers to acid exposure, one of which is the lower esophageal sphincter (LES).  The LES is a muscle at the junction of the esophagus and the stomach, which functions to prevent acid from refluxing back into the esophagus.  The most common cause of GERD is transient relaxation of the LES, which can be caused by a number of dietary and environmental factors.  A hiatal hernia, when the stomach slips above the diaphragm, can also weaken the LES.  In addition, abnormalities in esophageal motility, salvia production, gastric emptying may cause GERD.

What are the complications of GERD?
Besides the aggravating symptoms, GERD can lead to other esophageal disorders.  Chronic acid exposure of the esophagus can cause strictures or narrowing of the esophagus limiting the ability to swallow.  In addition, chronic GERD can lead to cellular changes in the esophagus called Barrett’s Esophagus, which is a risk factor for esophageal cancer.  Cough, asthma, and hoarseness may also be consequences of GERD.

Barrett’s Esophagus

Barrett’s Esophagus involves a change in the normal squamous lining of the esophagus to an intestinal type as a response to acid exposure from GERD.  Barrett’s Esophagus is significant because it carries an elevated risk for esophageal cancer, abut 30-125 times that of the general population.  The annual risk of esophageal cancer with Barrett’s Esophagus is approximately 0.5%.

SYMPTOMS

Symptoms of GERD result from acid exposure to the esophagus.  The classic symptom of GERD is heartburn, a burning feeling that radiates from the stomach to the neck, typically occurring after meals.  Other common symptoms include acid regurgitation and difficulty swallowing.  Some less common symptoms include nausea, hiccups, chest pain, cough, asthma, sore throat, and hoarseness.

DIAGNOSIS

The diagnosis of GERD is made by the presence of typical symptoms and a response to medications that block acid production.  In some cases other tests are needed to make the diagnosis.  An upper endoscopy allows visualization of the esophagus to assess for inflammation form GERD.  The gold standard for the diagnosis of GERD is to detect acid in the esophagus, which can be achieved with BRAVO esophageal pH study.  For this test a small sensor is placed in the esophagus during endoscopy that monitors the pH of the esophagus for 48 hours and can definitively diagnose GERD.  Esophageal manometry, which measures the muscular contractions of the esophagus and the strength of the LES, can also aid in the diagnosis.

TREATMENT

What are the non-surgical treatments for GERD?
The initial treatment of GERD involves lifestyle modification including dietary changes, avoiding alcohol/tobacco, and weight loss.  Medical therapy is often required and is aimed at reducing acid production in the stomach.  Surgical endoscopic procedures, which tighten the junction of the esophagus and stomach, are available for patients who do not respond to lifestyle changes or medical therapy.

What are the non-surgical treatments for GERD?
The initial treatment of GERD involves lifestyle modification including dietary changes, avoiding alcohol/tobacco, and weight loss.  Medical therapy is often required and is aimed at reducing acid production in the stomach.  Surgical endoscopic procedures, which tighten the junction of the esophagus and stomach, are available for patients who do not respond to lifestyle changes or medical therapy.