While nearly everyone has the occasional heartburn, if the burning sensation caused by acid in your esophagus persists, you could have GERD. The disease may be more common than you think.
Gastroesophageal reflux disease, commonly referred to as GERD, is a condition where the contents of the stomach come back up into the esophagus. The regurgitated liquid usually contains acid produced by the stomach. While your stomach is designed to handle the acid it produces, your esophagus is not.
“Between 10 percent and 15 percent of the population in the United States experiences GERD on a monthly basis,” says Dr. Mary Maish, assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders.
Smart Business spoke with Maish about GERD, the symptoms associated with this disease and how it can be treated.
What causes GERD?
There are some known causes as well as many unknown causes. One thing that can cause GERD is a hiatal hernia, which is when part of your stomach pushes up into your chest. The esophagus extends from the neck through the chest and into the abdomen. In normal people, the stomach stays in the abdomen. For people with a hiatal hernia, the top portion of the stomach herniates, or pushes its way up into the chest, which is abnormal.
Another cause is that as we age our tissues tend to become more lax. The laxity in the diaphragmatic muscle does not provide the same sturdiness or strength that it needs to keep the stomach in the abdomen.
Also, patients that are very obese are more prone to GERD. Large amounts of fat put pressure on the stomach and can cause a hiatal hernia. Carbonated liquids, caffeine, alcohol, spicy foods and heavy fatty meals can also exacerbate reflux.
What are some of the symptoms associated with this affliction?
Heartburn occurs in about 80 percent of the patients with GERD. They may also have epigastric pain, chest pain, changes in their voice and respiratory symptoms such as recurrent bronchitis, recurrent pneumonia or a persistent cough. Other possible symptoms include ear, nose and throat issues like persistent dental caries, recurrent earaches, persistent sore throats and hoarseness. Gastrointestinal symptoms may include bloating, gassiness, nausea, vomiting and diarrhea.
How is GERD diagnosed?
There are a number of objective tests that can be used to diagnose GERD. A barium swallow allows us to not only look at how the esophagus is moving, but also helps us determine whether or not there is reflux of material from the stomach back up into the esophagus. Manometry testing consists of a small catheter placed in the nose, down the esophagus and into the stomach where it measures pressures along the esophagus. Most importantly, it measures the pressure of the lower esophageal sphincter that connects the esophagus to the stomach. If the pressure is low then we know that the patient is likely to be experiencing a lot more reflux than an average person who has normal pressure.
A pH probe test measures the total amount of acid that is dispensed over a 24-hour period of time. There are normal amounts of acid that come up from the stomach into the esophagus in every individual, but this test will measure how much acid, based on the pH, that someone is being exposed to. Finally, an endoscopy allows us to look at the lining of an esophagus and determine if there are any complications from GERD.
How is it treated?
Patients with mild GERD, or occasional reflux, are generally treated with acid inhibition medicine, or what we call proton pump inhibitors. These medicines include Prilosec, Nexium and Prevacid. It can also be treated intermittently with H2-blockers such as Pepcid, Tagamet and Zantac.
If complications persist, what surgery options are there?
If the symptoms are persistent and severe, or if there is any indication of complications from reflux then surgery can be considered. The type of surgery that we recommend is called a Nissen fundoplication. During this surgery the top part of the stomach is wrapped around the bottom part of the esophagus in order to create a new valve because the old valve is not working properly. The procedure is done laparoscopically with minimally invasive techniques and generally there is only a one- or two-day hospital stay.
DR. MARY MAISH is assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders. Reach Esophageal Center Coordinator Rebecca Allegretto, RN, MBA, at firstname.lastname@example.org or (310) 825-6167 or through the Web site www.esophagealcenter.ucla.edu.