Gastroesophageal Reflux Disease

By Dr. Ramon S. Generoso, M.D.

What is GERD?

  • Also known as heartburn, reflux or acid reflux.
  • Symptoms may include: Burning or tightness in the chest, a sour taste in the mouth or back of throat, frequent belching, and difficult or painful swallowing.
  • In the U.S., 20% of adults experience heartburn at least one day a week, and 40% experience heartburn once a month.
  • Each year, $9.3 billion dollars spent for the evaluation and treatment of GERD.

What causes GERD?

The main cause is transient relaxation of the lower esophageal sphincter (LES). The LES is the ring of muscle that separates the esophagus from the stomach. Certain foods and chemicals cause the LES to relax. These include nicotine, caffeine, fatty or fried foods, peppermint and alcohol among others.

What is a hiatal hernia?

A hiatal hernia develops when part of the stomach moves upward above the diaphragm. This may promote acid reflux by allowing acid in the stomach to reflux more easily into the esophagus. It also hampers the esophagus' ability to clear acid back into the stomach.

The contribution of the hiatal hernia to GERD is controversial. Opinion has shifted widely from one that virtually equated hiatal hernia with reflux disease to one that denied it a causal role. Epidemiologic and physiologic data confirm the importance of the hiatal hernia in patients with more severe esophagitis, peptic stricture, or Barrett's esophagus. Some studies have found that in individuals with reflux symptoms, the presence of hiatal hernia confers a significantly increased risk of erosive esophageal injury.

Do I need to have an endoscopy?

Most people with GERD do not require an endoscopy. This is recommended for those with "alarm symptoms" which include:

  • Age greater than 50
  • Male gender
  • Caucasian race
  • Greater than 5 years of symptoms
  • Severe symptoms, or heartburn which occurs at least 3x a week
  • Elevated BMI
  • Family history of esophageal cancer
  • Fevers, weight change, fatigue

This is because these alarm symptoms increase the risk for complications of GERD, such as:

  • Erosive Esophagitis – significant inflammation of the esophagus
  • Peptic Stricture – narrowing which forms from scarring due to inflammation
  • Barrett's Esophagus
  • Esophageal Adenocarcinoma

An endoscopy will also help exclude other diseases that may give symptoms that mimic GERD such as eosinophilic esophagitis (an allergic type of inflammation), esophagitis from certain pills, and motility problems that may affect how the esophagus functions.

What is Barrett's esophagus?

A change in the lining of the esophagus may develop over time, due to persistent exposure to stomach acid. This new lining is called Barrett’s esophagus. This change is irreversible, and is considered “premalignant” as it may eventually develop into esophageal cancer, the most dreaded complication of acid reflux disease.

How is GERD treated?

  • Lifestyle modification is the cornerstone of treating GERD.
  • Elevate the head of the bed
  • Weight loss for overweight patients
  • Avoid:
    • Lying down after meals
    • Bedtime snacks
    • Cigarette smoking
    • Alcohol
    • Foods that promote reflux

In addition to modifying your lifestyle and diet, you may need medications on an as needed basis for symptom relief. These medications include antacids or acid suppressants such as ranitidine. For more frequent symptoms, a 14 day course of a stronger acid suppressant, called a proton pump inhibitor (PPI) such as Prilosec or omeprazole can be obtained over-the-counter without need for a prescription. If your symptoms persist, be sure to contact your doctor.

If any of these symptoms or conditions sound familiar and you would like more information, we would be happy to meet with you.