Diagnosis and Treatment

Amar Bansal, M.D.

Gastroenterologist at Dreyer Medical Clinic - Mercy Campus and Fox Valley Villages

Gastroesophageal Reflux Disease (GERD) is one of the most common digestive disorders. It is a condition where stomach acid refluxes upwards into the esophagus. Usually, the acid in your stomach is retained by a muscular valve at the end of the esophagus, known as the Lower Esophageal Sphincter (LES). The LES is supposed to remain closed, except when swallowing. If it opens at other times, stomach acid can flow upward (reflux) into the esophagus, causing heartburn. Typical symptoms include an uncomfortable feeling of burning, warmth, heat, or pain just behind the breastbone, which is commonly referred to as heartburn. Other symptoms can include nausea, increased belching, regurgitation of food, and even chronic cough.

Occasional heartburn does not necessarily mean you have GERD. In GERD, the symptoms last longer and occur more often. Approximately 10% of the population in the United States experiences heartburn every day. In addition, as many as 50% of patients with unexplained chest pain, chronic hoarseness, or asthma may be suffering from GERD. Diagnosing GERD usually involves a multi-step approach. The first step is having a full medical history taken along with a physical exam by a health care professional. If GERD is suspected, an acid reducer may be given on a trial basis to see if symptoms improve. Also, tests may be ordered to diagnose and/or confirm the diagnosis of GERD. Tests may also be used to evaluate persistent GERD or GERD that is difficult to manage. Such tests can include upper gastrointestinal endoscopy or an upper GI series. In many cases, a gastroenterologist can best assist with this process.

Endoscopy is a test performed by a gastroenterologist that allows examination of the esophagus, stomach, and the beginning portion of the small intestine. It uses a thin, flexible viewing instrument that is passed down the throat under mild sedation. Endoscopy can reveal problems that do not show up on other tests, and can allow for tissue sampling, as well as the removal of abnormal growths.

The treatment of GERD varies with the severity of the disease. Simple lifestyle modifications and non-prescription acid reducers, such as over the counter antacids and H2-receptor blockers, are usually instituted for mild disease. Lifestyle modifications include quitting tobacco use, avoiding caffeine and alcohol, losing weight, eating smaller and more frequent meals, and avoiding foods that worsen symptoms. For more significant disease, prescription-strength acid reduction medications called proton pump inhibitors may be used. In rare instances, a surgical technique called fundoplication may be performed, where part of the stomach is wrapped around the lower esophagus to help strengthen the LES.

You should seek medical advice if you have symptoms frequently, such as a few times a week, and if your symptoms are not relieved with lifestyle modifications and nonprescription medications. You should also consult your health care provider if you have symptoms that return after medication for treatment wears off. Immediate medical attention should be sought if you have GERD and have problems swallowing, unintentional weight loss, or regurgitate blood.

If left untreated, GERD can cause serious complications, including inflammation of the esophagus (esophagitis), ulcers, bleeding, and narrowing of the esophagus (stricture). Approximately 10% of patients with GERD will develop a condition called Barrett's esophagus. In this condition, the cells lining the esophagus have been replaced by cells similar to those that line the inside of the stomach. Barrett's esophagus increases the chance of developing esophageal cancer. Upper GI endoscopy and tissue sampling is necessary to make the diagnosis of Barrett's esophagus.

GERD is a very common condition affecting millions of people of all ages, race, and gender. While in most patients GERD is a chronic condition, it is also a disease that can be managed successfully with no major alterations in long-term health or lifestyle.