Acid RefluxHeartburn, Gastroesophageal Reflux Disease (GERD)
Acid reflux is the condition that occurs when the acid backs up from the stomach into the esophagus and sometimes all the way up to the throat and the mouth.
Some degree of acid reflux is normal. The reflux episodes are usually short lived and they don’t cause any symptoms or damage to the esophagus.
Patients with gastroesophageal reflux disease (GERD) usually have more frequent episodes of reflux (more than 2-3 times a week) and these episodes cause bothersome symptoms such as heartburn (burning sensation in the chest), chest pain, cough, difficulty swallowing or hoarseness. In patients with GERD, exposure of the esophageal lining to acid can lead to complications such as esophagitis (inflammation of the esophagus), esophageal strictures and Barrett’s esophagus.
The most frequent symptom of GERD is heartburn, felt as a burning sensation in the middle of the chest.
Other symptoms of GERD include:
- Chest pain
- Difficulty swallowing (dysphagia)
- Pain with swallowing (odynophagia)
- Dry cough
- Regurgitation of food or sour liquid
- Sore throat
- Sensation of a lump in the throat
- Recurrent lung infections
- Chronic sinusitis
- Stomach pain or indigestion
The risk factors for GERD include:
- Drinking alcohol
- Consuming fatty foods, chocolate, caffeine
- Eating large meals and eating soon before bedtime
- Diabetes causing delayed gastric emptying
- Hiatal hernia (loose opening between the stomach and the esophagus)
When to see a doctor:
Mild occasional heartburn that responds to over the counter medications is usually not worrisome. However, if the symptoms occur more than 2-3 times a week, are severe or do not resolve with medication, a medical evaluation is necessary. Alarming symptoms such as chest pain, difficulty swallowing, weight loss or vomiting blood require immediate medical attention.
GERD is diagnosed clinically based on the symptoms and the response to treatment whether lifestyle changes or medications. Sometimes certain diagnostic tests may be indicated:
- Upper endoscopy (EGD): while the patient is sedated, the doctor introduces a flexible tube with a camera at its tip from the mouth down to the stomach to evaluate the upper GI tract.
- pH study: A capsule is placed in the esophagus to monitor the level of acid exposure.
- Manometry study: A probe is inserted into the esophagus to measure the pressure of the lower esophageal sphincter and evaluate the motility of the esophagus.
Most patients with acid reflux do not develop any complications but untreated GERD can lead to a certain number of complications:
- Esophagitis and esophageal ulcers: inflammation and ulceration of the lining of the esophagus
- Esophageal strictures: Narrowing of the lumen of the esophagus
- Barrett’s esophagus: change in the lining of the esophagus to a tissue that is premalignant and can lead to esophageal cancer.
1. Diet and lifestyle changes:
- Maintain a healthy weight
- Do not eat soon before bedtime
- Do not eat and lie down
- Avoid large meals, fatty foods, chocolate, caffeine and alcohol
- Stop smoking
- Raise the head of the bed (but do not use additional pillows)
- Histamine blockers
- Proton pump inhibitors
- In certain cases surgery can be performed to reinforce the lower esophageal sphincter by wrapping the top of the stomach around the lower esophagus (Nissen fundoplication)