Gastroesophageal Reflux Disease
Gastroesophageal Reflux Disease (GERD), Barrett’s Esophagus and Ablation Therapies
- Gastroesophageal reflux disease is very common, affecting 20% of Americans.
- Classic symptoms include heartburn and regurgitation. Other symptoms may include chest discomfort, asthma and/or a cough.
- Treatment can include lifestyle changes, over-the-counter or prescription medications, surgery and possibly endoscopic therapies.
- Barrett’s esophagus is a change in the lining of the esophagus caused by chronic acid reflux and can only be detected by upper endoscopy with biopsy.
- Barrett’s esophagus is associated with an increased risk of developing esophageal adenocarcinoma (a type of cancer of the esophagus).
- Esophageal adenocarcinoma has been increasing in frequency in the U.S. over the past 30 years.
- Individuals with longstanding reflux should be screened via endoscopy for Barrett’s esophagus
- Early detection and treatment is highly desirable as this is a potentially lethal malignancy.
What is Gastroesophageal Reflux Disease?
Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents (including acid) causes troublesome symptoms and/or complications including damage to the lining of the esophagus. It is estimated that GERD affects up to 20% of adults in the U.S. who experience symptoms on a daily to weekly basis.
What are the symptoms of gastroesophageal reflux?
The most common and typical symptoms of GERD are heartburn and regurgitation. Heartburn is a burning sensation in the lower chest just behind the breastbone that can extend upward; it is worsened by bending or lying down. Regurgitation is the sensation of food or sour liquid refluxing back into the esophagus. Individuals with these classic symptoms have a straightforward diagnosis. However, symptoms may be varied and also include: chest discomfort (which may be difficult to discern from cardiac-related pain), asthma, cough, nausea, bad breath and chronic hoarseness.
How is GERD treated?
Initial treatment of GERD includes lifestyle modifications, dietary changes and over-the-counter antacids. Elevating the head of the bed and refraining from eating at least two hours before bedtime can be helpful for those with nighttime symptoms. Dietary changes include avoiding overeating, particularly acidic and fat-laden foods, and eliminating or reducing smoking and alcohol consumption. Specific foods, such as chocolate, peppermints and tomato products, can exacerbate symptoms, but sensitivities vary widely among patients. Obesity is strongly associated with both GERD and its complications and weight loss is recommended.
For individuals who do not have adequate symptom improvement with the above lifestyle alterations, medications may be necessary. These include histamine 2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) which are available over the counter and by prescription. Patients who have frequent GERD symptoms or use these OTC medications regularly should see a physician. Proton pump inhibitors decrease gastric acid secretion more completely and are used more often in patients with more severe GERD.
Surgical therapy is available for those who do not respond to lifestyle and medication therapy or who do not wish to remain on medications. Surgery consists of wrapping the top of the stomach to reform the natural acid barrier and fixing the defect in the diaphragm and hiatal hernia if present. This type of surgery is called a fundoplication. Surgical therapy and medical therapy are generally equally effective. The decision of medical versus surgical therapy depends on how well the patient is likely to tolerate surgery, their response to medical therapy and the underlying causes of the GERD. In addition, there are several endoscopic treatments for GERD. However, these are still relatively new and, for the most part, unproven or still investigational.
What are the complications of gastroesophageal reflux?
Complications of acid reflux can include esophageal strictures (narrowing), ulcerations and Barrett’s esophagus, which is a precancerous change in the lining of the esophagus. Symptoms of complications of GERD include: dysphagia (difficulty swallowing), odynophagia (pain upon swallowing), refractory heartburn, anemia, vomiting or weight loss. Any of these symptoms merit seeing a doctor for further care. At that time, the individual should undergo an upper endoscopy to help evaluate the source of the problem.