Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux is movement of stomach contents upward into the esophagus – usually including stomach acid (called acid reflux). Heartburn, or ‘acid indigestion’, is one symptom of GERD – a burning pain that moves upwards towards the throat, sometimes causing a bitter taste (called brash). The esophagus is the tube that goes from the mouth down to the stomach. Unlike the stomach, it does not handle acid exposure well.  Over 200,000 people in the Chicago area suffer from GERD.

Symptoms of gastroesophageal reflux

Alarm symptoms – require immediate evaluation by a physician

• Chest pain: cardiac causes must be evaluated
• Bleeding: can be vomiting blood, blood in stool, or black tarry bowel movements
• Anemia (low blood count)
• Dysphagia (difficulty swallowing, or a feeling that food gets stuck on the way down)
• Weight loss
• Frequent heartburn – two or more times per week per medical studies

Typical symptoms of reflux

• Heartburn
• A feeling of fluid coming up, sometimes with a sour taste

Laryngeal symptoms of reflux

• Choking
• Coughing (chronically)
• Hoarse voice
• Frequent throat clearing

Respiratory symptoms

• Wheezing
• Asthma-like symptoms
A majority of people with asthma have acid reflux. GERD may be worsening your asthma if:
• asthma started in adulthood
• asthma is worse after meals or lying down
• asthma that is mainly at night

Complications of gastroesophageal reflux

Esophagitis is inflammation of the esophagus, and can result in ulceration or bleeding. Esophageal stricture (a narrowing or near-blockage of the esophagus) can develop from chronic acid injury and scarring, usually in the lower esophagus. This can cause dysphagia, a feeling that food (or liquid) gets stuck on the way down.  Barrett’s esophagus is a change in the tissue of the esophagus. This can be a precursor to esophageal cancer – which is nearly eight times more likely among people who have heartburn two times a week or more, and 43 times more likely with 20 years of frequent heartburn.

Causes of gastroesophageal reflux

• Lower esophageal sphincter, the valve at the bottom of the esophagus, does not work well
• Hiatal hernia, in which part of the stomach has slipped above the diaphragm into the chest
• Weight gain or pregnancy
• Connective tissue disorders, like scleroderma (rare)

Diagnosis of gastroesophageal reflux disease

• Endoscopy (with biopsies if needed) can be useful to find esophagitis, strictures, or Barrett’s esophagus
• pH impedance studies can determine if fluid is coming upwards into the esophagus and if that is acidic
• Motility (esophageal manometry) studies can determine whether the esophagus is squeezing properly

Treatment of gastroesophageal reflux disease

The key goals of treatment are:

• Control of symptoms
• Find esophagitis, strictures, Barrett’s esophagus, or other complications and treat as needed
• Prevent these issues from coming back (or monitor Barrett’s esophagus)

Infrequent symptoms

Diet and lifestyle changes can be effective, monitored by a food and symptom journal:
• Avoid things that switch off the lower esophageal sphincter valve: chocolate, alcohol, coffee, mint, greasy foods
• Avoid things that irritate the esophagus: tomato products, spicy food, citrus juices
• Eat smaller meals
• Avoid eating before lying down or sleeping – at least two hours, and four if possible
• Stop smoking
• Lose weight
• Raise the head of the bed by securing its legs to 3-5 inch blocks (test them to make sure the legs don’t slip on the blocks)

Medications for gastroesophageal reflux disease
There are acid-reducing medications, called H2 blockers and proton pump inhibitors, which are effective and can heal esophagitis in almost all cases. These should be taken in the 30 minutes before meals, and proton pump inhibitors should be taken every day (not just when symptoms happen). It is important to check with your physician to make sure these do not interact with your other medications. Long-term use of proton pump inhibitors may be necessary, although these medications may be associated with side effects such as osteoporosis. Even if they are effective, the alarm symptoms list above still warrant physician diagnosis.