Overview

Gastroesophageal reflux disease, also known as GERD, is a condition that results from the acid in the stomach splashing up into the esophagus. When the sensitive lining of the esophagus is exposed to stomach acid a burning pain (heartburn) may result.

Symptoms of GERD may include:

• Heartburn----a burning feeling in the upper abdomen. It can travel through the chest and into the throat and neck. It is believed to be caused by an acid irritating the esophagus.
• Regurgitation-a warm, salty, bitter taste in the mouth. It occurs when stomach contents flow back into the esophagus and into the mouth. It frequently occurs with belching.
• Chest pain----pain in the chest is believed to reflect spasm in the esophagus. It is caused by acid irritating the esophagus. This can mimic a heart attack.
• Hoarseness or laryngitis----these can develop if the acid and/or stomach contents reach the mouth and throat.
• Dental disease----occurs because of the effects of the acid on teeth.
• Choking/Wheezing---may occur especially at night when stomach contents may enter the lungs. This is called aspiration. In patients with asthma, wheezing and shortness of breath may be aggravated by reflux.

In severe GERD other symptoms that may occur include:

• Difficulty swallowing
• Painful swallowing
• Bleeding esophageal ulcers

Stomach acid causes inflammation and ulceration, usually in the lower esophagus. Severe inflammation and ulceration over time lead to scarring and stricture of the esophagus. Patients with esophageal strictures commonly describe food as getting "stuck" especially foods such as bread and meats. Ulcers in the esophagus caused by the acid of stomach contents usually cause painful swallowing and often bleeding. Another condition that may be seen in patients with long standing GERD is Barrett's esophagus. Barrett's esophagus is a change in the lining of the esophagus caused by years of acid reflux and inflammation. Some research suggests that people with this condition may be at a slightly higher risk for developing cancer of the esophagus. This condition is usually identified in patients that have undergone an upper endoscopy procedure.

What causes GERD?

There are several factors that may contribute to GERD. The most common factor is a weak lower esophageal sphincter (LES). The LES acts as a valve to the stomach, remaining closed until swallowing forces the valve open. Normally the LES closes immediately after swallowing to prevent reflux. In people who experience reflux, the LES may be weak and stomach acid splashes back into the esophagus.

Hiatal Hernias are also commonly associated with GERD. A hiatal hernia occurs when part of the stomach bulges up through the diaphragm and into the chest. The diaphragm is a flat muscle that separates the chest from the abdomen. Coughing, vomiting, straining, weight gain and pregnancy can all contribute to a hiatal hernia. Some research suggests that a hiatal hernia can prevent the LES from functioning properly. Hiatal hernias are a very common abnormality, however not all patients with hiatal hernias have GERD. The exact relationship between hiatal hernia and GERD is unknown.

Other factors that may contribute to GERD include:

• Fatty foods
• Smoking
• Chocolate
• Caffeine
• Alcohol
• Obesity
• Pregnancy
• Delayed stomach emptying

How is GERD Treated?

Gastroesophageal reflux disease can be managed with dietary and lifestyle changes, and/or medications. Medical management consists of taking medication designed to decrease acid in the stomach. Medications such as Zantac, Axid, Pepcid, Prilosec are commonly used. The reflux does not stop, it continues without the stomach acid, therefore symptoms disappear. Since reflux disease is a mechanical problem, medical treatment can alleviate symptoms of GERD but may not cure the problem.

Reasons for Surgery

There are many reasons to consider a surgical approach to GERD. These include:

• symptoms continue with medications
• severe esophagitis
• hoarseness or laryngitis thought to result from GERD
• repeated bouts of lung infections caused by aspiration of acid into the lungs
• asthma that is thought to result from GERD
• inability to comply with lifestyle and dietary modifications
• expense of many of the medications used for reflux
• complications from GERD such as strictures or Barrett's esophagus