Gastroesophageal Reflux Disease (GERD)

GERD, also known as acid reflux, is a condition in which stomach acids or bile salts back up into the esophagus (the tube that connects the mouth to the stomach) producing a burning sensation behind the breastbone and esophageal irritation or inflammation. Normally, acid is trapped in the stomach by a circular band of muscle called the lower esophageal sphincter (LES), which remains closed except when swallowing. If the sphincter relaxes abnormally or becomes weakened, stomach acid tends to back up, causing symptoms of heartburn. This can also be exacerbated by the presence of a hiatal hernia (when part of the stomach is protruding through the diaphragm and into the chest).

An estimated 17 million Americans currently suffer from heartburn and other symptoms of GERD. For many people, it can be treated with the correct combination of lifestyle changes and medication. For others, surgical intervention can help to eliminate the symptoms and prevent further damage to the esophagus.


Diagnosis

Highly trained gastrointestinal specialists work with thousands of patients each year to diagnose mild to severe cases of GERD. A doctor should be consulted about any of the following symptoms of GERD:

* Frequent heartburn, or a burning pain behind the breastbone, often accompanied by a sour taste and the sensation of food coming back into the mouth. It often gets worse when a person eats, bends over or lies down.
* Chest or upper abdomen pain, especially pain that disrupts sleep
* Regurgitation (backflow of stomach fluids into the mouth)
* Difficulty swallowing
* Belching, especially belching that is acidic or sour-tasting
* Chronic sour or bitter taste in the mouth
* Hoarseness, especially in the morning
* Sore throat
* Coughing, wheezing or repeated need to clear the throat


Treatment

The easiest way to treat reflux symptoms is to block acid production in the stomach. In most cases, acid irritation causes the symptoms. Acid can be blocked by several medications. More than half of all patients get better with acid-suppression therapy. Many physicians will treat a reflux patient with acid suppression for about two months before pursuing other treatment.

Lifestyle Changes and Medication
For cases of mild heartburn, a doctor may suggest over-the-counter or prescription medications that block acid production in the stomach — as well as lifestyle changes.

GERD has an excellent prognosis; 80 to 90 percent of patients improve after treatment with medication. However, these remedies may offer only temporary or partial relief from GERD symptoms. Additionally, severe GERD sometimes causes serious complications, including esophageal ulcer, strictures and Barrett's esophagus.

Surgery
Anti-reflux surgery (laparoscopic nissen fundoplication) offers an alternative to medication for GERD. This procedure strengthens the sphincter by wrapping part of the stomach around the lower esophagus to prevent reflux and maintain the position of the stomach and lower esophagus in the abdomen.

Minimally Invasive Techniques
Endoscopic treatments offer an alternative for patients who are not candidates for surgery or for those patients who don't want lifelong medication treatment or surgery. The following endotherapies are outpatient procedures.