What is GERD?
Gastroesophageal reflux disease (GERD) is a chronic medical condition that is characterized by abnormal reflux of acid into the esophagus (food pipe) which causes discomfort and can lead to complications. Patients with GERD typically have symptoms of acid reflux that occur two or more times a week. GERD is caused by dysfunction of the valve that separates the esophagus from the stomach, the lower esophageal sphincter (LES).
Symptoms of GERD vary between patients. The most common GERD symptom is heartburn, often described as a burning in the chest and upper abdomen that occurs after eating. Some patients may experience pain or difficulty with swallowing, and an acidic taste in the mouth. Chronic acid reflux can also cause symptoms of nausea, vomiting, accelerated tooth decay, hoarseness, sore throat, and chronic cough.
Chronic untreated GERD can lead to complications, including inflammation or ulceration of the esophagus (esophagitis), esophageal narrowing (strictures), pre-cancerous changes (Barrett’s esophagus), and esophageal cancer.
Patients with suspected GERD should be evaluated by a gastroenterologist. Testing for GERD often includes an upper endoscopy which allows the physician to ensure that there are no pre-cancerous or cancerous changes in the esophagus. Further testing may be indicated based on symptoms and response to treatment. Further testing may include testing acid levels in the esophagus (pH testing), and testing of the coordination and strength of the muscles lining the esophagus (esophageal manometry).
Medical treatment of GERD includes the use of antacids, H2 Receptor blockers, and proton pump inhibitors (PPI’s). There are certain risks with long-term PPI use and the decision regarding the type of medication to use. The duration of treatment should be guided by a gastroenterologist and individualized for each patient.
Lifestyle changes and diet modification can often reduce GERD symptoms. Patients should avoid overeating, avoid eating late at night, avoid or quit smoking, and lose weight if overweight. Certain foods can worsen GERD symptoms. Greasy or fatty foods, caffeine, alcohol, carbonated beverages, chocolate, and peppermints should be avoided in patients with frequent heartburn.