Ask The Expert

Gastroesophageal Reflux Disease (acid Reflux)

June 12, 2008|By Holly Selby

Napped right after that second bowl of ice cream? Ate too much at the post-graduation picnic? Overimbibed while watching the O's game? All of these behaviors can trigger what doctors call gastroesophageal reflux disease (GERD), or acid reflux. In fact, from 10 percent to 20 percent of Americans have symptoms of GERD once a week, says Andrew Rosenstein, gastroenterologist with St. Joseph Medical Center. Another 7 percent may suffer every day from GERD.

What is GERD or acid reflux disease?

The broad definition of GERD is symptoms or actual mucosal tissue damage produced by abnormal reflux of gastric contents into the esophagus. Or another way of saying that is: It occurs when gastric contents wash up into the back of the esophagus.

Is there a difference between heartburn and acid reflux?

Heartburn is really a symptom of GERD; it is that sensation of burning that you have, perhaps after a big meal. It is one of the many symptoms of GERD.

What are the other symptoms?

In addition to heartburn, the most common symptoms are regurgitation, trouble swallowing and a "foreign body" or globus sensation, which is when they feel like there is something in the esophagus, but there isn't.

What causes GERD?

Acid reflux is caused by something called transient lower esophageal sphincter relaxation.

Periods of relaxation (in which gastric contents occasionally may wash back up into the esophagus) are normal. But in patients with acid reflux, a greater number of these [relaxation] episodes are associated with the contents washing up into the esophagus, and we actually don't know why that occurs.

Do certain behaviors or factors trigger acid reflux?

Obesity is a factor. We don't completely understand the mechanism by which obesity causes reflux, but it can raise the pressure in the stomach and increase the risk of hiatal hernia (in which the stomach slides into the chest), which in turn, increases the risk of acid reflux.

Smoking also is a factor. Saliva is one of the mechanisms we use to clear out the esophagus, and patients who smoke have decreased salivation. Alcohol is an irritant and can increase reflux, too.

How is GERD diagnosed?

Typically it is diagnosed by taking a history, which may include the patient complaining of heartburn or other classic reflux symptoms. Initially if the symptoms are mild, I would treat the patient with over-the-counter medications and see how the patient responds.

If you want to know for sure, your doctor can measure the pH or acid level in the esophagus. This is done by implanting a dime-size chip in your esophagus, which measures the pH level over a 24-hour period while the patient records his symptoms.

And if the patient has certain warning signs such as weight loss, anemia or difficulty swallowing, you perform an endoscopic evaluation to make sure they don't have cancer or ulcers.

Many people have heartburn; when should a doctor be called?

An important point to make is if you have those kinds of symptoms - weight loss, anemia or difficulty swallowing - you should call your doctor.

How is GERD treated?

Lifestyle modifications are very important: Cut back on alcohol or smoking or portion sizes. Cut down on fat because fat stays in the stomach for a longer time. Don't recline for four hours after eating. For mild symptoms, over-the-counter medications can be effective. Patients with more significant symptoms often require prescriptions. In certain circumstances, when medications don't work, surgery can be used.

Is there anything new in research into or treatment of GERD?

Since 2001, there has been a shift in the way people think about reflux. Before then, we thought, "We can fix reflux; it is all about the acid."

But we realized that there were patients who weren't responding to treatment of the acid. We began researching nonacid reflux. Through testing, we can detect patients with episodes of reflux in their esophagus that is nonacidic.

What does this mean for treatment?

We aren't talking about a huge percentage of patients who don't respond to medicine treating acid. But we are looking for new ways to treat nonacid reflux. In some cases, this would be with surgery or new medications. A lot of research is ongoing for endoscopic treatments for reflux. Some of these show promise, but the bottom line is that they are not quite ready for prime-time.


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