Acid Reflux/GERD

Acid reflux and heartburn are both conditions that many people experience from time to time. If these conditions occur frequently, you may have a more serious condition called gastroesophageal reflux disease (GERD).

Acid reflux occurs when stomach acid backs up into your esophagus. This may cause heartburn and may ultimately cause damage to the lining of the esophagus.

When you swallow, a muscle called the lower esophageal sphincter (LES) relaxes to allow food and liquid to flow down into your stomach, and then it closes again. Sometimes, however, this muscle relaxes abnormally or weakens causing stomach acid to flow back up into your esophagus. Some acid reflux symptoms include tasting regurgitated food or sour liquid at the back of your mouth or feeling a burning sensation in your chest, also known as heartburn. This backwash of acid can irritate the lining of your esophagus, causing it to become inflamed. Over time, the inflammation can erode the esophagus, causing complications such as bleeding or swallowing problems.

GERD is when a person experiences chronic acid reflux.

Symptoms of Acid Reflux/GERD

• A burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth
• Chest pain
• Difficulty swallowing (dysphagia)
• Dry cough
• Hoarseness or sore throat
• Regurgitation of food or sour liquid (acid reflux)
• Sensation of a lump in the throat

Risk Factors of Acid Reflux/GERD

• Obesity
• Hiatal hernia
• Pregnancy
• Smoking
• Asthma
• Diabetes
• Overeating
• Connective tissue disorders, such as scleroderma

Complications of Acid Reflux/GERD

• Narrowing of your esophagus- GERD can cause the esophagus to narrow. The acid exposure to the lower esophagus can damage the cells and lead to the formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing (dysphagia).
• Esophageal ulcers- GERD can also lead to esophageal ulcer, an open sore in the esophagus. An esophageal ulcer may bleed, cause pain and make swallowing difficult.
• Increased risk of Barrett’s esophagus and esophageal cancer- GERD can also lead to precancerous changes in the esophagus, known as Barrett’s esophagus. In Barrett’s esophagus, the color and composition of the tissue lining the lower esophagus change. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but your doctor will likely recommend regular endoscopy exams to look for early warning signs of esophageal cancer.

Tests to Diagnose Acid Reflux/GERD
When acid reflux becomes chronic, there are some procedures and tests that your doctor can perform to diagnose GERD.

• Barium esophagram- an X-ray of your upper digestive system. This procedure requires you to drink a chalky liquid that coats and fills the inside lining of your digestive tract. This allows the doctor to see the shape and condition of your esophagus, stomach and upper intestine.
• Upper endoscopy- by passing a flexible tube down your throat, an endoscopy allows the doctor to visually examine the inside of your esophagus. You doctor might also use the endoscopy to collect a sample of tissue from your esophagus for further testing. This is usually done with sedation.
• Esophageal pH (acid) test- this test monitors the amount of acid in your esophagus. The device used to measure acid can identify when and for how long stomach acid regurgitates into your esophagus.
• Esophageal motility test- this test measures the movement and pressure in your esophagus.

Lifestyle Changes to Treat Acid Reflux/GERD
Acid reflux and heartburn can usually be controlled by lifestyle changes and over-the-counter medications such as antacids, H2 blockers and PPIs, also known as proton pump inhibitors. If 4 to 8 weeks of twice-daily PPI therapy is unsuccessful, further investigation with endoscopy is recommended. Here are some of the lifestyle changes that may help alleviate reflux and heartburn symptoms:

• Maintain a healthy weight
• Avoid tight-fitting clothes
• Avoid foods and drinks that trigger heartburn (common triggers are fatty or fried foods, tomato sauce, alcohol, mint, garlic, onion and caffeine)
• Eat smaller meals
• Watch portion sizes- larger and higher-fat meals tend to stay in the stomach longer before moving to the small intestine, so the LES and esophagus are potentially exposed to stomach contents/acid for a longer time
• Keep a heartburn/food journal- record symptoms, the time they occurred, what you ate, and activities you engaged in before the discomfort started
• Don’t lie down after a meal
• Elevate the head of you bed
• Don’t smoke

While some people experience acid reflux/GERD and heartburn relief by making changes to their lifestyle or taking medication, others may continue to experience these symptoms. Continued acid reflux symptoms or heartburn symptoms may mean that they have gastroesophageal reflux disease (GERD) and need to see a gastroenterologist. Most GERD can be controlled through medications. However, medication may not work for all patients. There are some procedures that can be done to treat GERD.

Treatments for Acid Reflux/GERD

• Nissen fundoplication- surgery to reinforce the lower esophageal sphincter
• Surgery to create a barrier preventing the backup of stomach acid
• Stretta procedure- a procedure to produce scar tissue in the esophagus
• Linx- surgery to strengthen the lower esophageal sphincter