Heartburn / GERD

Gastroesophageal Reflux Disease is a common chronic digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. The LES relaxes to allow food and liquid to flow down the esophagus into the stomach and then contracts to keep the contents of the stomach from flowing back up into the esophagus. GERD is a major risk factor for cancer of the esophagus.

GERD occurs when the LES relaxes too often or for too long, allowing stomach contents to flow back up into the esophagus. This can happen after eating, lying down, or bending over. The symptoms of GERD include heartburn, chest pain, and a sour taste in the mouth.

There are a number of things that can cause GERD (relaxation of the LES), including:

• Eating large meals
• Eating certain foods or drinks (such as fatty or fried foods, coffee, tea, alcohol, chocolate, peppermint, garlic, onions, citrus fruits and juices, tomato-based products, and spicy foods)
• Obesity
• Hiatal hernia
• Pregnancy
• Smoking
• A genetic predisposition
• Taking certain medications (such as ibuprofen, aspirin, and muscle relaxers)

GERD is defined by recurrent and troublesome heartburn and regurgitation. Heartburn is the most common symptom. Heartburn is a burning sensation in the chest or throat. Other symptoms may include:

• sore throat
• coughing
• hoarseness
• chest pain
• throat clearing
• chronic laryngitis
• dysphagia- difficulty swallowing
• belching

GERD is often diagnosed on clinical symptoms, but specialized testing such as endoscopy and pH monitoring may be necessary in some patients. If the patient is experiencing chest pain it is important to rule out heart disease. Dysphagia can be caused by some underlying disorders which must be evaluated. In young patients with symptoms of GERD it is critical to prevent long term complications.

A trial of proton pump inhibitor (PPI) therapy is often diagnostic for patients with typical symptoms. However, if the patient doesn’t respond to this treatment, or if the diagnosis is unclear, endoscopy, and other testing will be recommended.

Patients with GERD symptoms combined with warning signs of malignancy such as dysphagia (difficulty or pain with swallowing), weight loss and bleeding and being older, male, and obese should undergo endoscopy.

• Lifestyle changes (eat smaller meals, lose weight, limit alcohol consumption, avoid foods that trigger reflux, sleep with the head of your bed raised, use OTC antacids and H2 blockers that reduce stomach acid, and stop smoking), medication and surgery are the main treatment options. Medication with PPI is the most common treatment and is usually 20 mg once daily, with the aim of using the lowest effective dose. Proton Pump Inhibitors are medicines that are used to reduce the amount of stomach acid made by the glands in the stomach lining. They are oral medications that take about 30 minutes to work and should be taken before the first meal of the day. Your Gastroenterology associate will discuss the benefits and potential side effects with you.
• Endoscopy is a procedure to determine if they have GERD. Your doctor at Gastroenterology Associates of Brooklyn may recommend an endoscopy if your symptoms remain after 4-8 weeks of PPI treatment, when you have difficulty swallowing and if you are male and have a history of GERD symptoms for more than five years. Endoscopy is a minimally invasive procedure to evaluate the condition of your digestive system and the cause of your heartburn. It is usually an outpatient procedure. Your Gastroenterology associate uses a thin scope with a light and camera to look inside the digestive system, esophagus, stomach, and part of the small intestines. They will take a small tissue sample and send it to a lab for testing.
• Surgery may be recommended if lifestyle changes and medications do not help, or you cannot or do not want to take medications regularly. It is a very effective minimally invasive surgery called fundoplication.