GERD / Reflux
What is GERD?
Gastroesophageal reﬂux disease, or GERD, is a very common digestive condition that typically presents as a burning chest pain, usually after eating. Pain is the result of acidic stomach content moving into the esophagus.
Unlike the stomach, the esophagus is not equipped to handle exposure to acid and digestive enzymes. A large, spicy meal, fatty food and obesity all facilitate exposure of the esophagus to acid. The major mechanism appears to be relaxation of the lower esophageal sphincter, a valve that creates a barrier between the esophagus and stomach. Increased abdominal pressures, from obesity, push stomach contents into the esophagus. The barrier between the stomach and esophagus can be further compromised by a hiatal hernia, which occurs in 50 – 60% of those with GERD.
While heartburn is the major symptom, other symptoms include chest tightness and mouth watering.
Tests & Diagnosis
Typically, improvement in symptoms in response to treatment is highly suggestive of GERD. If your doctor suspects your chest pain or heartburn is from acid, he will likely give you antacids. If you have had longstanding symptoms, have difﬁculty swallowing or weight loss, your doctor may recommend more diagnostic testing or referral to a specialist. Untreated GERD can lead to complications such as ulcers or a narrowing of the esophagus (esophageal strictures). Occasionally the cells of the esophagus can change because of the acid exposure, increasing the risk of esophageal cancer.
If symptoms are rare (1-2 times per week), over the counter antacids may sufﬁce. For more frequent symptoms, daily acid suppression with a proton pump inhibitor is often utilized. Lifestyle modiﬁcation may also be helpful, including weight loss, decreasing the amount of fat in the diet and eating smaller meals. In select patients with severe symptoms, surgery to create a tighter barrier to acid can be considered. We can provide guidance on the best approach to minimize symptoms and stress related to GERD.