Management and Treatment of Acid Reflux Disease

Definition of Gastroesophageal Reflux (GERD)

Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter – LES, (where the muscle connects the esophagus with the stomach) – causing the stomach’s contents to back-up into the esophagus.

Description of Gastroesophageal Reflux (GERD)

The esophagus is the tubelike structure that connects the mouth to the stomach. When you swallow, food and beverages are moved down the esophagus by wavelike involuntary muscle contractions to the stomach’s entrance. At that point, the muscle of the LES relaxes (opens) to let the food pass into the stomach and quickly closes again.

The backwash of stomach contents into the esophagus, commonly called reflux, occurs when the LES muscle is very weak or, more commonly, when it inappropriately relaxes causing heartburn. Heartburn is the burning sensation in the throat or chest caused by the backwash of the stomach contents (usually acidic).

GERD is extremely common, with 20 percent of all adults reporting at least weekly episodes of heartburn. Up to 10 percent of all adults complain of daily symptoms. Most patients have mild disease and few develop esophageal mucosal damage (reflux esophagitis) or more severe problems.

Causes and Risk Factors of Gastroesophageal Reflux (GERD)

Some doctors believe that a hiatal hernia may weaken the LES and cause reflux. A hiatal hernia is a defect in the diaphragm that permits a portion of the stomach to pass through the diaphragm’s opening into the chest.

Dietary and lifestyle choices may also contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, and coffee or alcoholic beverages, may weaken the LES, causing reflux. Additionally, studies have shown that cigarette smoking, obesity, pregnancy, and asthma may also be associated with GERD.

Symptoms of Gastroesophageal Reflux (GERD)

The most common symptom of GERD is heartburn. Heartburn most often occurs 30 to 60 minutes after meals. The heartburn is usually intensified by eating, lying down, bending over or exercising. Patients often report relief from taking antacids or baking soda.

Additional, atypical symptoms may include regurgitation of acidic materials, chest pain, asthma, chronic cough, chronic bronchitis, chronic sore throat, morning hoarseness, swallowing difficulty, bloating, belching, nausea, and weight loss. Some patients with severe esophagitis may be almost asymptomatic.

Diagnosis of Gastroesophageal Reflux (GERD)

Medical history is most important because physical examination and laboratory tests are often normal in uncomplicated GERD. Further investigation may include upper endoscopy with biopsy (viewing the esophagus and stomach through a narrow tube and sampling a small piece of tissue) and rarely, barium studies or pH monitoring (to document abnormal acid exposure in the esophagus).

Treatment of Gastroesophageal Reflux (GERD)

Non-Surgical Treatment

For patients with mild GERD, doctors recommend simple lifestyle changes, such as quitting smoking or losing weight, dietary changes, and taking over-the-counter (OTC) antacids.

Physicians suggest eating smaller meals and avoiding acidic foods (such as tomato products, citrus fruits, spices, and coffee), fatty foods, peppermint, chocolate, and alcohol. Most importantly, it is recommended to avoid eating three (3) hours prior to bedtime or to lie down.

Elevating the head of the bed on 6-inch blocks may reduce heartburn by allowing the effect of gravity to minimize reflux of stomach contents into the esophagus at night.

Quitting smoking may also reduce the symptoms of GERD. Additionally, refrain from wearing tight clothes that put pressure on the abdomen.

Antacids may help neutralize the stomach acid and stop heartburn. Antacids have long been a mainstay of treatment of gastroesophageal reflux. These agents not only buffer acidic gastric contents but may also lower esophageal sphincter pressure by stimulating gastrin release in response to alkalization in the stomach. Alginate antacid (Gaviscon Liquid), Maalox TC, Mylanta II, and other medications, may provide relief of occasional heartburn.

When patients with mild to moderate symptoms of GERD fail to improve with lifestyle changes and antacids, the next step is to try other medications. Doctors may suggest a Histamine2 (H2) receptor antagonist, such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or nizatidine (Axid), each if which has a moderate ability to suppress acid.

Another option is to prescribe prokinetic drugs, such as cisapride (Propulsid), that helps in contracting the LES, clearing the esophagus, and enhancing gastric emptying.

If GERD is considered severe, the doctor may prescribe proton pump inhibitors, such as omeprazole and lansoprazole.

If these behavior modifications and drug therapies do not work, the doctor may recommend further testing and ultimately, surgery.

Surgical Treatment

Surgery may be warranted in patients whose medical therapy has failed, who have experienced complications or side effects with the drug treatment(s), who have had relapses of GERD, or who have been diagnosed with Barrett’s esophagus, esophageal stricture, esophageal ulcers, esophageal bleeding or a hiatal hernia.

There are two types of anti-reflux surgeries: open and laparoscopic. Laparoscopic surgery (done via tiny incisions in the abdomen) is the procedure of choice due to the reduced post-surgical recovery time. The most common laparoscopic anti-reflux surgery is called laparoscopic Nissen fundoplication. In this procedure, surgeons rebuild the upper end of the stomach into a high-pressure zone, strong enough to prevent acid juices from rising into the esophagus, but not so strong that food cannot enter the stomach.

You can also opt for a minimally invasive procedure such as esophyx transoral incisionless fundoplication, which is a 30-45 minute procedure wherein the body’s anti-reflux barrier is reconstructed in order to treat chronic acid reflux and GERD.

Questions To Ask Your Doctor About Gastroesophageal Reflux (GERD)

  • What tests need to be done to diagnose the condition?
  • How are these tests performed?
  • What is the cause of the reflux?
  • Will you be prescribing any medications?
  • What are the side effects?
  • What antacids do you recommend?
  • How often can the antacids be taken?
  • Any dietary suggestions?
  • Are there any complications to reflux?
  • Could an ulcer develop?
  • Do some herbal remedies relieve or prevent heartburn?
  • Will secondhand smoke make the condition worse?
  • Does stress increase reflux?

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