Diagnosis Information: 
Gastroesophageal Reflux

GERD or hiatus hernia or reflux esophagitis is a common problem that occurs to as many as 25% of the population although many fewer people than that have serious complications from this disease. Nevertheless, approximately 25 million Americans will have heartburn on any given day. The disorder occurs when the muscle controlling the passage between the esophagus and the stomach weakens and is unable to prevent acid from the stomach from washing back into the esophagus. The symptoms begin with a burning pain behind the breastbone, radiating up into the throat. The most typical and classic symptoms are repeated episodes of heartburn with reflux and regurgitation of sour tasting food or liquid into your throat and difficulty swallowing. The heartburn typically occurs after a large meal or often when you bend over or lie down. Certain foods tend to make GERD worse. These include:

Fatty foods
Fried foods
Peppermint
Caffeine containing foods (coffee, tea, chocolate, cola)
Alcohol
Citrus fruits and juices
Tomatoes and tomato products
Pepper
Other foods tend to improve GERD. These include:
Non-acidic fruits (bananas, apples, pears)
Low-fat, low-cal, high-fiber foods
Antacids

The typical management of GERD ranges from modifying your lifestyle (raising the head of your bed, discontinuing alcohol, discontinuing smoking) through medications such as oral antacids, Tums, Maalox or Mylanta to antacid medications such as Zantac or Cimetidine or Pepcid, or even up to the strongest anti ulcer medication known as Proton Pump inhibitors such as Prilosec or Previcid. Finally, however, if the medications fail to provide adequate control, patients often need to consider undergoing surgical therapy.

In normal digestion, food travels from the mouth, through the esophagus and into the stomach. In the stomach, the gastric secretions, which include acid, break down the food as it moves into the intestine. Most people have what is referred to as a lower esophageal sphincter (LES) and this closes down after food has passed through it preventing acid or gastric contents from refluxing into your esophagus.

People who have GERD have an abnormally weak lower esophageal sphincter and frequently also have a hiatal hernia. A hiatal hernia occurs when the stomach moves from within the abdomen up into the chest. This enlarges the opening, changes the pressure relationship and causes reflux of gastric contents into the esophagus.

GERD can lead to inflammation in the esophagus (known as esophagitis), ulceration and also scarring and stricture. Occasionally, and in a very small percentage of patients, the changes in the esophagus can lead to cancer in the end of the esophagus and or the beginning of the stomach.

In order to determine whether or not you are a good candidate for reflux surgery, your internist and your gastroenterologist may suggest that you undertake a number of tests. These include a barium swallow to evaluate your esophagus and stomach, a gastroscopy in which a gastroenterologist uses a flexible scope to look down into your stomach and to evaluate whether or not there are ulcerations or scarring in the esophagus.

Additionally, the gastroenterologist may test the degree of muscle tone in your esophagus through a test known as esophageal manometry. In this test a small catheter is placed all the way into your stomach through your nose. The resulting test will show the pressures that are generated in your stomach, the lower esophageal sphincter and in your esophagus. Additionally, the doctor may decide to perform a 24-hour pH study. In this test, a small catheter is placed in your stomach and left in there for 24 hours. The catheter measures the amount of acid in your stomach and your esophagus and can tell very precisely when acid is in the esophagus. Simultaneously, you will keep a diary for the 24 hours the catheter is in place and record any time that you have heartburn. This will be checked against the measurement of the pH to make certain that the type of symptoms you have can be corrected by surgery.

The earliest form of management involves changes in your lifestyle such as raising the head of your bed six to eight inches and changing what you eat. Food items that should be avoided in your diet include coffee, tea, carbonated drinks and caffeine. Fried and fatty foods should also be avoided, as should spicy foods. Chocolate, peppermint, onions and citrus fruit often increase a person's symptoms. Likewise, alcohol and cigarette smoke worsen GERD. Finally, patients who are overweight can produce reflux. Many people can control their symptoms by simply losing weight.

If management of your lifestyle does not offer relief, medical treatment includes over-the-counter antacids, H2 blockers, which in their strongest form need a prescription and ultimately Prevacid or Prilosec. Additionally, medications that promote stronger peristalsis in your stomach may be useful. These include Reglan and Propulsid.

If patients have developed a severe stricture at the end of the esophagus, they may require dilatation. This can be done with an instrument known as a Bougie, which is a long flexible rubber tube used to stretch the esophagus.