While nearly everyone has the occasional heartburn, if the burning
sensation caused by acid in your esophagus persists, you could have GERD.
The disease may be more common than
you think.
Gastroesophageal reflux disease, commonly referred to as GERD, is a condition
where the contents of the stomach come
back up into the esophagus. The regurgitated liquid usually contains acid produced
by the stomach. While your stomach is
designed to handle the acid it produces,
your esophagus is not.
“Between 10 percent and 15 percent of
the population in the United States experiences GERD on a monthly basis,” says Dr.
Mary Maish, assistant professor of surgery
and surgical director of the UCLA Center
for Esophageal Disorders.
Smart Business spoke with Maish about
GERD, the symptoms associated with this
disease and how it can be treated.
What causes GERD?
There are some known causes as well as
many unknown causes. One thing that can
cause GERD is a hiatal hernia, which is
when part of your stomach pushes up into
your chest. The esophagus extends from
the neck through the chest and into the
abdomen. In normal people, the stomach
stays in the abdomen. For people with a
hiatal hernia, the top portion of the stomach herniates, or pushes its way up into the
chest, which is abnormal.
Another cause is that as we age our tissues tend to become more lax. The laxity in
the diaphragmatic muscle does not provide
the same sturdiness or strength that it
needs to keep the stomach in the abdomen.
Also, patients that are very obese are
more prone to GERD. Large amounts of fat
put pressure on the stomach and can cause
a hiatal hernia. Carbonated liquids, caffeine, alcohol, spicy foods and heavy fatty
meals can also exacerbate reflux.
What are some of the symptoms associated
with this affliction?
Heartburn occurs in about 80 percent of the patients with GERD. They may also
have epigastric pain, chest pain, changes in
their voice and respiratory symptoms such
as recurrent bronchitis, recurrent pneumonia or a persistent cough. Other possible
symptoms include ear, nose and throat
issues like persistent dental caries, recurrent earaches, persistent sore throats and
hoarseness. Gastrointestinal symptoms
may include bloating, gassiness, nausea,
vomiting and diarrhea.
How is GERD diagnosed?
There are a number of objective tests that
can be used to diagnose GERD. A barium
swallow allows us to not only look at how
the esophagus is moving, but also helps us
determine whether or not there is reflux of
material from the stomach back up into the
esophagus. Manometry testing consists of
a small catheter placed in the nose, down
the esophagus and into the stomach where
it measures pressures along the esophagus.
Most importantly, it measures the pressure
of the lower esophageal sphincter that connects the esophagus to the stomach. If the
pressure is low then we know that the
patient is likely to be experiencing a lot
more reflux than an average person who has normal pressure.
A pH probe test measures the total
amount of acid that is dispensed over a 24-hour period of time. There are normal
amounts of acid that come up from the
stomach into the esophagus in every individual, but this test will measure how
much acid, based on the pH, that someone
is being exposed to. Finally, an endoscopy
allows us to look at the lining of an esophagus and determine if there are any complications from GERD.
How is it treated?
Patients with mild GERD, or occasional
reflux, are generally treated with acid inhibition medicine, or what we call proton
pump inhibitors. These medicines include
Prilosec, Nexium and Prevacid. It can also
be treated intermittently with H2-blockers
such as Pepcid, Tagamet and Zantac.
If complications persist, what surgery
options are there?
If the symptoms are persistent and
severe, or if there is any indication of complications from reflux then surgery can be
considered. The type of surgery that we
recommend is called a Nissen fundoplication. During this surgery the top part of the
stomach is wrapped around the bottom
part of the esophagus in order to create a
new valve because the old valve is not
working properly. The procedure is done
laparoscopically with minimally invasive
techniques and generally there is only a
one- or two-day hospital stay.
DR. MARY MAISH is assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders. Reach
Esophageal Center Coordinator Rebecca Allegretto, RN, MBA, at
[email protected] or (310) 825-6167 or through the
Web site www.esophagealcenter.ucla.edu.