GERD, or gastroesophageal reflux disease, occurs when the lower esophageal sphincter (LES) fails to close properly and chyme (a mixture of food, stomach acid, and digestive enzymes) leaks back (refluxes) into the esophagus.

When reflux occurs, the acidic chyme comes into contact with the sensitive mucous membrane that lines the esophagus causing a painful burning sensation commonly known as heartburn. Over time, this can cause cells in the lining of the esophagus to transform into acid-resistant cells similar to those that line the intestines. This is a condition known as Barrett’s esophagus, which may lead to esophageal cancer. Relatively few people with GERD develop Barrett’s esophagus.

It is important to understand that occasional heartburn is not uncommon and not considered to be GERD. However, if heartburn occurs more than twice a week, it may be considered GERD.

Signs and Symptoms of GERD

The symptoms of GERD are relatively easy to recognize, as they are essentially the same as heartburn: a painful burning sensation in the upper chest or throat. This often occurs at night, because the body is horizontal, making it easier for chyme to enter the esophagus. Some people with GERD don’t experience heartburn. Instead, they experience hoarseness in the morning or have trouble swallowing. GERD may also cause a dry cough and bad breath.

Diagnosis of GERD

In order to determine if you are suffering from GERD, your physician may require you to undergo one or more tests. These may include:

• Upper Endoscopy – this procedure allows a physician to look inside the esophagus, stomach, and duodenum (part of the small intestine). During an upper endoscopy, the patient swallows a thin lighted tube called an endoscope, which transmits an image to a television monitor, so the physician can examine the lining of these organs.
• Esophageal pH monitoring – a test that measures how often and for how long stomach acid enters the esophagus from the stomach. A sensor at the end of a thin catheter is threaded through the patient’s nose and positioned in his or her esophagus, just above the lower esophageal sphincter. Once in place, the sensor detects stomach acid over a 24-hour period.
• Bravo Capsule pH Monitoring – a new, catheter-free pH test in which a capsule collects pH data and transmits it via radio waves to a small external receiver worn by the patient.
• Pharyngeal monitoring

Treatment Options

Lifestyle Changes – this is often the primary course of treatment for GERD. Changes may include cessation of smoking and alcohol consumption, diet modification, voluntary weight loss, avoidance of lying down for three hours after meals and raising the head of one’s bed by six to eight inches using wooden blocks.

Medications – there are many drugs available over the counter to combat the symptoms of mild heartburn or GERD. In addition, prescription medications may offer temporary relief. Prescription proton pump inhibitors may also be effective for most people who suffer from GERD.

Surgery – When lifestyle changes and medications fail to achieve results, surgery may offer relief to patients suffering from GERD.

• A Nissen fundoplication is the most common surgical treatment for GERD. During the procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen it and prevent acid reflux. This can be performed laparoscopically, using a tiny camera and surgical instruments that enter the abdomen through several small incisions. This minimally invasive approach means patients may experience less pain and faster recovery times than when undergoing traditional open surgery.
• A Stretta procedure involves a balloon placed in the esophagus just above the stomach via a thin tube. The balloon is inflated, exposing four probes that discharge high-frequency radio waves into the lower esophageal sphincter (LES). The LES then becomes much tighter, which keeps stomach acid from refluxing into the esophagus.