Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

Gastroesophageal reflux disease (GERD) is a digestive disorder that involves acidic stomach contents moving up into the esophagus, which is the tube that connects the mouth to the stomach. GERD causes troublesome symptoms and can sometimes cause serious complications.

At Loma Linda University Health, our board-certified gastrointestinal specialists provide advanced care for those suffering from GERD. We treat more people with esophageal conditions than any center in the region.

WHAT ARE THE SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

The symptoms of GERD may include the following:

• Heartburn (painful burning in the chest area)
• Regurgitation of food or a feeling of burning acid coming up into the throat or mouth
• Problems swallowing
• Pain in the chest that is not due to a heart condition
• A feeling of a lump in one’s throat
• Rarely, unexplained nausea
• Rarely a cough, voice hoarseness, or wheezing

WHAT CAUSES GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

One common cause of GERD is a stomach abnormality called a hiatal hernia. A hiatal hernia can occur in people of any age. It happens when the upper part of the stomach and lower esophageal sphincter (LES) move above the diaphragm.

In women, pregnancy can be one cause of GERD. Connective tissue disorders, which are systemic diseases that can affect several organs, can also cause GERD.

HOW IS GASTROESOPHAGEAL REFLUX DISEASE (GERD) DIAGNOSED?

Gastroesophageal reflux disease starts with a medical exam and a discussion of health history. When a physician suspects a patient may be suffering from GERD, testing to confirm a diagnosis may be recommended. Those tests may include:

• Upper endoscopy - Using a thin tube with a camera on the end, the physician will look into the esophagus and stomach. A small sample of tissue from the lining may be taken and sent to the lab. Patients are normally under sedation for this procedure.
• Esophageal impedance testing - A thin tube is placed through the nose and down into the esophagus. The tube measures how much acid and other gastric juices come back up into the esophagus.
• Esophageal manometry - A thin tube is passed through the nose and down into the esophagus to measure the esophageal pressure when you take several swallows.
• Barium Esophagram or Upper GI imaging - The patient is asked to drink contrast material, which assists with providing visibility into the esophagus and stomach.

HOW IS GASTROESOPHAGEAL REFLUX DISEASE (GERD) TREATED?

Lifestyle Changes

The management of gastroesophageal reflux disease (GERD) begins by making lifestyle changes, including:

• Avoiding spicy, acidic or fatty foods. Common offenders are tomatoes, citrus fruits, fruit juices, chocolate, peppermint and fried foods.
• Avoiding acidic drinks like coffee, tea, alcohol, and soda.
• Losing weight, for those who are overweight.
• Eating smaller meals and avoiding large meals late in the day.
• Avoiding bedtime snacks. Keep the stomach empty for 3-4 hours before bed.
• Waiting to exercise after eating.
• Avoiding exercises that increase abdominal pressure (weight lifting, sit-ups).
• Avoiding bending down after eating a meal.
• Avoiding tight-fitting clothing.
• Elevating the head of the bed by at least six inches. You may do this by placing blocks under the head of the bed or by using a wedge pillow. Using several pillows does not work as well. You can buy a wedge pillow at any local bed and bath store.
• Quitting smoking.

Your doctor can tailor strategies to your specific situation, which may include the following:

Medications – Over the Counter

Antacids – These non-prescription medications can help control your symptoms by reducing excess stomach acid and relieving pain:

• Tums
• Alka-Seltzer®
• Maalox®
• Mylanta®
• Pepto-Bismol®
• Rolaids®
• Riopan®
• Gaviscon®

These medications may have side effects, such as diarrhea or constipation. Talk to your doctor about the product that is best for you.

Medications – Over the Counter and Prescription Strength

Histamine 2 (H2) blockers – These medications reduce the production of stomach acid and counteract the corrosive effects of acid:

• Cimetidine (Tagamet HB®)
• Famotidine (Pepcid AC®)
• Nizatidine (Axid AR®)
• Ranitidine (Zantac 75®)

Long-term use of these medications should only be undertaken with the supervision of your physician.

Proton pump inhibitors (PPIs) – This group of drugs can relieve symptoms in almost all GERD patients. These include:

• Omeprazole (Prilosec®)
• Lansoprazole (Prevacid®)
• Pantoprazole (Protonix®)
• Rabeprazole (Aciphex®)
• Esomeprazole (Nexium®)
• Dexlansoprazole (Dexilant®)

Because these medications work in different ways, combinations of drugs may be the best approach to controlling your symptoms. Long-term use should only be undertaken with the supervision of your physician.

If lifestyle changes and medications do not work, a small number of patients may require surgery to treat GERD.

Surgical Treatments

If lifestyle changes and medications do not work, a small number of patients may require surgery to treat GERD. Loma Linda University Health offers surgery using the minimally-invasive, state-of-the-art Nissen fundoplication. This is the current gold standard for surgery for GERD. Partial fundoplications are also offered depending on the ability of the patient’s esophagus to move food toward the stomach (esophageal motility). We also offer endoscopic therapies and LINX if the patient is an appropriate candidate.

Nisson Fundoplication – These procedures involve repairing the hiatal hernia (if present) and tightening the lower esophageal sphincter. This fundoplication procedure may be done through a small minimally-invasive cut in the abdominal wall and the use of a thin, lighted instrument that holds a tiny camera (laparoscope). You will most likely be sedated for this procedure. A short stay in the hospital may be required.

Endoscopic Therapies – Loma Linda University Health offers transoral incisionless fundoplication (TIF or Esophyx). This creates a partial fold at the lower esophageal sphincter muscle by stapling it up against the lower esophagus. We also offer Stretta system, which uses radiofrequency to stimulate the sphincter to cause hypertrophy (enlargement) of the esophageal muscles, thus creating a stronger lower esophageal sphincter.

LINX device – A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to prevent acid reflux, but weak enough to allow food to pass through. The Linx device can be implanted using minimally-invasive surgery.

WHAT ARE THE COMPLICATIONS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

If you allow gastroesophageal reflux disease to go untreated, you will most likely continue to experience the unpleasant symptoms of GERD, such as heartburn, problems swallowing, chest pain, nausea, and other symptoms.

Complications of GERD if left untreated can be serious. These complications include:

Inflammation of the esophagus – This is referred to as esophagitis. This can lead to bleeding, ulcers, and chronic scarring. This scarring can narrow the esophagus, eventually interfering with your ability to swallow.

Barrett’s esophagus – This is a serious complication of GERD. In Barrett's esophagus, normal tissue lining the esophagus changes to tissue that is similar to the lining of the intestine. When this happens, there is an increased risk of developing esophageal cancer.

People who have Barrett's esophagus may require periodic endoscopic procedures with esophagus biopsies to check for pre-cancerous cells (dysplasia).

WHO IS AT RISK FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

Smokers, people who are overweight and people who eat a lot of spicy, acidic, or fatty foods are at risk of developing gastroesophageal reflux disease. In addition, those who drink a lot of acidic drinks like coffee, tea, alcohol, and soda, and those who eat large meals, especially within four hours of going to bed, have an increased risk of developing GERD.

Pregnant women are at high risk for developing GERD because pregnancy can cause the upper part of the stomach and lower esophageal sphincter (LES) to move above the diaphragm. This is referred to as a hiatal hernia.

People with connective tissue diseases are also at a high risk of developing GERD. These diseases include:

• Rheumatoid arthritis (RA)
• Scleroderma
• Granulomatosis with polyangiitis (GPA)
• Churg-Strauss syndrome
• Lupus
• Microscopic polyangiitis
• Polymyositis/dermatomyositis
• Marfan syndrome

NEXT STEPS

Don’t ignore the signs. Never ignore pain in your chest. Seek medical intervention right away. Being proactive is important. After ruling out a heart condition as the cause of your chest pain, the next step is a medical evaluation for other causes. To request an evaluation at Loma Linda University Health, contact this department or schedule the appointment through MyChart.