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Gastroesophageal Reflux Disease (GERD)

Health NewsHeartburn isn't unusual. The National Institutes of Health (NIH) estimate that millions of Americans have heartburn at least once a month. (Read about "Heartburn") Many of them suffer each day. Twenty-five percent of pregnant woman will get heartburn every day and 50 percent occasionally. It's a big problem. Heartburn can also be one of the main symptoms of a serious condition called Gastroesophageal Reflux Disease or GERD.

GERD is the result of problems where the stomach and the esophagus meet. The muscle there is called the lower esophagus sphincter, (LES) and is designed to let food pass through to the stomach and keep it there. When the muscle is weakened or relaxed, it can let the contents of the stomach flow back into the esophagus. This results in the burning sensation we call heartburn. Heartburn pain is sometimes mistaken for a heart attack. (Read about "Heart Attack") NIH says one thing that can help people tell the difference is the fact that exercise may aggravate pain from heart disease, whereas heartburn pain is less likely to be affected by physical activity.

Digestive SystemAlthough the main symptoms are persistent heartburn and acid regurgitation, some people have GERD without heartburn. According to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK), these people may experience pain in the chest, hoarseness in the morning, or trouble swallowing. NIDDK says GERD can also cause a dry cough and bad breath.

Barrett's esophagus

GERD can result in serious conditions if it isn't treated. Esophagitis results from too much stomach acid in the esophagus and can mean bleeding and ulcers there. (Read about "Gastrointestinal Bleeding") The chronic damage and scaring of the esophagus can result in a narrowing. A condition called Barrett's esophagus can also result. It is severe damage to the skin-like lining of the esophagus. It is sometimes seen as a precursor to cancer. (Read about "Esophagus Cancer) According to NIDDK, Barrett's esophagus affects about one percent of adults in the United States. The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett's esophagus twice as often as women. In some patients with high-risk Barrett's esophagus, a doctor may recommend removal of the pre-cancerous cells.

Causes

No one knows the exact cause of GERD. The National Digestive Diseases Information Clearinghouse (NDDIC) says many doctors believe that hiatal hernias are a major cause of GERD. (Read about "Hernia") A hiatal hernia happens when a portion of the upper part of the stomach slips by the diaphragm into the chest cavity. The diaphragm separates the stomach from the chest and helps the LES keep things in the stomach. With a hiatal hernia that extra help is lost. NDDIC says obesity and pregnancy (Read about "Obesity" "Healthy Pregnancy") can result in a hiatal hernia. Many people over the age of 50 have one even though they are otherwise healthy. Most of the time, the condition does not require treatment.

Diet and lifestyle are also believed to contribute to GERD. Reflux can happen when the LES is weakened by things such as:

NIH studies show that smoking also relaxes the LES. And once again, obesity and pregnancy can cause GERD all by themselves.

Lifestyle changes

Most of the time doctors will recommend lifestyle changes first, including changes in diet, to try to cut back the amount of reflux and the damage caused by the acid to the esophagus. Some of the things you can do to control heartburn from GERD according to the American College of Gastroenterology (ACG) include:

Many times the above actions can help relieve the heartburn. If the problem persists, it is imperative that you consult with your doctor.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach. They can include any of the following:

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.

Testing

If the heartburn goes on, according to NIDDK and ACG, there are tests that can be used to look at the area, including the following:

There are other tests that put small amounts of acid into the esophagus to make sure the symptoms are caused by acid there, as well as other tests that check the strength of the LES.

Surgery

Surgery is an option when medicine and lifestyle changes do not work.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD, according to NIDDC. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. (Read about "Endoscopy" "Robotic Surgery") To perform the fundoplication, surgeons use small instruments that hold a tiny camera. AGC says laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

FDA has approved other endoscopic surgical treatments for chronic heartburn. One puts stitches in the LES to create little pleats that help strengthen the muscle. Another uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. In another procedure, a catheter is used to deliver radiofrequency energy to the lower esophagus. Again, as scar tissue forms, it strengthens the muscle to help it function better. The long-term effects of these procedures are unknown, according to NIDDC.

FDA has also approved the use of an implanted device to help people with GERD. An implanted device can reinforce the LES to keep stomach acid from flowing into the esophagus. The implant is put into position during endoscopy. Once again, NIDDC says the long-term effect of using an implant for GERD is unknown.

GERD and the heartburn that comes with it are certainly uncomfortable. Surgery is almost always a last resort for GERD. There are also many new drugs coming into play to help heartburn sufferers. Many of them are over-the-counter, but it is still important that you discuss the situation with your doctor before self-medicating.

Related Information:

    Medicine & Digestion

    Stomach Cancer

    Digestive System

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