Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.
Digestion begins in the mouth as food is broken down by chewing into smaller pieces and by saliva releasing digestive enzymes such as α-amylase and Lingual lipase. When food is swallowed it enters the esophagus, a muscular tube that carries food from the mouth to the stomach for further digestion. Contractions call peristalsis push food down the esophagus.
At the bottom of the esophagus food passes through a muscular valve called the Lower Esophageal Sphincter or LES and into the stomach. The digestive juices secreted by the stomach are highly acidic. When the stomach contracts to move the food into the intestine the LES closes tightly in order to prevent these acidic juices from moving back into the esophagus where they can cause damage.
A breathing muscle called the diaphragm separates the chest from the abdomen. To reach the stomach the esophagus passes through the diaphragm at a point called the hiatal ring. If the patient has gastroesophageal reflux disease or GERD, their LES does not close properly allowing acidic stomach contents to flow backward into the esophagus.
If GERD is not treated it can lead to variety of esophageal problems, including:
— Stricters or narrowing,
— Barrett’s esophagus, in which the normal stratified squamous epithelium lining of the esophagus is replaced by simple columnar epithelium, which are usually found lower in the GI tract.
— Hiatal hernia,
— Zollinger-Ellison syndrome, which can present with increased gastric acidity due to gastrin production.
— Hypercalcemia, which can also increase gastrin production, leading to increased acidity.
— Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.
— Epigastric burning pain traveling up into the chest known as (heartburns), which can sometimes spread to the throat, along with a sour metallic taste in the mouth,
— Difficulty swallowing (dysphagia)
— Dry cough,
— Sore throat,
— Hoarseness, which is due to acid damaging the larynx or the voice box,
— Regurgitation of food or sour liquid (acid reflux),
— Sensation of a lump in the throat.
GERD is most often diagnosed based on patient history and symptoms.
In some patients in whom the diagnosis is not clear, 24-hour pH monitoring is done to confirm the etiology.
Endoscopy, is not routinely needed if the case is typical and responds to treatment. It is however recommended when people either do not respond well to treatment or have alarming symptoms, including:
— Blood in the stool,
— Weight loss, or
— Voice changes.
— Some physicians encourage either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett’s esophagus.
The treatments for GERD include lifestyle modifications, medications, and possibly surgery.
All patients should:
— Lose weight if obese.
— Avoid alcohol, nicotine, spicy food, caffeine, chocolate and peppermint.
— They should also Avoid eating 3-4 hours before sleep.
— Elevate their head off the bed while sleeping.
The primary medications used for GERD are:
— H2 receptor blockers such as ‘Ranitidine’, which are also the first line medication.
— Proton-pump inhibitors or PPI’s such as ‘Omeprazole’, can be used if H2 receptor blockers do not control the symptoms
For those patients who do not respond to medical therapies surgery may be required.
— The standard surgical treatment for severe GERD is Nissen Fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to reinforce the sphincter and prevent acid reflux and to repair a hiatal hernia.
— Endocinch can also be done which by using a scope a suture is placed around the LES to make it tighter.
This video tutorial is brought to you by: Ali Feili, M.B.A., M.D.