Everyone experiences heartburn once in a while, usually after a large or
spicy meal. Most people just pop a few antacids, but for some, over-the-counter
medications aren’t enough. If you continue to have heartburn symptoms
even after taking non-prescription drugs, you might have gastroesophageal
reflux disease (GERD).
Pulse recently spoke with gastroenterologist James A. Sattler, MD, medical director,
Digestive Care Consultants, to learn more about it.
WHAT IS GERD?
Gastroesophageal reflux occurs when the muscle at the bottom of the esophagus
weakens or relaxes when it should not, allowing stomach contents to flow
back into the esophagus rather than passing through the stomach into the
intestine. All people reflux to some degree. It’s considered gastroesophageal
reflux disease if symptoms are present more than twice a week for a few
weeks. Some large hiatal hernias can also lead to increased amounts of reflux.
WHAT ARE THE SYMPTOMS?
Since stomach contents are acidic, the most common symptom of GERD is a
burning sensation in the upper abdomen, which often radiates to the area
under the breast bone. This is commonly known as heartburn. A sour or
bitter taste in the mouth may be present. Some of the less common symptoms
occur when stomach contents reflux above the esophagus causing throat
pain, hoarseness, chronic cough, the sensation of a lump in the throat,
asthma, dental erosions, burning in the mouth, or recurrent sinusitis.
HOW CAN YOU PREVENT GERD?
Limit foods and habits that relax the lower esophageal sphincter such as
caffeine, alcohol and tobacco. Don’t excessively fill the stomach.
Eat smaller portions, more frequent meals, limit carbonated beverages
and fatty foods. Maintain a normal weight to decrease pressure from the
abdominal wall on the stomach. Stop eating a few hours before bedtime
so there is less food to reflux.
HOW IS GERD DIAGNOSED?
There is no specific test. A diagnosis of GERD is generally made by the
presence of symptoms that respond to lifestyle modifications or a short
course of treatment with acid-reducing medications such as histamine 2
(H2) blockers or proton pump inhibitors (PPIs). Patients should first
see their primary care physician. Referral to a gastroenterologist may
be needed for further evaluation and possible endoscopy to evaluate the
lining of the esophagus, stomach and duodenum.
WHAT ARE THE RISKS OF UNTREATED GERD?
Ulceration and possible narrowing of the esophagus leading to difficulty
swallowing. Exacerbation of asthma, bronchitis, sinusitis and rarely pneumonia.
A change in the lining of the esophagus (known as Barrett’s esophagitis),
has a small risk of developing into esophageal cancer.
WHEN IS SURGERY RECOMMENDED?
Generally, it’s an individual personal decision for patients with
symptoms that do not respond to or only partially respond to lifestyle
modifications and medication. Often patients with significant regurgitation
of stomach contents don’t adequately respond to medical treatment
alone. Surgery is recommended to prevent irreversible damage to the lungs
for patients whose GERD is unresponsive to treatment and continue to experience
symptoms of asthma, bronchitis or pneumonia.
WHAT’S NEW IN GERD TREATMENT?
There are new, state-of-the-art diagnostic tools now available at Torrance
Memorial Medical Center. One of these enables us to treat some GERD patients
endoscopically with a procedure known as a Transoral Incisionless Fundoplication
(TIF), which repairs the gastroesophageal valve without incisions via
the mouth, reducing the need for traditional surgery. Torrance Memorial
has excellent specialists employing the latest minimally invasive surgical
TELL US ABOUT THE COORDINATION OF CARE.
For the majority of patients, coordination of care involves their primary
care physician and gastroenterologist. The team approach for patients
that have GERD symptoms affecting their throat, sinuses or lungs involves
the primary care physician and gastroenterologist who collaborate and
coordinate additional care with the ENT (ear nose and throat), pulmonary
(lung), allergy and surgical specialists as needed.