What is GERD? (or GastroEsophageal Reflux Disease)
Heartburn is frequently referred to as acid indigestion. It is generally
described as a burning feeling or pain in the chest, usually felt behind
the breastbone that sometimes moves upward to the neck and throat. Heartburn
may last as long as two to three hours and usually occurs, or is worse,
after eating. Smoking, caffeine and alcohol may increase the level of
acid in your stomach, causing even more heartburn.
While heartburn is typically not serious, this burning feeling which
usually is felt behind the breast bone after meals, when accompanied by
a sour-tasting fluid in your throat and difficulty swallowing, can be
more serious. These are all classic symptoms of a common health problem
called gastro-esophageal reflux disease or GERD. (This also is known as
Persons with GERD or reflux disease often complain of having:
- painful heartburn.
- pain occurring in the middle of the chest.
- coughing and/or choking while lying down.
- increased salivation.
- difficulty in sleeping after eating.
- asthma-like symptoms may occur while sleeping.
- chronic bronchitis.
- chronic hoarseness or vocal cord injury, especially in non-smokers.
What Causes Heartburn?
The burning feeling of heartburn is caused by acid that escapes from your
stomach through a weakened one-way valve near the top of your stomach
(the lower esophageal sphincter or LES). The acid can travel upward as
far as your throat.
This acid backup occurs when the muscles operating the valve between
the stomach and the esophagus are weak, allowing acid from the stomach
to surge upward or reflux (back up) into the esophagus and cause painful
heartburn and indigestion.
When you eat, food normally travels from your mouth down the esophagus
to your stomach. When you swallow food, muscles at the back of your mouth
(soft palate) form the food into a soft mass called a bolus. The epiglottis,
a leaf-shaped structure at the root of your tongue, folds over the top
of the windpipe to protect your trachea and airway. The food is propelled
from the back of your mouth into your esophagus. The esophagus is a muscular
tube, approximately 10 inches long that leads directly into the stomach.
The food automatically travels through the esophagus as a result of wave-like
muscular contractions called peristalsis.
Symptoms of Heartburn
- Burning sensations in the chest - These may start in the upper abdomen
& radiate into the neck.
- Regurgitation of sour or bitter tasting material into the throat &
- Regurgitation that occurs when lying down/sleeping
- Heartburn 1-4 hours after eating
- Heartburn immediately after drinking orange juice
- Swallowing pain or difficulty, bleeding
Your evaluation will include having a physical exam, completing a medical
history form or questionnaire, and talking with a doctor about the problem.
The doctor will want to know how severe the problem is and how it is limiting
or affecting your lifestyle. You will explain any medications and lifestyle
changes you have tried and whether they have been effective for your symptoms.
Other complications that are resulting from your condition will also be
evaluated. You will be asked to have diagnostic testing, which will include:
- Esophageal Motility
- EGD-a test that measures the strength of the esophageal sphincter
- Occasionally a 24 hour pH
What if I need surgery?
Laparoscopic Surgery There are now laparoscopic surgical alternatives available for treating
hiatal hernias and gastroesophageal reflux disease. Using the same manner
of the open surgery, the hernia is repaired or sewn up and the upper portion
of the stomach is wrapped around the intersecting area where the esophagus
opens into the stomach. This strengthens the area and prevents acid and
food from backing up by correcting the reflux.
Incisionless Endoscopic Surgery Patients with reflux without a hiatal hernia or a very small hiatal hernia may be candidates for the newer incisionless transoral surgery.
What Really Causes Gastroesophageal Reflux Disease?
Along the way, food passes through a specialized one-way valve or muscle
called the lower esophageal sphincter (LES), which is the opening to your
stomach. When you swallow, the LES opens, allows food to enter your stomach
and then quickly closes. When you have GERD, or reflux, the LES does not
work well enough to hold food and fluids in the stomach and allows food
and stomach juices and acids to wash back into the esophagus. This increase of the pressure in the stomach and/or relaxation of the
muscle tone of the valve can be caused by a variety of things. Factors
that increase pressure include:
- normal aging.
- a full stomach/over-eating.
- lying down.
- bending forward.
- lifting heavy objects.
- any sudden physical exertion or straining.
Loosening of the muscle tone of the valve also may be caused by normal
aging and pregnancy, as well as by fatty foods, alcohol, coffee, and nicotine
(cigarettes). Medications, especially smooth muscle relaxants, such as
theophylline, oral bronchodilators, calcium channel blockers and diazepam
can cause a lack of muscle tone in the sphincter. When diet and lifestyle
are the causes of the problem, usually foods such as chocolate, peppermint,
fried foods, coffee, alcohol and cigarette smoking are involved.